The value of area-based analyses of donation patterns for recruitment strategies.

BACKGROUND: Lack of ready access to a donation site may be a potential barrier to or influence the frequency of blood donations. In this study, we applied geographic analysis to blood donor behavior and use of different donation sites. STUDY DESIGN AND METHODS: The study population consisted of blood donors who gave whole blood in Georgia between 2004 and 2008. Zip code, city, and county of donor's residence were matched with the addresses of their donation sites. Donors were dichotomized as either nonmetro Atlanta or metro Atlanta residents. Six donation site categories were defined: donation within the same or a different zip code, within the same or a different city, and within the same or a different county. Logistic regression was used to compare donations by zip code, city, and county. RESULTS: The study population consisted of 402,692 blood donors who donated 1,147,442 whole blood units between 2004 and 2008, more than half of whom (56.4%) resided in the metro Atlanta area. The majority of donors were white (75.0%) and female (55.7%). In nonmetro Atlanta, repeat donors were more likely to have donated at fixed sites (p < 0.001). In metro Atlanta, repeat donors were more likely to have donated at a mobile site than at a fixed site (p < 0.001). CONCLUSION: Geographic and demographic differences in blood donation patterns exist. The locations of donor residences and blood donation sites influence donor behaviors. Understanding the geographic influence on donation patterns provides an important tool for optimizing donor recruitment strategies.

Blood donations motivators and barriers: a descriptive study of African American and white voters.

African American adults are half as likely to donate blood than whites. In order to understand this difference, African American and white participants completed a survey regarding demographics, medical and donation history, and motivators and barriers. The most agreed upon motivators to blood donation were more convenient place and times, being asked and taking less than hour. Motivator responses which differed by race included donating for infectious disease test and reward, and assurance donating is safe. The most agreed upon barriers were not having a convenient place, not knowing where (response differed by race) and fear of needles, pain and feeling faint.

Predictors of high chlamydia and gonorrhea positivity rates among men in the southern United States.

BACKGROUND: Routine screening for Chlamydia trachomatis and Neisseria gonorrhoeae in men in the United States is not recommended. However, untreated men remain a potential reservoir for chlamydial and gonococcal infections and reinfection among women. Chlamydia and gonorrhea positivities and associated epidemiology were evaluated among males in the southern United States. METHODS: Data were analyzed from 603320 males, aged 15 to 60 years, who were undergoing chlamydia and gonorrhea testing in sexually transmitted disease, family planning, correctional, college, and other facilities between 2001 and 2005. RESULTS: Males screened were primarily non-Hispanic black (63%) or non-Hispanic white (37%). Overall, chlamydia and gonorrhea positivities were both 13%. From 2001 to 2005, the chlamydia positivity increased 32% and the gonorrhea positivity decreased 28%. With increasing age, chlamydia positivity decreased, while gonorrhea positivity remained relatively stable. However, in men aged less than 30 years, both chlamydia and gonorrhea positivities were significantly higher than in men aged 30 years or greater (P < .01). Non-Hispanic blacks had a 5-fold higher risk for gonorrhea and 1.5-fold higher risk for chlamydia than non-Hispanic whites (P < .001). Men living in metropolitan statistical areas had a 1.27-fold higher risk for gonorrhea than men living in non-metropolitan statistical areas (P <.001). CONCLUSIONS: Chlamydia and gonorrhea positivity rates were high in males in the southern United States relative to the rates among men in the United States and were influenced by demographic and geographic factors.

Epidemiological Profiles of Foreign-Born and US-Born Hispanic Blood Donors in a Major Metropolitan Area in the United States.

Background. The explosive growth of Hispanics in the US makes this population a significant and untapped source for blood donation. Methods. A cross-sectional study was performed to evaluate blood donation behaviors and demographics of foreign-born and US-born Hispanic donors between 2006 and 2009 in metropolitan Atlanta, GA, USA. Bivariate analyses and multivariate logistic regression were used to assess factors associated with foreign-born donors. Results. 5,119 foreign-born and 11,841 US-born Hispanics donated blood. Foreign-born Hispanic donors were more likely than US-born donors to be blood group O (57.6% versus 52.0%; P < .001) and more frequent donors (2.2 versus 2.0; P < .001). Cuban-born donors had the highest rates of return donation (63.2%). In contrast, Mexicans, the most prevalent subpopulation among foreign-born Hispanic donors (31.8%), had the lowest rates of return donation (42.0%). Conclusions. The heterogeneity found among Hispanic donors in this study is valuable for the design of recruitment strategies to increase blood donations.

Demographic differences in estimated blood donor eligibility prevalence in the United States.

BACKGROUND: The prevalence of blood donor eligibility factors has a major impact on the availability of blood donors and thus the blood supply in the United States. The prevalence of these factors may differ between demographic groups and thus help explain the differences in blood donation rates. STUDY DESIGN AND METHODS: The study population (18-69 years old who were African American [AA], white, or Hispanic) was 185,073,489. Forty eligibility factors determined by US Food and Drug Administration's Code of Federal Regulations and AABB Standards for Blood Banks and Transfusion Services were used to calculate whole blood donation eligibility rates. Eligibility data were obtained from the 2007 to 2008 National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, US Census Bureau, and Centers for Disease Control and Prevention. Eligibility rates were determined by race/ethnicity, sex, and age groups (18-39 and 40-69 years). RESULTS: In 2007 to 2008, 122 million Americans (65.9% of the study population and 41.0% of the total US population) were estimated to be eligible to donate blood in the United States. Significant differences in eligibility rates by demographic characterizers were determined (p < 0.001): AAs (36.5%), whites (46.4%), and Hispanics (40.7%); males (45.4%) and females (42.7%); individuals 18 to 39 years old (35.8%); and individuals 40 to 69 years old (32.9%). CONCLUSIONS: AAs were significantly less eligible to donate blood than whites and Hispanics. Disparities in donor eligibility exist by race/ethnicity, sex, and age groups.

Demographic patterns of blood donors and donations in a large metropolitan area.

BACKGROUND: Nationally, minorities are underrepresented in community blood donation programs. The reason for this disparity is poorly understood. To better understand why minorities do not donate, first, accurate blood donor and donation data are needed. METHODS: Donor and donation demographic data were collected for 2004-2007 from a single blood collection agency in the Atlanta, Georgia, metropolitan area. Population data from the same area were acquired from the US Census. Donor and donation rates per 1000 population were calculated by race/ethnicity, gender, and age. RESULTS: Of the 389 340 blood donations reported by donors aged 16 to 69 years (98.7% of all donations), the collections were from white (77.7%), African American (16.3%), Hispanic (2.3%), Asian (2.2%), and other (1.6%) donors. Forty- to 49-year-olds (26.8%) donated the highest percentage of units. The blood donor rates were 11 per 1000 population for whites, 6 per 1000 for African Americans and 3 per 1000 population for Hispanics. The blood donation rates were 77 donations per 1000 population for whites, 22 per 1000 population for African Americans and 10 per 1000 population for Hispanics. CONCLUSION: Minorities are underrepresented in the blood donor pool. New recruitment strategies are needed to increase minority blood donor and donation rates.

Pathophysiology of early trauma-induced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion.

BACKGROUND: Trauma patients present with a coagulopathy, termed early trauma-induced coagulopathy (ETIC), that is associated with increased mortality. This study investigated hemostatic changes responsible for ETIC. METHODS: Case-control study of trauma patients with and without ETIC, defined as prolonged prothrombin time (PT), was performed from prospective cohort of consecutive trauma patients who presented to Level I trauma center. Univariate and multivariate analyses were performed. RESULTS: The case-control study group (n = 91) was 80% male, with mean age of 37 years, 17% penetrating trauma and 7% mortality rate. Patients with ETIC demonstrated decreased common and extrinsic pathway factor activities (factors V and VII) and decreased inhibition of the coagulation cascade (antithrombin and protein C activities) when compared with the matched control patients without ETIC. Both cohorts had evidence of increased thrombin and fibrin generation (prothrombin fragment 1.2 levels, thrombin-antithrombin complexes, and soluble fibrin monomer), increased fibrinolysis (d-dimer levels), and increased inhibition of fibrinolysis (plasminogen activator inhibitor-1 activity) above normal reference values. Patients with versus without ETIC had increased mortality and received increased amount of blood products. CONCLUSION: ETIC following injury is associated with decreased factor activities without significant differences in thrombin and fibrin generation, suggesting that despite these perturbations in the coagulation cascade, patients displayed a balanced hemostatic response to injury. The lower factor activities are likely secondary to increased hemodilution and coagulation factor depletion. Thus, decreasing the amount of crystalloid infused in the early phases following trauma and administration of coagulation factors may prevent the development.

Contribution of attitudinal factors to blood donation in African American church attendees.

BACKGROUND: Historically, African Americans have a general mistrust for the health care system that has contributed to significant health disparities. The goal of this study was to evaluate whether this distrust among African Americans affects attitudes toward blood donation. STUDY DESIGN AND METHODS: Fifteen African American churches in metropolitan Atlanta participated in an 81-item self-administered survey. The questionnaire assessed barriers and motivators for, and knowledge and beliefs about, blood donation in African Americans. Bivariate analysis and logistic regression models were performed. RESULTS: A total of 930 individuals responded to the survey. This group was 99% African Americans, 71% female, and 84% college educated, 54% with a household income of at least $50,000 and mean age of 47±14 years. Donation history was 3% current donors, 46% lapsed donors, and 40% nondonors. Respondents who trusted versus distrusted hospitals had more knowledge of the blood supply and less fear of donation and were more likely to respond to blood needs of the community. In a multivariate logistic regression model, donors were more likely to trust hospitals (p=0.003) and were more likely to have participated in research (p<0.001) than nondonors. CONCLUSION: African American distrust of the health care system is associated with decreased likelihood of previous blood donation. This may be secondary to donor centers being viewed as a component of the health care system. Building trust between donor centers and African American community by ensuring the safety of donation may increase African American blood donation rates.

Chlamydia prevalence among college students: reproductive and public health implications.

BACKGROUND: Routine chlamydia screening is not readily available at all college campuses. OBJECTIVES: : To assess the prevalence of Chlamydia trachomatis among asymptomatic college students and to compare chlamydia positivity by selected demographic variables. METHODS: Analysis of demographical data collected on 789 students who volunteered for a urine screening of C. trachomatis and Neisseria gonorrheae infections at 10 colleges in Alabama, Georgia, and Mississippi. RESULTS: The median age was 20 years. The chlamydia prevalence among all students was 9.7%. Students under the age of 20 years were 66% more likely to be infected than were older students (95% CI 1.01-2.73). Younger female students were 92% more likely to be infected than were older female students (95% CI 1.03-3.59). CONCLUSIONS: The chlamydia prevalence was higher in younger college students; more screening efforts and increased awareness are needed to reduce the prevalence of chlamydial infections among students.

Chlamydial and gonococcal infections in women seeking pregnancy testing at family-planning clinics.

OBJECTIVE: The objective of the study was to assess genital chlamydia and gonorrhea prevalence and associated predictors in women seeking pregnancy testing. STUDY DESIGN: The study included analysis of demographics and results of pregnancy, chlamydia, and gonorrhea testing in 1465 females seeking pregnancy testing at family-planning clinics in South Carolina. RESULTS: The median age was 22 years (range 16-45), the race distribution consisted of 53% African Americans and 47% Caucasians, and 64% of subjects were pregnant. Chlamydia and gonorrhea were detected in 12% and 2% of subjects, respectively. Predictors of chlamydia and gonorrhea included younger age and African American race. Chlamydia and gonorrhea prevalence did not differ in pregnant vs nonpregnant subjects. CONCLUSION: Chlamydia prevalence was high and gonorrhea prevalence low in women seeking pregnancy testing at family-planning clinics, and both were predicted by younger age and African American race but not pregnancy status. Because the majority seeking pregnancy testing were pregnant, chlamydia testing in this population at risk for chlamydia-associated morbidity has potential benefit.