Community-Based Disaster Coalition training.

INTRODUCTION: One key activity of the University of South Florida Preparedness and Emergency Response Learning Center is designing, developing, and delivering community preparedness, response, and recovery system training. BACKGROUND/RATIONALE: Coalitions are vital for addressing emergencies or disaster situations within communities. The University of South Florida Community-Based Disaster Coalition was designed to address the challenges of building and sustaining coalitions, emphasize methods to enhance their sustainability and effectiveness, and strengthen their purpose and community impact during disasters. METHODS/ACTIVITY: Teams of participants were offered 2 years of training to support coalition-building efforts. In year 1, participants engaged in 3 days of facilitator-led instruction, hands-on activities, tabletop exercises, and breakout groups to learn techniques to strengthen their coalition, which are the focus of this study. In year 2, participants engaged in additional training through course refreshers, distance learning opportunities, and webinars. Participants were grouped by county or region and comprised 6 to 9 people from a range of backgrounds and professions. RESULTS/OUTCOMES: During the 2012 (year 1) trainings, 184 people attended the program, representing nearly half (31; 46%) of Florida counties. Performance data indicated that participants significantly improved their knowledge scores, and course evaluations indicated that they were satisfied with the course overall. DISCUSSION: The Community-Based Disaster Coalition trainings focused on community capacity of disaster response in 31 counties, which represents close to 13 million people or nearly three-fourths of Florida residents. Training evaluations supported previous findings regarding critical coalition elements for development and sustainment, such as clear coalition purpose and goals. LESSONS LEARNED/NEXT STEPS: Several lessons were evident and inform future Community-Based Disaster Coalition efforts including adapting training to meet coalition needs; supporting the process of coalition building; following up with extended training opportunities and resources; continuing to provide trainings to counties that have not yet participated; and expanding training in other states, regions, territories, and internationally.

Self-immunization with live attenuated influenza vaccine in a mass vaccination clinic.

OBJECTIVE: An influenza pandemic may demand that a large number of influenza immunizations be rapidly given with limited resources. This study tested the utility and practicality of self-immunization with live attenuated influenza intranasal vaccine in a mass vaccination event. METHODS: The self-immunization clinic model was evaluated in a three-tiered fashion using student, first responder, and open community events. RESULTS: A single nurse was easily able to direct 89 people through the process of self-administration of the vaccine in a three-hour first-responder event and 122 people in a three-hour open community event. 96% of participants believed that they had performed the self-administration correctly, and the same percentage reported that they would like to receive influenza immunization by self-vaccination in the future. CONCLUSIONS: The self-immunization clinic is a practical and potentially useful model in an influenza pandemic setting.

Sexual partnerships, risk behaviors, and condom use among low-income heterosexual African Americans: a qualitative study.

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18-44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types-one-night stand, "regular" casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.

Health disparities and health equity: the issue is justice.

Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.

Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS).

New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans--the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups.

Application of the attitude-social influence-efficacy model to condom use among African-American STD clinic patients: implications for tailored health communication.

The purpose of the current investigation was to apply the attitude-social influence-efficacy (ASE) model to achieve a theory-based understanding of condom use among low income, heterosexually active African-American STD clinic patients. N = 293 participants were recruited from a large, publicly-funded metropolitan STD clinic in the Southeastern United States and surveyed using an ACASI computer program. Results indicated that several ASE variables exhibited meaningful relationships with condom stages of change in univariate analyses, replicating patterns found in previous research. Fewer variables remained significant in multivariate analyses, however. There was also some support for the proposition that early stage movement (e.g., Precontemplation to Contemplation) is based more upon perceptions of condom use (e.g., pros, perceived norms), whereas later stage movement (e.g., Preparation to Action/Maintenance) is based more upon perceived and actual skills acquisition (e.g., condom self-efficacy, negotiation strategies). Results varied with regard to main and casual condom stage of change. Implications for developing tailored HIV prevention interventions with heterosexual African-Americans are discussed.

Psychosocial constructs associated with condom use among high-risk African American men newly diagnosed with a sexually transmitted disease.

BACKGROUND: African American men are disproportionately burdened by the US AIDS epidemic. PURPOSE: The purpose of this study was to determine associations between condom-related psychosocial constructs and condom use among a sample of young, heterosexual, African American men newly diagnosed with a sexually transmitted disease. METHODS: This cross-sectional study collected data from 266 men. Predictors included seven scale measures and 12 covariates. Unadjusted odds ratios were estimated followed by multivariable logistic regression. RESULTS: Nearly one half (47.7%) used condoms at last sex. Five of the psychosocial measures had significant bivariate associations with condom use (p < 0.05). Specific attitudes toward condom use and partner-related barriers retained multivariable significance. Changes of one standard deviation in these measures increased the estimated odds of condom use by 40% (p = 0.021) and 55% (p = 0.002), respectively. CONCLUSION: Specific attitudes toward condom use and partner-related barriers may be particularly important constructs to consider when designing behavioral interventions for high-risk, heterosexual, African American men.

A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: a randomized controlled trial.

OBJECTIVE: We evaluated the efficacy of a brief, clinic-based, safer sex program administered by a lay health adviser for young heterosexual African American men newly diagnosed with a sexually transmitted disease (STD). METHODS: Subsequent to STD diagnosis, eligible men (N = 266; aged 18-29 years) were randomized to either a personalized, single-session intervention (delivered by a lay health adviser) or standard of care. We conducted behavioral assessments at baseline and 3 months postintervention (retention was 74.1%). We also conducted a 6-month clinic record review. RESULTS: Compared to men randomized to the control condition, those receiving the intervention were significantly less likely to acquire subsequent STDs (50.4% vs 31.9%; P = .002) and more likely to report using condoms during last sexual intercourse (72.4% vs 53.9%; P = .008). They also reported fewer sexual partners (mean 2.06 vs 4.15; P < .001) and fewer acts of unprotected sex (mean 12.3 vs 29.4; P = .045). Based on a 9-point rating scale, men in the intervention group had higher proficiency scores for condom application skills (mean difference = 3.17; P < .001). CONCLUSION: A brief clinic-based intervention delivered by a lay health adviser may be an efficacious strategy to reduce incident STDs among young heterosexual African American men.

Is suspicion of genital herpes infection associated with avoiding sex? A clinic-based study.

OBJECTIVE: The present study tested the research hypothesis that sexually transmissible disease (STD) clinic patients suspecting genital herpes infection would be more likely than their 'non-suspecting' counterparts to abstain from sex to avoid transmission of a perceived STD. METHODS: Recruitment (n = 351) occurred in a publicly-funded STD clinic located in a metropolitan area of the southern USA. Participants were tested for herpes simplex virus type 2 (HSV-2) using a rapid test manufactured by Biokit (Lexington, MA, USA) and they completed a self-administered questionnaire (using a 3-month recall period). RESULTS: Well over one-third (38.7%) of those indicating suspicion also indicated avoiding sex with steady partners because of concerns about STDs as compared with 28.0% among those not indicating suspicion (prevalence ratio = 1.38; 95% CI = 1.02-1.87, P = 0.036). The relationship between suspicion and avoiding sex with non-steady partners was not significant (P = 0.720). The relationship with steady partners only applied to people who were female (P = 0.013), single (P = 0.017), reported symptoms of genital herpes (P = 0.003), perceived that genital herpes would have a strong negative influence on their sex life (P = 0.0001), and who subsequently tested positive for HSV-2 (P = 0.012). CONCLUSIONS: Among STD clinic attendees, suspicion of genital herpes infection may translate into partner protective behaviour, but only for a minority of people and only with respect to sex with steady partners. Clinic-based and community-based education programs may benefit public health by teaching people (especially single women) how to effectively recognise symptoms of primary genital herpes infections. Reversing the often prevailing ethic of genital herpes as a 'community secret' will clearly be a challenge to these education programs.

Do protective behaviors follow the experience of testing positive for herpes simplex type 2?

OBJECTIVE: To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). METHODS: Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). RESULTS: Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group x time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. CONCLUSIONS: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.

Differential impacts of smoke-free laws on indoor air quality.

The authors assessed the impacts of two different smoke-free laws on indoor air quality. They compared the indoor air quality of 10 hospitality venues in Lexington and Louisville, Kentucky, before and after the smoke-free laws went into effect. Real-time measurements of particulate matter with aerodynamic diameter of 2.5 microm or smaller (PM2.5) were made. One Lexington establishment was excluded from the analysis of results because of apparent smoking violation after the law went into effect. The average indoor PM2.5 concentrations in the nine Lexington venues decreased 91 percent, from 199 to 18 microg/m3. The average indoor PM2.5 concentrations in the 10 Louisville venues, however, increased slightly, from 304 to 338 microg/m3. PM2.5 levels in the establishments decreased as numbers of burning cigarettes decreased. While the Louisville partial smoke-free law with exemptions did not reduce indoor air pollution in the selected venues, comprehensive and properly enforced smoke-free laws can be an effective means of reducing indoor air pollution.

An event-specific analysis of condom breakage among African American men at risk of HIV acquisition.

BACKGROUND: African American men are at high risk of human immunodeficiency virus acquisition. Condom breakage is an understudied aspect of their sexual protective behavior. This study identified user errors leading to condom breakage using an event-specific analysis among young African American men newly diagnosed with a sexually transmitted disease (STD). METHODS: Recruitment occurred in a publicly funded STD clinic located in a metropolitan area of the Southern United States. Of 296 African American men screened as eligible, 271 (91.5%) agreed to participate. Men completed a self-administered questionnaire. Men reporting condom use with men were excluded from the analysis, leaving an analytic sample of 264 men. The recall period was for the last time men used condoms for penile-vaginal sex (within the past 3 months). RESULTS: More than one-fifth (21.2%) reported condom breakage. Each year of advancing age decreased the odds of breakage by 10% [adjusted odds ratio (AOR) = 0.90, 95% confidence interval (CI) = 0.81-0.99, P = 0.028]. Men who had used an oil-based lubricant were more than 3 times as likely to report breakage (AOR = 3.21, 95% CI = 1.48-7.00, P = 0.003) and those who completely unrolled the condom before putting it on were also about 3 times more likely to report breakage (AOR = 3.34, 95% CI = 1.76-6.50, P = 0.0001). The breakage rate for men indicating both errors, i.e., use of an oil-based lubricant and unrolling the condom before application, was 54.5% compared with 33.3% among those indicated either error, and 12.8% among those indicating neither error. Attributable risk for the 2 errors combined was 39%. CONCLUSIONS: Condom breakage among this sample of men at high risk for human immunodeficiency virus infection was common. This problem could be mitigated by counseling men to avoid the use of oil-based lubricants and by teaching them basic condom application skills.

Young African American men having sex with multiple partners are more likely to use condoms incorrectly: a clinic-based study.

This study tested the research hypothesis that men's errors using condoms would be associated with having multiple sex partners. Specifically, men engaging in sex with three or more women were compared with those having sex with two or fewer women. Recruitment (N = 271) occurred in a publicly funded sexually transmitted disease (STD) clinic located in a metropolitan area of the Southern United States. All men were clinically diagnosed with an STD. They completed a self-reported questionnaire (using a 3-month recall period). Those reporting sex with men were excluded from the analysis. About one half of the men (48.5%) reported penetrative sex with three or more women. The authors found that among young African American men, newly diagnosed with an STD, reporting recent (past 3 months) sex with multiple partners may be emblematic of condom errors. These men may benefit from clinic-based, targeted counseling and education designed to foster improved quality of condom use.

Refining self-reported condom use among young men at risk of HIV acquisition.

This descriptive study evaluated the validity of self-reported condom use among young African American men. Thirty percent (n = 79) of the men reported consistent condom use. After accounting for late application and/or early removal of condoms, slippage, and breakage, 26 men remained classified as consistent users. Among the 79 men initially classified as consistent condom users, 695 sexual episodes were reported as 'condom-protected;' however, after correcting for user error, 29.6% of the sexual episodes were actually not protected. Studies assessing self-reported condom use among young African American men should assess user errors as well as frequency of condom use.

Educating health professionals to respond to bioterrorism.

In September 2003, a consortium of bioterrorism and health education experts from the University of Louisville, the University of Kentucky, the Kentucky Department for Public Health, and the Louisville Metro Health Department received funding from the Health Resources and Services Administration (HRSA) to develop a broadly based bioterrorism education program for health professionals in the Commonwealth of Kentucky and the surrounding region. This grant will fund a series of presentations tailored to the needs of professionals in medicine, dentistry, public health, nursing, behavioral medicine, allied health, pharmacy, veterinary medicine, and agriculture, providing coordinated training both on site and through distance learning technology. This article outlines the major grant-funded activities envisioned for the grant years 2003 through 2005, focusing on the use of standardized patients and computerized biosimulators, the transdisciplinary partnerships of the universities involved, and the essential collaboration provided by the state and local health departments.

What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000.

The United States has made progress in decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health inequalities persist. We examined trends in black-white standardized mortality ratios (SMRs) for each age-sex group from 1960 to 2000. The black-white gap measured by SMR changed very little between 1960 and 2000 and actually worsened for infants and for African American men age thirty-five and older. In contrast, SMR improved in African American women. Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated.