Low secondary transmission of 2009 pandemic influenza A (H1N1) in households following an outbreak at a summer camp: relationship to timing of exposure.

Following an outbreak of 2009 pandemic influenza A (H1N1) at a residential summer camp for boys aged 10-16 years, we assessed secondary household transmission of the novel virus after their return home. Of 212 study participants who attended camp, 49 had confirmed or probable influenza for a primary attack rate of 23%. Of 87 exposed household contacts who did not attend camp, only three instances of probable transmission were observed, for a household secondary attack rate of 3·5%. All secondary cases occurred in households where the ill camp attendee returned home 1 day after onset of illness, with an attack rate of 14·3% in household contacts in this category. Returning home after peak infectivity to others and advanced warning prior to reintegration of sick individuals into the household probably contributed to the overall low secondary attack rate observed.

Outbreaks of noroviral gastroenteritis in Florida, 2006-2007.

Noroviruses are an important cause of sporadic cases and outbreaks of acute gastroenteritis. During 2006-2007, widespread increases in acute gastroenteritis outbreaks consistent with norovirus were observed in the United States. We conducted a statewide survey to characterize norovirus outbreak activity in Florida during a 1-year period. From July 2006 to June 2007, 257 outbreaks of norovirus gastroenteritis were identified in 39 of Florida's 67 counties. About 44% of outbreaks were laboratory confirmed as norovirus and 93% of these were due to genogroup GII. About 63% of outbreaks occurred in long-term care facilities and 10% of outbreaks were classified as foodborne. The median number of ill persons per outbreak was 24, with an estimated total of 7880 ill persons. During the study period, norovirus outbreak activity in Florida was widespread, persistent, and consistent with increased activity observed in other parts of the country.

Cannabis-induced psychosis-like experiences are associated with high schizotypy.

OBJECTIVE: Recent studies have suggested that cannabis use is a risk factor for developing schizophrenia. We tested the hypothesis that cannabis use increases the likelihood of psychosis-like experiences in non-clinical participants who scored highly on a measure of schizotypy. METHOD: The psychological effects of cannabis were assessed in 137 healthy individuals (76% female, mean age 22 years) using a newly developed questionnaire concerned with subjective experiences of the drug: the Cannabis Experiences Questionnaire. The questionnaire has three subscales: Pleasurable Experiences, Psychosis-Like Experiences and After-Effects. Respondents also completed the brief Schizotypal Personality Questionnaire. RESULTS: Cannabis use was reported by 72% of the sample. Use per se was not significantly related to schizotypy. However, high scoring schizotypes were more likely to report both psychosis-like experiences and unpleasant after-effects associated with cannabis use. The pleasurable effects of cannabis use were not related to schizotypy score. CONCLUSION: High scoring schizotypes who use cannabis are more likely to experience psychosis-like phenomena at the time of use, and unpleasant after-effects. Our results are consistent with the hypothesis that cannabis use is a risk factor for full psychosis in this group.

Marijuana use and social networks in a community outbreak of meningococcal disease.

BACKGROUND: We examined the role of social networks and marijuana smoking in a community outbreak of infections due to Neisseria meningitidis. METHODS: We interviewed all patients and their contacts. Isolates were tested by pulsed field electrophoresis and multilocus enzyme electrophoresis. RESULTS: Nine cases of meningococcal disease occurred in the outbreak; isolates from seven cases with positive cultures were identical. Multiple overlapping social networks were found for case-patients and their contacts. All case-patients were linked by the marijuana-related activities of their contacts. CONCLUSION: Investigation of social networks and marijuana exposure might help identify close contacts of patients with meningococcal disease and help prevent secondary infections.

Influence of a counteradvertising media campaign on initiation of smoking: the Florida "truth" campaign.

OBJECTIVES: The purpose of this study was to assess the short-term effects of television advertisements from the Florida "truth" campaign on rates of smoking initiation. METHODS: A follow-up survey of young people aged 12 to 17 years (n = 1820) interviewed during the first 6 months of the advertising campaign was conducted. Logistic regression analyses were used to estimate the independent effects of the campaign on smoking initiation while other factors were controlled for. RESULTS: Youths scoring at intermediate and high levels on a media effect index were less likely to initiate smoking than youths who could not confirm awareness of television advertisements. Adjusted odds ratios between the media index and measures of initiation were similar within categories of age, sex, susceptibility, and whether a parent smoked. CONCLUSIONS: Exposure to the "truth" media campaign lowered the risk of youth smoking initiation. However, the analysis did not demonstrate that all such media programs will be effective.

Changes in youth cigarette use and intentions following implementation of a tobacco control program: findings from the Florida Youth Tobacco Survey, 1998-2000.

CONTEXT: Many states are developing tobacco use prevention and reduction programs, and current data on tobacco use behaviors and how these change over time in response to program activities are needed for program design, implementation, and evaluation. OBJECTIVES: To assess changes in youth cigarette use and intentions following implementation of the Florida Pilot Program on Tobacco Control. DESIGN, SETTING, AND PARTICIPANTS: Self-administered survey conducted prior to program implementation (1998), and 1 and 2 years (1999, 2000) later among a sample of Florida public middle school and high school students who were classified as never users, experimenters, current users, and former users of cigarettes based on survey responses. MAIN OUTCOME MEASURES: Changes in cigarette use status, intentions, and behaviors among students over a 2-year period. RESULTS: Surveys were completed by 22,540, 20,978, and 23, 745 students attending 255, 242, and 243 Florida public middle and high schools in 1998, 1999 and 2000, respectively. Response rates for the 3 survey years ranged from 80% to 82% and 72% to 82% for the middle school and high school surveys, respectively. After 2 years, current cigarette use dropped from 18.5% to 11.1% (P<.001) among middle school students and from 27.4% to 22.6% (P =.01) among high school students. Prevalence of never use increased from 56.4% to 69. 3% (P<.001) and from 31.9% to 43.1% (P =.001) among middle school and high school students, respectively. Prevalence of experimenting decreased among middle school and high school students from 21.4% to 16.2% (P<.001) and from 32.8% to 28.2% (P<.001), respectively. Among never users, the percentage of committed nonsmokers increased from 67.4% to 76.9% (P<.001) and from 73.7% to 79.3% (P<.001) among middle school and high school students, respectively. Among experimenters, the percentage of students who said they will not smoke again increased from 30.4% to 42.0% (P<.001) in middle school and from 44.4% to 51.0% (P<.001) in high school. CONCLUSIONS: Progress toward reduction of youth tobacco use was observed in each of the 2 years of Florida's Pilot Program on Tobacco Control. Our results suggest that a comprehensive statewide program can be effective in preventing and reducing youth tobacco use. JAMA. 2000;284:723-728

Florida's "truth" campaign: a counter-marketing, anti-tobacco media campaign.

The "truth" campaign was created to change youth attitudes about tobacco and to reduce teen tobacco use throughout Florida by using youth-driven advertising, public relations, and advocacy. Results of the campaign include a 92 percent brand awareness rate among teens, a 15 percent rise in teens who agree with key attitudinal statements about smoking, a 19.4 percent decline in smoking among middle school students, and a 8.0 percent decline among high school students. States committed to results-oriented youth anti-tobacco campaigns should look to Florida's "truth" campaign as a model that effectively places youth at the helm of anti-tobacco efforts.

The industry manipulation attitudes of smokers and nonsmokers.

A cross-sectional random sample was obtained of Florida youth between the ages of 12-17. Data were collected through a telephone survey after obtaining parent and child consent. Industry manipulation attitudes of three groups (self-identified nonsmokers who did not use cigarettes in the past 30 days, self-identified nonsmokers who used cigarettes in the past 30 days, and self-identified smokers who used cigarettes in the past 30 days) were compared. Constraints resulting from the method of data collection resulted in a conservative estimate of the strength of the association between industry manipulation attitudes and smoking behavior.

Using YPLL in health planning.

OBJECTIVE: The measurement of years of potential life lost before age 65 (YPLL) is one of the Health Outcome Indicators defined by the state of Florida to measure progress toward Healthy People 2000 objectives. The authors describe the outcomes of their work with county health agencies to encourage use of the YPLL statistic. METHODS: Calculations of the 1993 YPLL rates for Florida counties with populations greater than 50,000 and of inter-county variability in YPLL rates were used to train county health agencies in the use of YPLL. RESULTS: Sixty-eight percent of all years of potential life lost in Florida in 1993 were attributed to 10 causes. While the total YPLL rates ranged from 3500 per 100,000 to 7000 per 100,000 across Florida counties, the leading causes differed substantially across counties. The YPLL measure was found to be useful in helping county health agencies plan programs to reduce premature mortality. CONCLUSIONS: Federal, state, and county health units can use YPLL rates to help guide activities toward Healthy People 2000 and to help identify new health problems that require forming new community alliances, but staff members must be trained to use the YPLL statistic appropriately. Causes that vary little across counties enable the implementation of statewide prevention approaches while causes that differ greatly by county will require locally designed interventions.

Failure of cooking to prevent shellfish-associated viral gastroenteritis.

BACKGROUND: In January 1995, Florida experienced the largest outbreak of oyster-associated gastroenteritis ever reported. METHODS: We interviewed both the cohort of persons from 38 gatherings where illness was reported and a sample of harvesters and harvest-area residents. Oysters were traced by means of tags and dealer records, and water quality measures in harvest areas were reviewed. We examined stool specimens for small round structured viruses by means of electron microscopy and amplification of RNA by reverse-transcriptase polymerase chain reaction. We also tested serum specimens for antibodies to Norwalk virus. RESULTS: Of 223 oyster eaters, 58% (129/223) became ill, compared with 3% (2/76) of non-oyster eaters (relative risk, 22; 95% confidence interval, 5.6-87.0). Most oyster eaters (67% [149/223]) ate only cooked (grilled, stewed, or fried) oysters. Oyster eaters who reported eating only thoroughly cooked oysters were as likely to become ill as those who ate raw oysters (relative risk, 0.68; 95% confidence interval, 0.45-1.0; P = .1). In 29 clusters, implicated oysters were from Apalachicola Bay, Florida. A community outbreak occurred in 2 bayside communities before the oyster harvest, leading to an increase in the reportedly common practice of overboard dumping of feces. Small round structured viruses were identified in the stool specimens of 2 harvest-area residents and 9 persons from 8 clusters. Results of water quality tests for fecal coliforms were within acceptable limits. CONCLUSIONS: This large outbreak of gastroenteritis associated with oysters may have resulted from overboard dumping of feces during a community outbreak of diarrheal illness. Our findings of acceptable water quality measures for fecal contamination and the lack of appreciable protective effect from cooking leave the consumer with no assurance of safety.

Medicaid costs of live births from unintended pregnancies in Florida.

The Florida Pregnancy Risk Assessment Monitoring System (PRAMS) survey, a population-based, random sample mail-telephone query of new mothers of live-born infants, includes questions about pregnancy timing and wantedness, sources of payment for care, other related topics, mother's risk behaviors, satisfaction with prenatal care, and the newborn's health. There were 2,059 completed responses in 1993. Results are weighted for factors affecting response rates to reflect all births. An estimated 13.8% (95% confidence interval 11.7, 15.9) of all Florida babies in 1993 were unwanted at conception, and 20.3% (16.5, 24.1) of those whose deliveries were paid for by Medicaid were unwanted. The Medicaid program currently pays for the prenatal, intrapartum, delivery and infant health care of an estimated 16,000 pregnancies and newborns each year that were unwanted at conception. The total annual cost is estimated at $401 million, or over 8% of all 1992-93 Medicaid costs.

Elevated blood lead prevalence in Florida two-year-olds.

The prevalence of blood lead values of 10 mcg/dl or higher was estimated in Florida two-year-olds in a population-based random sample survey. Subjects were chosen at random from birth certificates of children born in Florida in mid-1991. Parents were interviewed and children's blood specimens obtained in the summer of 1993. Results are based on 387 subjects. Overall prevalence of elevated blood lead was 3.2% (95% confidence limits 2.2, 4.0), with nine children in the range of 10 to 14 mcg/dl and four of 15 or over. In certain subgroups, prevalence was higher: nonwhite 9.4% (2.9, 15.9); mother not married 8.3% (3.1, 13.5); mother on Medicaid 6.7% (2.5, 10.8); housing built in 1978 or before 7.1% (2.3, 11.8); yard dirt or dirt plus grass 10.8% (4.6, 16.9). In Florida, prevalence is much lower than in the nation as a whole. A screening strategy that concentrates on screening Medicaid-eligible children and those living in homes built before 1978 would appear to be quite efficient and may uncover a prevalence of 7.0% or more.

The relative effectiveness of sanctions applied to first-time drunken driving offenders.

We selected for study drivers who were sentenced either to jail or a certified driver intervention program (DIP) in Franklin County, Ohio, in 1987 after their first drunken driving (DUI) conviction. Because each drunken driving charge was assigned to one of a pool of 15 judges with widely varying sentencing patterns, there was no apparent bias in subject allocation to the two treatments. For the jailed (n = 124) and DIP (n = 218) cohorts, we compared the likelihood of subsequent impaired driving, as evidenced by rearrest for a new alcohol-related driving offense or involvement in a car crash after drinking in the 4 years following the study-selected event. After controlling for potentially important covariates, such as gender, age, race, blood alcohol concentration, additional charges filed at the time of arrest, and driving history, we derived logistic regression results indicating that DIP attendees had significantly lower rates of subsequent impaired driving. Drivers who had no prior history of at least one non-DUI alcohol-related offense were significantly more likely to display additional impaired driving when jailed as opposed to those enrolled in a DIP (odds ratio [OR] = 2.53, confidence interval [CI] = 1.44, 4.45), while those with previous alcohol-related offenses may have fared better in jail (OR = .56, CI = .11, 2.76). Drivers younger than 21 years of age were also at elevated risk for repeat offenses (OR = 2.46, CI = 1.13, 5.35). DIPs appear most effective when used for persons who have not had previous alcohol-related crashes or driving offenses.

Patient-to-patient transmission of hepatitis B in a dermatology practice.

OBJECTIVE: The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. METHODS: Historical cohort, matched case-control, and cross-sectional survey methods were used. RESULTS: The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. CONCLUSIONS: HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.

Outbreak of Legionnaire's disease linked to a decorative fountain by molecular epidemiology.

The incubation period of Legionnaires' disease in five patients was traced to attendance at conventions in a hotel in the Orlando, Florida, area between January 6 and February 2, 1992. The five case patients (mean age, 69 years) were older than 55 randomly chosen controls (mean age, 53 years) who had also attended one of the same conventions (p = 0.007). All case patients were males, as were 40% of the controls (p = 0.01). No significant differences in exposures were found between case patients and controls, but all case patients and 65% of the controls reported exposure to a decorative fountain in the hotel lobby. Water from the fountain was the only one of 55 environmental specimens to test positive for Legionella. Both the environmental isolate and the only clinical isolate were Legionella pneumophila serogroup 1, with identical patterns identified on monoclonal antibody subtyping and pulsed-field gel electrophoresis (PFGE) of genomic restriction fragments. The fountain's recirculating system had been irregularly maintained, and water in the fountain may have been heated by submersed lighting. These findings demonstrate the utility of monoclonal antibody subtyping and PFGE of genomic restriction fragments in assessing the significance of environmental isolates of L. pneumophila, especially when other epidemiologic findings are inconclusive. They also show that decorative fountains may be a potential source of infection with L. pneumophila, and emphasize the need for standard maintenance and disinfection procedures.

Insurance coverage and usage of preventive health services.

The 1991 Florida Behavioral Risk Factor Survey which included 2,246 respondents to a random-digit-dial telephone survey, showed that 19.2% of Florida residents aged 18 and older reported they had no health insurance, and 24.7% reported they had no insurance covering outpatient services. Lack of insurance coverage was reported more frequently by younger adults (70% under age 40 vs 93% over age 60), by those with less than a high-school education (69% vs 85% for those with some college), by members of racial-ethnic minority groups (Hispanics 67.5%, Blacks 71.5%, whites 85%), and by residents of southeastern Florida. Persons without insurance coverage were less likely to report having had a check-up by a physician in the last year, more likely to report they needed to see a physician but could not because of cost (37% vs 9%), and less likely to have received a mammogram (33% vs 56%) or Pap smear (51.6% vs 67.8%) in the last year. These findings support the need for health-care reform to include assurance that health insurance covers preventive services.