A Fay-Herriot Model for Estimating Subjective Cognitive Decline among Military Veterans.

BACKGROUND: Although studies have examined the geographic distribution of dementia among the general population in order to develop geographically targeted interventions, no studies have examined the geographic distribution of subjective cognitive decline (SCD) among military veterans specifically. OBJECTIVES: To map the geographic distribution of subjective cognitive decline from 2011-2019 in the United States among military veterans. DESIGN: Cross-sectional. SETTING: United States. PARTICIPANTS: Individuals reporting previous service in the United States Armed Forces. MEASUREMENTS: Using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data, which is last year for which geocoded SCD data is publicly available, we estimated the survey-weighted county-level prevalence of veteran SCD for counties with >30 veterans (43 counties in 7 states). We then developed a Fay-Herriot small area estimation linear model using auxiliary data from the Census, with county-level veteran-specific covariates including % >65 years old, % female, % college educated, and median income. Following model validation, we created beta-weighted predictions of veteran SCD for all USA counties for 2011-2019 using relevant time-specific Census auxiliary data. We provide choropleth maps of our predictions. RESULTS: Results of our model on 43 counties showed that county-level rates of SCD were significantly associated with all auxiliary variables except annual income (F = 1.49, df = 4, 38). Direct survey-weighted rates were correlated with model-predicted rates in 43 counties (Pearson r = 0.32). Regarding predicted rates for the entire USA, the average county-level prevalence rate of veteran SCD in 2011 was 13.83% (SD = 7.35), but 29.13% in 2019 (SD = 14.71) - although variation in these rates were evident across counties. CONCLUSIONS: SCD has increased since 2011 among veterans. Veterans Affairs hospitals should implement plans that include cognitive assessments, referral to resources, and monitoring patient progress, especially in rural areas.

Modeling flame extinction and reignition in large eddy simulations with fast chemistry.

This work seeks to support the validation of large eddy simulation models used to simulate fire suppression. The emphasis in the present study is on the prediction of flame extinction and the prevention of spurious reignition using a fast chemistry, mixing-controlled combustion model applicable to realistic fire scenarios of engineering interest. The configuration provides a buoyant, turbulent methane diffusion flame within a controlled co-flowing oxidizer. The oxidizer allows for the supply of a mixture of air and nitrogen, including conditions for which oxygen-dilution in the oxidizer leads to flame extinction. Measurements to support model validation include local profiles of thermocouple temperature and oxygen mole fraction, global combustion efficiency, and the limiting oxygen index. The present study evaluates the performance of critical-flame-temperature-based extinction and reignition models using the Fire Dynamics Simulator, an open-source fire dynamics solver. Alternate model cases are explored, each offering a unique treatment of extinction and reignition. Comparisons between simulated results and experimental measurements are used to evaluate the capability of these models to accurately describe flame extinction. Of the considered cases, those that include provisions to prevent spurious reignition show excellent agreement with measured data, whereas a baseline case lacking explicit reignition treatment fails to predict extinction.

Cuban healthcare providers in Venezuela: a case study.

Approximately 31,000 Cuban healthcare providers reside in Venezuela as part of an initiative to increase Venezuelans' access to health care. The concept began in 1999 as part of the new constitution, and has grown steadily to include 6000 clinics, health promotion and prevention programmes, an integrated healthcare system, and a vision to train and deploy community public health physicians selected from and trained within the neighbourhood. In the case study described herein, physician-patient consultations increased from 3.5 million to 17 million, and the numbers of primary care physicians, nurses and dentists increased dramatically. Furthermore, in Caracas, there has been a 30% reduction in the use of emergency rooms at public hospitals. Estimates are provided for preventive services and potential lives saved. As health care is a politically-laden issue in many countries, all approaches to reducing healthcare disparities are worth analysing for their potential contributions to population health improvement.

Health risk behavior of rural secondary school students in Zimbabwe.

A socioculturally appropriate health risk behavior instrument, modeled after the U.S. Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS), was administered to 717 secondary school students in a rural area of Zimbabwe. Comparisons of risk behaviors by gender and school grade were made using univariate procedures and multiple logistic regression. Males were significantly more likely than females to have had sexual intercourse (odds ratio = 5.02, p < .0001) and to report drug use behaviors. Males also were significantly more likely to report early initiation (by age 13 years) of alcohol use, cigarette smoking, and marijuana use. School site violence and drug use behaviors also were prevalent in this sample. An interaction between gender and grade was evident for some behaviors. Additional research may further the understanding of these risk behaviors and facilitate development of effective, culturally relevant risk reduction programs.

Developing youth capacity for community-based research: the Sarasota County demonstration project.

Although youth involvement in health promotion efforts is not a new concept, projects that actively involve youths in planning research, collecting data, and making research design decisions are rare. This article describes the evaluation process and outcomes for a youth-directed data collection initiative. Eleven youth researchers conducted 112 personal in-depth interviews and 22 focus groups involving 206 youths in 5th through 12th grade. Youth researchers felt confident they could conduct focus groups and in-depth interviews and staff ratings of youths' effectiveness in moderating focus groups indicated they were successful in carrying out the qualitative research.

Youth and tattoos: what school health personnel should know.

Though tattooing has been practiced by various cultures for centuries, this art form has undergone dramatic changes the past few decades. Today, tattoos appeal to diverse populations and mainstream culture. The proliferation of tattooing prompted increased concern for safety and awareness of hazardous conditions. Transmission of infectious diseases, such as hepatitis B and C, and theoretically, HIV, can occur when proper sterilization and safety procedures are not followed. While there are many populations at risk, a critical at-risk group is adolescents. Tattooing among adolescents is a risk-taking behavior that warrants the attention of health education in assisting adolescents in becoming informed decision-makers. Teaching and advocacy strategies are suggested, and roles for school health personnel are presented.

Continuing education about physically abusive relationships: does education change the perceptions of health care practitioners?

BACKGROUND: The purpose of this study is to determine the effectiveness of mandatory continuing education for domestic violence. METHOD: This study surveyed health care professionals attending the 1993 and 1997 National Perinatal Association Conference in Florida to determine change their awareness and identification of pregnant women involved in physically abusive relationships. RESULTS: Even though in 1993 Florida initiated a mandatory 1-hour continuing education credit on domestic violence, the findings report that there were no statistically significant changes for awareness and identification. However, there was a statistically significant increase in the availability of patient education materials within the 4-year period. CONCLUSION: Both the 1993 and 1997 respondents expressed a desire for more professional education related to domestic violence.

Alcohol attitudes and beliefs related to actual alcohol experience in a fifth-grade cohort.

Despite a gradual overall decrease in alcohol consumption in the United States, alcohol remains the most widely used and abused drug in society. This study assessed lifetime and recent alcohol use in a cohort of fifth graders, and examined attitudes and beliefs held by these youth concerning alcohol. An instrument addressing alcohol use, other substance use, and other health-related problem behaviors was completed by 813 fifth graders in a west central Florida school district. Among respondents, 48.9% had "ever tried" alcohol, and 17.9% had consumed alcohol in the past 30 days (active drinkers). Significant differences in alcohol-related attitudes and beliefs were found according to current drinking status, gender, and race/ethnicity. Possible reasons for these differential findings are presented, and implications for prevention and intervention are discussed.

Middle school students and bicycle helmet use: knowledge, attitudes, beliefs, and behaviors.

Previous research has shown that bicycle helmet use among older children and adolescents continues to be low. This study determined middle school students' knowledge, attitudes, beliefs, and behaviors related to bicycle helmet use. Six middle schools in Hillsborough County, Fla., served as the research settings. A pretested survey instrument was administered to students. Overall, 3,333 sixth and seventh graders responded. Results showed that most children owned a bicycle, 38.1% owned a helmet, but only 15.8% wore a helmet the last time they rode a bike. Many students (49.7%) did not know or did not believe there was a bicycle helmet law in Florida. Predictors of helmet use were intention to use a helmet the next time one rides a bike, having a helmet, siblings' use of helmets, and friends' use of helmets.

Evaluation of a poison prevention lesson for kindergarten and third grade students.

OBJECTIVES: The purpose of this study was to evaluate the MORE HEALTH poison prevention lesson that is given to kindergarten and third grade students in Hillsborough County, Florida. The lesson reaches approximately 6000 students per year. METHODS: The evaluation was based on a post-test only control group design. Three schools were chosen as evaluation sites and three served as control settings. Students were administered a previously tested, age appropriate questionnaire that addressed the goals of the poison lessons. In addition, a survey was developed for intervention school parents to determine their poison prevention practices. RESULTS: One hundred ninety four intervention schoolchildren and 184 control schoolchildren completed the study. Children in the intervention schools consistently answered more questions correctly than those in the control schools. The parent survey showed that the majority have homes that are safe from poisons, although fewer than 50% said they had syrup of ipecac in their homes. CONCLUSIONS: These results show that key concepts related to poison prevention can be communicated effectively to primary school students and parents report having homes safe from many poisons.

Relationship of adolescent self-esteem to selected academic variables.

This study investigated whether self-esteem precedes various academic behaviors and beliefs among 593 high school students (63.7% female, 60.9% African American). Measures of home and school self-esteem, grade point average, perceived academic standing and progress, and educational plans were collected by survey and archival review of grade and attendance records at the beginning (pre-test) and end of the school year (post-test). Self-esteem and academic variables differed by gender, race, and guardianship. Self-esteem related significantly to academics and absenteeism. Results suggest selected academic variables predict self-esteem even when the effects of gender, race, and guardianship are removed and pretest self-esteem scores are controlled. In conclusion, student academic performance influences subsequent academic and home self-esteem. Creation of positive academic experiences for youth may be a critical activity, since experts contend that low self-esteem is associated with subsequent behavioral problems. The markedly lower self-esteem of Native American and Hispanic youth warrants further investigation.

An academic paradox: high school students' perceptions of their class standing and self-reported risk-taking.

The centers for Disease Control and Prevention (CDC) administered its 75-item 1991 Youth Risk Behavior Surveillance survey to a nationwide random sample of 12,248 high school students. In a secondary analysis of their data, one item on students' perceived class standing, was compared with selected health risk-taking practices. The 7.7% of students who indicated that they were "below the middle" in comparison with their classmates reported more participation in all risk-taking behaviors than students who reported being "in the middle" (28.6%) or "above the middle" (63.7%). Students' grades, ages, and ethnicity showed significant differences, with younger students and selected ethnocultural minority students more likely to report being "below the middle." Perceived class standing may be a proxy measure for estimating participation in health-compromising practices.

Instruments to measure social support and related constructs in pregnant adolescents: a review.

This review examines some of the key issues related to measuring social support and identifies 28 instruments which have been used in research with pregnant adolescents. The major external and internal variables that affect social support for pregnant adolescents are defined. Relevant questions are offered to guide the researcher in the choice of a social support instrument, and the 28 social support instruments are described by author, availability, length and item type, psychometric properties, and selected references and notes. Although not an exhaustive list, these 28 instruments are representative of the broad spectrum of measurement tools available which were chosen because they have been used in a variety of social support research endeavors.

PIP: Social support is widely regarded as a significant determinant of the outcome of adolescent pregnancy in the US. In general, adolescent mothers with adequate, positive family and peer support are more likely to complete school, enter the labor market, have good self-esteem, and have healthy children. There is no concise and universally accepted definition of social support, however. In addition, the frequency of social support does not necessarily relate to the significance or quality of the interaction. The US research literature contains 28 social support instruments, 19 of which assess some degree of external social support variables for the pregnant adolescent (e.g., perceived quality of relationships, number of life stressors, degree of satisfaction with social supports). The internal variable instruments evaluate depression, personal attitudes, introspection, psychological distress, self-image, loneliness, and anxiety. This paper summarizes, in tabular form, each of these scales (authors, availability, length and item type, psychometric properties, and selected references and notes). Ideal would be a combination of qualitative and quantitative procedures to yield maximally comprehensive social support data. The instrument review suggests a need for additional research in the areas of longitudinal parental attachment, the effectiveness of supportive interventions as a buffering variable for stressful life events, and the relationship of social support and mental health.

Restricting smoking at the University of Köln, Germany: a case study.

The effects of a new policy limiting smoking to separate, designated areas in School of Education buildings at the University of Köln, Germany, were analyzed. Although the majority (77%) of the 1,223 students surveyed did not expect the changed policy to affect their smoking habits, approximately 28% of the men and 30% of the women said they were smoking less at the university after the change went into effect. Ninety-one percent of the nonsmoking students and 68% of the smokers supported the new policy. Smoking rates among Köln students are not significantly different from those of the adult German population, where 34% of the women and 41% of the men are smokers. The findings in this study indicate that such a policy change may result in a net decrease in amount smoked and could be a successful intervention in countries where smoking rates are traditionally higher than they are in the United States.

Beliefs and mammography screening.

INTRODUCTION: Breast cancer is a leading form of preventable cancer among women in the United States. Despite improvements in mammography and other early detection techniques, special populations, including older and minority women, continue to experience high incidence and mortality rates. Knowledge, attitudes, and beliefs are ubiquitous constructs in preventive medicine, health behavior, and behavioral epidemiology. These constructs often are used to explain variation in health screening behavior. While all three have been examined in relation to mammography screening, concentration on the single category of beliefs and the relation between specific beliefs and mammography screening practices has remained largely uninvestigated. METHODS: Using logistic regression modeling, we examined the relationship between four individual beliefs and mammography screening in a cross-sectional study of 407 women. RESULTS: After we controlled for confounding factors in a multivariable analysis, belief in the efficacy of early detection in improving breast cancer outcome (odds ratio [OR] = 2.98; 95% confidence intervals [CI] = 1.62, 5.47) and perceived risk (OR = 0.49; 95% CI = 0.26, 0.94) were significantly associated with screening practice. Belief that mammography is dangerous (OR = 0.46; 95% CI = 0.18, 1.18) or painful (OR = 1.25; 95% CI = 0.75, 2.08) was not significantly associated with screening practice. CONCLUSIONS: Information on the relationship between beliefs and screening practices may be used both to understand screening behaviors and to develop targeted strategies to improve mammography compliance.

Acquisition of high-risk behavior by African-American, Latino, and Caucasian middle-school students.

The purpose of this study was to measure the stages of acquisition of selected high-risk health behaviors in 768 randomly selected 7th- and 8th-graders in a Florida school district. Specific high-risk health behaviors included use of alcohol, tobacco, and drugs, fighting and weapon carrying, and suicide ideation. Analysis indicated few behaviors that were significantly different when African-American and Latino students were compared with Caucasian students. The most weapon carrying was reported by Latinos. Fewer Caucasian students than their minority peers used inhalants. Knowledge of stages of acquisition among small diverse samples may assist school personnel to intervene during the inculcation process with appropriate responsive programs.

HIV risk behaviors: a comparison of U.S. Hispanic and Dominican Republic youth.

Sexual behaviors of adolescents place them at a high risk for HIV infection and other sexually transmitted diseases. International comparisons of sexual risk-taking among youth employing a common set of survey items are rare. Moreover, such studies can assist in explaining observed differences in disease rates, or predicting future trends in transmission, and identifying health educational needs unique to a particular population or setting. To assess variations in risk-taking patterns, a comparison of HIV behavioral risk factors was made between U.S. Hispanic and Dominican Republic (D.R.) youth. The Spanish version of the Youth Risk Behavior Surveillance (YRBS) survey was administered to 1,175 D.R. high school students. Responses were compared to those in the U.S. from the Centers for Disease Control and Prevention's 1990 YRBS data tape for 2285 Hispanic youth. Frequency and cross-tabulation data were compared by country and gender. There were significant differences in AIDS education at school, discussions about AIDS conducted in the home, age of first sexual experience, condom use, and past experience with STDs. Results show that adolescents in both countries are at risk, but with different mediating factors. Inadequate condom use and early initiation of sex place the D.R. youth at risk, while more U.S. youth are engaging in sexual intercourse and using alcohol or other drugs in conjunction with sexual episodes. Some implications for prevention education are discussed.

PIP: A comparison of human immunodeficiency virus (HIV) risk factors between US Hispanic and Dominican Republic youth indicated sexual intercourse under the influence of drugs and alcohol places the former group at risk, while early initiation of sex and inadequate condom use are the main risk factors in the latter group. The data on 2285 US Hispanic adolescents (mean age, 15.6 years) were derived from the 1990 Youth Risk Behavior Surveillance survey. A Southeastern-Puerto Rican version of this survey was administered to 1175 Dominican Republic youth (mean age, 16.8 years). 78.5% of US Hispanic youth and 59.9% of Dominican youth had been taught about acquired immunodeficiency syndrome (AIDS) in school, and 51.5% and 70.9%, respectively, had discussed AIDS at home. 54.1% of US teens (66.0% of males and 43.6% of females) and 31.0% of Dominican respondents (61.2% of males and 10.0% of females) were sexually active. 15% of US Hispanics had engaged in sex before 13 years of age, while 30.4% of Dominicans were sexually active by 12 years of age. Four or more life-time sexual partners were reported by 31.1% of US and 37.6% of Dominican youth. US Hispanics were more likely than Dominicans to have used drugs or alcohol prior to the most recent sexual intercourse (24.8% vs. 10.8%, respectively). The frequencies of condom use during the most recent intercourse were 38% and 34%, respectively. Continued unprotected sexual activity in this age group can have profound effects on the growth curve of HIV, suggesting a need for earlier and better sex education programs.

Sexual risk-taking by Muscovite youth attending school.

Sexual behaviors of adolescents place them at a high risk for HIV and other sexually transmissible infections. Studies of sexual risk-taking and other health compromising practices by youth in countries other than the United States are relatively rare. Examination of health practices across cultures provides insights with respect to explaining international differences in disease rates, helps predict future trends in disease transmission, and identifies health education needs of particular populations or settings. Sexual behavioral risk factors were studied in a sample of 1,090 youth (mean age = 14 years) in Moscow using a translated version of the Youth Risk Behavior Surveillance (YRBS) survey developed by the U.S. Centers for Disease Control and Prevention. Only 26.3% of Muscovite youth report being taught about HIV/AIDS infection in school, and just 41.7% indicate discussion of HIV/AIDS occurred with parents or other familial adults. Overall, 15.7% of females and 23.7% of males report at least one sexual intercourse in their lifetime. About 8.8% of the sample reported participation in sexual intercourse before age 12, and 34.9% indicated having had sexual intercourse with four or more partners. Concomitant use of alcohol and other drugs is common (24.4%) prior to the most recent intercourse, and use of a condom occurs in fewer than half (41.7%) of recent sexual episodes.