Communities putting prevention to work: local evaluation of community-based strategies designed to make healthy living easier.

This introduction is an overview of the articles presented in this supplement that describe implementation and evaluation activities conducted as part of the Centers for Disease Control and Prevention's (CDC's) Communities Putting Prevention to Work (CPPW) initiative. CPPW was one of the largest federal investments ever to combat chronic diseases in the United States. CPPW supported high-impact, jurisdiction-wide policy, systems, and environmental changes to improve health by increasing access to physical activity and healthy foods, and by decreasing tobacco use and exposure to secondhand smoke. The articles included in this supplement describe implementation and evaluation efforts of strategies implemented as part of CPPW by local awardees. This supplement is intended to guide the evidence base for public health interventions on the basis of jurisdiction-wide policy and environmental-level improvements and to encourage rigorous evaluation of the public health interventions.

The emotional experience of intercourse and sexually transmitted diseases: a decision-tree analysis.

BACKGROUND: Epidemiologic data document high risks for many sexually transmitted diseases (STDs) among US adolescents and young adults. GOAL: This case-control study used decision trees to investigate the relationship between STD incidence and emotional reactions to intercourse. STUDY DESIGN: For this study, 188 adolescents and young adults (mean age, 24.9 years [SD = 8.2]) at a regional public STD clinic completed a behavioral and psychological questionnaire and underwent a workup for STD. RESULTS: The prevalence of STD in this group was 44.8%. Decision-tree analysis identified emotional reactions to intercourse that were associated with STD diagnosis for some patients: feeling good about oneself after sex half the time or less (OR = 3.21; 95% CI = 1.73-5.95), feeling comfortable during sex half the time or less (OR = 2.17; 95% CI = 1.07-4.40), and feeling angry after sex (OR = 1.90; 95% CI = 0.91-3.99). Findings of a logistic regression model of emotional reactions to intercourse were significant (chi-square = 24.6; df = 8; P < 0.002), but adding behavioral variables did not improve prediction. CONCLUSIONS: For some of these young adults at the time of life when they are at highest risk of STD, emotional factors have higher odds ratios for STD diagnosis than the traditionally assessed behavioral variables. This underscores the need for interventions targeted to specific subgroups and for readily available mental health services.