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On February 23, 2018, PubMed Central Canada (PMC Canada) will be taken offline permanently. No author manuscripts will be deleted, and the approximately 2,900 manuscripts authored by Canadian Institutes of Health Research (CIHR)-funded researchers currently in the archive will be copied to the National Research Council’s (NRC) Digital Repository over the coming months. These manuscripts along with all other content will also remain publicly searchable on PubMed Central (US) and Europe PubMed Central, meaning such manuscripts will continue to be compliant with the Tri-Agency Open Access Policy on Publications.

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1.  The Impact of Michigan’s Partial Repeal of the Universal Motorcycle Helmet Law on Helmet Use, Fatalities, and Head Injuries 
American journal of public health  2016;107(1):166-172.
To evaluate the impact of the partial repeal of Michigan’s universal motorcycle helmet law on helmet use, fatalities, and head injuries.
We compared helmet use rates and motorcycle crash fatality risk for the 12 months before and after the April 13, 2012, repeal with a statewide police-reported crash data set. We linked police-reported crashes to injured riders in a statewide trauma registry. We compared head injury before and after the repeal. Regression examined the effect of helmet use on fatality and head injury risk.
Helmet use decreased in crash (93.2% vs 70.8%; P < .001) and trauma data (91.1% vs 66.2%; P < .001) after the repeal. Although fatalities did not change overall (3.3% vs 3.2%; P = .87), head injuries (43.4% vs 49.6%; P < .05) and neurosurgical intervention increased (3.7% vs 6.5%; P < .05). Male gender (adjusted odds ratio [AOR] = 1.65), helmet nonuse (AOR = 1.84), alcohol intoxication (AOR = 11.31), intersection crashes (AOR = 1.62), and crashes at higher speed limits (AOR = 1.04) increased fatality risk. Helmet nonuse (AOR = 2.31) and alcohol intoxication (AOR = 2.81) increased odds of head injury.
Michigan’s helmet law repeal resulted in a 24% to 27% helmet use decline among riders in crashes and a 14% increase in head injury.
PMCID: PMC5308169  PMID: 27854530
2.  Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009–2014 
American journal of public health  2017;108(1):128-130.
To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States.
This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology.
Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months.
Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons.
PMCID: PMC5718928  PMID: 29161069
3.  Public Health’s Aspirational Identity: Who Do We Want to Be? 
Our extended families are large and—well—complicated. During a crisis, however, our true essences emerge. More often than not, our love and support for one another overcomes our sometimes fraught and fractious tendencies.
PMCID: PMC5719693  PMID: 29211539
4.  Tuberculosis in Jails and Prisons: United States, 2002–2013 
American journal of public health  2016;106(12):2231-2237.
To describe cases and estimate the annual incidence of tuberculosis in correctional facilities.
We analyzed 2002 to 2013 National Tuberculosis Surveillance System case reports to characterize individuals who were employed or incarcerated in correctional facilities at time they were diagnosed with tuberculosis. Incidence was estimated with Bureau of Justice Statistics denominators.
Among 299 correctional employees with tuberculosis, 171 (57%) were US-born and 82 (27%) were female. Among 5579 persons incarcerated at the time of their tuberculosis diagnosis, 2520 (45%) were US-born and 495 (9%) were female. Median estimated annual tuberculosis incidence rates were 29 cases per 100 000 local jail inmates, 8 per 100 000 state prisoners, and 25 per 100 000 federal prisoners. The foreign-born proportion of incarcerated men 18 to 64 years old increased steadily from 33% in 2002 to 56% in 2013. Between 2009 and 2013, tuberculosis screenings were reported as leading to 10% of diagnoses among correctional employees, 47% among female inmates, and 42% among male inmates.
Systematic screening and treatment of tuberculosis infection and disease among correctional employees and incarcerated individuals remain essential to tuberculosis prevention and control.
PMCID: PMC5104991  PMID: 27631758
5.  Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013–2014 
American journal of public health  2017;107(8):1332-1338.
To examine disparities in chronic conditions and health indicators among lesbian, gay, and bisexual (LGB) adults aged 50 years or older in the United States.
We used data from the 2013 and 2014 National Health Interview Survey to compare disparities in chronic conditions, health outcomes and behaviors, health care access, and preventive health care by sexual orientation and gender.
LGB older adults were significantly more likely than heterosexual older adults to have a weakened immune system and low back or neck pain. In addition, sexual minority older women were more likely than their heterosexual counterparts to report having arthritis, asthma, a heart attack, a stroke, a higher number of chronic conditions, and poor general health. Sexual minority older men were more likely to report having angina pectoris or cancer. Rates of disability and mental distress were higher among LGB older adults.
At substantial cost to society, many disparities in chronic conditions, disability, and mental distress observed in younger LGB adults persist, whereas others, such as cardiovascular disease risks, present in later life. Interventions are needed to maximize LGB health.
PMCID: PMC5508186  PMID: 28700299
6.  Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center 
American journal of public health  2016;106(11):1958-1960.
Community-engaged researchers who work with low-income communities can be reliant on grant funding. We use the illustrative case of the Penn Center for Community Health Workers (PCCHW) to describe a step-by-step framework for achieving financial sustainability for community-engaged research interventions. PCCHW began as a small grant-funded research project but followed an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. PCCHW is now fully funded by Penn Medicine and delivers the Individualized Management for Patient-Centered Targets (IMPaCT) community health worker interventionto 2000 patients annually.
PMCID: PMC5055768  PMID: 27631747
7.  Creating a Taxonomy of Local Boards of Health Based on Local Health Departments’ Perspectives 
To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs.
This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency.
The final classification scheme included 60 items across 6 governance function domains and an additional domain—LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics.
The LBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs.
PMCID: PMC5308160  PMID: 27854524
8.  Prevalence and Causes of Paralysis—United States, 2013 
American journal of public health  2016;106(10):1855-1857.
To estimate the prevalence and causes of functional paralysis in the United States.
We used the 2013 US Paralysis Prevalence & Health Disparities Survey to estimate the prevalence of paralysis, its causes, associated sociodemographic characteristics, and health effects among this population.
Nearly 5.4 million persons live with paralysis. Most persons with paralysis were younger than 65 years (72.1%), female (51.7%), White (71.4%), high school graduates (64.8%), married or living with a partner (47.4%), and unable to work (41.8%). Stroke is the leading cause of paralysis, affecting 33.7% of the population with paralysis, followed by spinal cord injury (27.3%), multiple sclerosis (18.6%), and cerebral palsy (8.3%).
According to the functional definition, persons living with paralysis represent a large segment of the US population, and two thirds of them are between ages 18 and 64 years. Targeted health promotion that uses inclusion strategies to account for functional limitations related to paralysis can be undertaken in partnership with state and local health departments.
PMCID: PMC5024361  PMID: 27552260
9.  A Traffic-Light Label Intervention and Dietary Choices in College Cafeterias 
American journal of public health  2016;106(10):1808-1814.
To examine whether traffic-light labeling and choice architecture interventions improved dietary choices among students at a northeastern US university.
In 6 cafeterias at Harvard University, in Cambridge, Massachusetts, we implemented a 7-week intervention including traffic-light labeling (red: least nutrient rich; yellow: nutrient neutral; green: most nutrient rich), choice architecture (how choices are presented to consumers), and “healthy-plate” tray stickers. During the 2014–2015 academic year, 2 cafeterias received all interventions, 2 received choice architecture only, and 2 were controls. We analyzed sales for 6 weeks before and 7 weeks during interventions. Using interrupted time-series analyses, we measured changes in red, yellow, and green items served. We collected 1329 surveys to capture perceptions of labeling.
Among 2.6 million portions served throughout the study, we found no significant changes in red (−0.8% change/week; P = .2) or green (+1.1% change/week; P = .4) items served at intervention sites compared with controls. In surveys, 58% of students reported using traffic-light labels at least a few times per week, and 73% wanted them to continue.
Although many students reported using traffic-light labels regularly and wanted interventions to continue, cafeteria interventions did not demonstrate clear improvements in dietary quality.
PMCID: PMC5024366  PMID: 27552277
10.  Police Brutality and Black Health: Setting the Agenda for Public Health Scholars 
American journal of public health  2017;107(5):662-665.
We investigated links between police brutality and poor health outcomes among Blacks and identified five intersecting pathways: (1) fatal injuries that increase population-specific mortality rates; (2) adverse physiological responses that increase morbidity; (3) racist public reactions that cause stress; (4) arrests, incarcerations, and legal, medical, and funeral bills that cause financial strain; and (5) integrated oppressive structures that cause systematic disempowerment.
Public health scholars should champion efforts to implement surveillance of police brutality and press funders to support research to understand the experiences of people faced with police brutality. We must ask whether our own research, teaching, and service are intentionally antiracist and challenge the institutions we work in to ask the same.
To reduce racial health inequities, public health scholars must rigorously explore the relationship between police brutality and health, and advocate policies that address racist oppression.
PMCID: PMC5388955  PMID: 28323470
American journal of public health  2016;106(6):e13-e14.
PMCID: PMC4880239  PMID: 27153027
12.  Public Health 3.0: Time for an Upgrade 
American journal of public health  2016;106(4):621-622.
PMCID: PMC4816012  PMID: 26959263
13.  Evaluating Public Health Interventions: 6. Modeling Ratios or Differences? Let the Data Tell Us 
American journal of public health  2017;107(7):1087-1091.
We provide an overview of the relative merits of ratio measures (relative risks, risk ratios, and rate ratios) compared with difference measures (risk and rate differences). We discuss evidence that the multiplicative model often fits the data well, so that rarely are interactions with other risk factors for the outcome observed when one uses a logistic, relative risk, or Cox regression model to estimate the intervention effect.
As a consequence, additive models, which estimate the risk or rate difference, will often exhibit interactions. Under these circumstances, absolute measures of effect, such as years of life lost, disability- or quality-adjusted years of life lost, and number needed to treat, will not be externally generalizable to populations other than those with similar risk factor distributions as the population in which the intervention effect was estimated. Nevertheless, these absolute measures are often of the greatest importance in public health decision-making.
When studies of high-risk study populations are used to more efficiently estimate effects, these populations will not be representative of the general population’s risk factor distribution. The relative homogeneity of ratio versus absolute measures will thus have important implications for the generalizability of results across populations.
PMCID: PMC5463222  PMID: 28590865
14.  [No title available] 
PMCID: PMC4940645  PMID: 27400347
15.  [No title available] 
PMCID: PMC4940676  PMID: 27400352
16.  [No title available] 
PMCID: PMC5388950  PMID: 28398792
17.  How California Prepared for Implementation of Physician-Assisted Death: A Primer 
American journal of public health  2017;107(6):883-888.
Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law.
To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations.
Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California’s culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants’ insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.
PMCID: PMC5425870  PMID: 28426307
18.  Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California 
American journal of public health  2016;106(7):1211-1213.
To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014.
Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549).
After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms.
More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California.
Public health implications
Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization.
PMCID: PMC4902724  PMID: 27077361
19.  Lower Sodium Intake and Risk of Headaches: Results From the Trial of Nonpharmacologic Interventions in the Elderly 
American journal of public health  2016;106(7):1270-1275.
To determine the effect of sodium (Na) reduction on occurrence of headaches.
In the Trial of Nonpharmacologic Interventions in the Elderly, 975 men and woman (aged 60–80 years) with hypertension were randomized to a Na-reduction intervention or control group and were followed for up to 36 months. The study was conducted between 1992 and 1995 at 4 clinical centers (Johns Hopkins University, Wake Forest University School of Medicine, Robert Wood Johnson Medical School, and the University of Tennessee).
Mean difference in Na excretion between the Na-reduction intervention and control group was significant at each follow-up visit (P < .001) with an average difference of 38.8 millimoles per 24 hours. The occurrence of headaches was significantly lower in the Na-reduction intervention group (10.5%) compared with control (14.3%) with a hazard ratio of 0.59 (95% confidence interval = 0.40, 0.88; P = .009). The risk of headaches was significantly associated with average level of Na excretion during follow-up, independent of most recent blood pressure. The relationship appeared to be nonlinear with a spline relationship and a knot at 150 millimoles per 24 hours.
Reduced sodium intake, currently recommended for blood pressure control, may also reduce the occurrence of headaches in older persons with hypertension.
PMCID: PMC4902761  PMID: 27077348
20.  HIV Testing and HIV Service Delivery to Populations at High Risk Attending Sexually Transmitted Disease Clinics in the United States, 2011–2013 
American journal of public health  2015;105(11):2374-2381.
We evaluated HIV testing and service delivery in Centers for Disease Control and Prevention (CDC)–funded sexually transmitted disease (STD) clinics.
We assessed HIV testing, HIV positivity, receipt of HIV test results, linkage to medical care, and referral services from 61 health department jurisdictions from 2011 to 2013.
In 2013, 18.6% (621 010) of all CDC-funded HIV-testing events were conducted in STD clinics, and 0.8% were newly identified as HIV-positive. In addition, 27.3% of all newly identified HIV-positive persons and 30.1% of all newly identified HIV-positive men who have sex with men were identified in STD clinics. Linkage to care within any time frame was 63.8%, and linkage within 90 days was 55.3%. Although there was a decrease in first-time HIV testers in STD clinics from 2011 to 2013, identification of new positives increased.
Although linkage to care and referral to partner services could be improved, STD clinics appear successful at serving populations disproportionately affected by HIV. These clinics may reach persons who may not otherwise seek HIV testing or medical services and provide an avenue for service provision to these populations.
PMCID: PMC4605158  PMID: 26378854
21.  Disability-Free Life Expectancy Over 30 Years: A Growing Female Disadvantage in the US Population 
American journal of public health  2016;106(6):1079-1085.
To examine changes in active life expectancy in the United States over 30 years for older men and women (aged ≥ 65 years).
We used the 1982 and 2004 National Long Term Care Survey and the 2011 National Health and Aging Trends Study to estimate age-specific mortality and disability rates, the overall chances of survival and of surviving without disability, and years of active life for men and women.
For older men, longevity has increased, disability has been postponed to older ages, disability prevalence has fallen, and the percentage of remaining life spent active has increased. However, for older women, small longevity increases have been accompanied by even smaller postponements in disability, a reversal of a downward trend in moderate disability, and stagnation of active life as a percentage of life expectancy. As a consequence, older women no longer live more active years then men, despite their longer lives.
Neither a compression nor expansion of late-life disability is inevitable. Public health measures directed at older women to postpone disability may be needed to offset impending long-term care pressures related to population aging.
PMCID: PMC4860065  PMID: 26985619
24.  A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs 
American journal of public health  2016;106(5):915-917.
To determine the association between multiple drug use and nonfatal overdose among young people (younger than 30 years) who inject drugs.
We completed a longitudinal study of 173 injection drug users younger than 30 years living in San Francisco, California, between April 2012 and February 2014.
The odds of nonfatal overdose increased significantly as heroin and benzodiazepine pill-taking days increased and when alcohol consumption exceeded 10 drinks per day compared with 0 drinks per day.
Heroin, benzodiazepine, and alcohol use were independently associated with nonfatal overdose over time among young people who inject drugs. Efforts to address multiple central nervous system depressant use remain an important component of a comprehensive approach to overdose, particularly among young people.
PMCID: PMC4878116  PMID: 26985620
25.  Do Community-Based Health Worker Interventions Improve Chronic Disease Management and Care among Vulnerable Populations? A Systematic Review 
American journal of public health  2016;106(4):e3-e28.
Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities.
This systematic review synthesized evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost effectiveness of such interventions in vulnerable populations with chronic, non-communicable conditions.
Search methods
Four electronic database searches, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, and hand searches of reference collections were undertaken to identify randomized controlled trials published in English before August 2014.
A total of 934 unique citations were screened initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and six companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion.
Data collection and analysis
Data were extracted by 4 trained research assistants (RA) using a standardized data extraction form developed by the authors. Subsequently, an independent RA reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by two RAs who extracted relevant study information. Inter-rater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions.
Main results
All but 4 studies were conducted in the U.S. The two most common areas for CBHW interventions were cancer prevention (n=30) and cardiovascular disease risk reduction (n=26). The roles assumed by CBHWs included: health education (n=48), counseling (n=36), navigation assistance (n=21), case management (n=4), social services (n=7), and social support (n=18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n=9) and supervision procedures (n=24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n=21) and cardiovascular risk reduction (n=16). Eight articles documented cost effective analysis and found that integrating CBHWs into the healthcare delivery system was associated with cost-effective and sustainable care.
CBHW interventions appear to be effective when compared to alternatives and also cost-effective for certain health conditions particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote non-communicable health outcomes among vulnerable populations.
PMCID: PMC4785041  PMID: 26890177

Results 1-25 (720)