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1.  A National Survey of Training Needs Reported by Public Health Professionals in Chronic Disease Programs in State, Territorial, and Local Governments 
In 2009 the National Association of Chronic Disease Directors (NACDD) published desirable competencies for professionals in public health chronic disease programs. Assessing the training needs of these professionals is an important step toward providing appropriate training programs in chronic disease prevention and control competencies.
Conduct a survey of the chronic disease workforce in state and local health departments to identify professional training needs.
We conducted a cross sectional survey of state, territorial and local public health professionals who work in chronic disease programs, to identify their self-reported training needs, using the membership lists of three professional organizations that included practitioners in chronic disease public health programs.
The survey was national, used a convenience sample and was conducted in 2011.
The survey was developed using an algorithm to select anonymous participants from the membership lists of the NACDD, the Directors for Health Promotion and Education (DHPE), and the National Association of County and City Health Officials (NACCHO).
Outcome measures
The survey included questions about professional background, chronic disease activities, confidence about skills, and needs for training.
The survey had 567 responses (38% response ratio). The majority of the respondents were female, non-Hispanic white, and aged 40 years or older. Respondents were not confident of their skills in health economics (38%) and technology and data management (23%). The most requested training topics were assessing the effects of policies, laws, and regulations (70%); and health economics (66%).
This survey included local, territorial, and state public health professionals who work in chronic disease programs. These reported training needs in quantitative measurement methods and policy-related topics suggest key subjects for future training and education curricula.
PMCID: PMC4072749  PMID: 24335714
health manpower; cross sectional surveys; chronic disease; public health professional education
2.  Changes in Georgia Restaurant and Bar Smoking Policies From 2006 to 2012 
The purpose of this study is to examine the change in smoking policy status among Georgia restaurants and bars from 2006 to 2012 and to identify restaurant and bar characteristics that are associated with allowing smoking.
Data were obtained from similar cross-sectional indoor air surveys conducted in 2006 and 2012 in Georgia. Both surveys were designed to gather information about restaurant and bar smoking policies. Weighted χ2 analyses were performed to identify changes in smoking policy status and other variables from 2006 to 2012. Weighted logistic regression analysis was used to test for significant associations between an establishment’s smoking policy and other characteristics.
The percentage of restaurants and bars in Georgia that allowed smoking nearly doubled, from 9.1% in 2006 to 17.6% in 2012. The analyses also showed a significant increase in the percentage of establishments that allow smoking when minors are present. Having a liquor license was a significant predictor of allowing smoking.
The Smokefree Air Act was enacted in 2005 to protect the health and welfare of Georgia citizens, but study results suggest that policy makers should reevaluate the law and consider strengthening it to make restaurants and bars 100% smokefree without exemptions.
PMCID: PMC4438425  PMID: 25974144
3.  A Flexible Urban Health Index for Small Area Disparities 
Available urban health metrics focus primarily on large area rankings. Less has been done to develop an index that provides information about level of health and health disparities for small geographic areas. Adopting a method used by the Human Development Index, we standardized indicators for small area units on a (0, 1) interval and combined them using their geometric mean to form an Urban Health Index (UHI). Disparities were assessed using the ratio of the highest to lowest decile and measurement of the slope of the eight middle deciles (middle; 80 %) of the data. We examined the sensitivity of the measure to weighting, to changes in the method, to correlation among indicators, and to substitution of indicators. Using seven health determinants and applying these methods to the 128 census tracts in the city of Atlanta, USA, we found a disparity ratio of 5.92 and a disparity slope of 0.54, suggesting substantial inequality and heterogeneity of risk. The component indicators were highly correlated; their systematic removal had a small effect on the results. Except in extreme cases, weighting had a little effect on the rankings. A map of Atlanta census tracts exposed a swath of high disparity. UHI rankings, ratio, and slope were resistant to alteration in composition and to non-extreme weighting schemes. This empirical evaluation was limited to a single realization, but suggests that a flexible tool, whose method rather than content is standardized, may be of use for local evaluation, for decision making, and for area comparison.
PMCID: PMC4199452  PMID: 24733190
Urban health; Urban metrics; Small area estimation; Indicators; Indices
4.  Mortality rates and the causes of death related to diabetes mellitus in Shanghai Songjiang District: an 11-year retrospective analysis of death certificates 
China is one of the countries with the highest prevalence of diabetes in the world. We analysed all the death certificates mentioning diabetes from 2002 to 2012 in Songjiang District of Shanghai to estimate morality rates and examine cause of death patterns.
Mortality data of 2654 diabetics were collected from the database of local CDC. The data set comprises all causes of death, contributing causes and the underlying cause, thereby the mortality rates of diabetes and its specified complications were analysed.
The leading underlying causes of death were various cardiovascular diseases (CVD), which collectively accounted for about 30 % of the collected death certificates. Diabetes was determined as the underlying cause of death on 28.7 %. The trends in mortality showed that the diabetes related death rate increased about 1.78 fold in the total population during the 11-year period, and the death rate of diabetes and CVD comorbidity increased 2.66 fold. In all the diabetes related deaths, the proportion of people dying of ischaemic heart disease or cerebrovascular disease increased from 18.0 % in 2002 to 30.5 % in 2012. But the proportions attributed directly to diabetes showed a downtrend, from 46.7–22.0 %.
The increasing diabetes related mortality could be chiefly due to the expanding prevalence of CVD, but has nothing to do with diabetes as the underlying cause. Policy makers should pay more attention to primary prevention of diabetes and on the prevention of cardiovascular complications to reduce the burden of diabetes on survival.
Electronic supplementary material
The online version of this article (doi:10.1186/s12902-015-0042-1) contains supplementary material, which is available to authorized users.
PMCID: PMC4559917  PMID: 26341126
5.  English Proficiency and Peer Interethnic Relations as Predictors of Math Achievement among Latino and Asian Immigrant Students 
Journal of adolescence  2012;35(6):10.1016/j.adolescence.2012.08.002.
Studies show math achievement to be the best predictor of entering post-secondary education. However, less is known about the predictors of math achievement, particularly among immigrant youth. This study examined English proficiency and peer interethnic relations as predictors of mathematics achievement among Latino and Asian high school students, postulating an interaction between the predictors and mediation by academic motivation. A multilevel moderated-mediation model was used to analyze data from a national sample of 2,113 non-native English speaking Latino and Asian students attending high school in the U.S. We found that higher academic motivation mediated the relationship between English proficiency during their sophomore year and gains in senior math achievement scores for both Asian and Latino students. For Latino students however, this indirect path was only significant for students whose perceptions of positive peer interethnic relations at school were average or above average.
PMCID: PMC3855053  PMID: 22959129
Math achievement; Academic motivation; Interethnic relations; English proficiency; Immigrant adolescents; Multilevel modeling
6.  Measurement Equivalence of the Language Brokering Scale for Chinese American Adolescents and their Parents 
Language brokering occurs frequently in immigrant families. Using data from 279 Chinese American families with adolescents who function as language brokers for their parents, the current study developed a comprehensive scale to assess adolescents’ and their parents’ perceptions of language brokering. Both versions, parent and adolescent, showed stable factor structures. We also examined measurement equivalence, including factorial and construct validity invariance, for each subscale across parent gender, adolescent gender, adolescent nativity, and translation frequency. In general, metric factorial invariance was observed for most subscales across different groups; these subscales can thus be used in future studies examining the relations between language brokering and other variables. Further, two adolescent subscales (i.e., adolescent-focused-burden, positive relations with parents) and three parent subscales (i.e., parent-focused-burden, negative feelings, positive relations with child) demonstrated strong factorial invariance consistently across different groups, and can thus be used in future studies examining mean group differences in language brokering experiences. In terms of construct validity equivalence, most subscales were associated with parent-child conflict and adolescent depressive symptoms to a similar degree across parent gender, adolescent gender and nativity. Implications of the current findings and recommendations for future use are discussed.
PMCID: PMC4041685  PMID: 24588602
language brokering; Chinese; adolescence; parent; measurement equivalence
7.  Does Workplace Social Capital Associate with Hazardous Drinking Among Chinese Rural-Urban Migrant Workers? 
PLoS ONE  2014;9(12):e115286.
The present study sought to investigate the associations between workplace social capital and hazardous drinking (HD) among Chinese rural-urban migrant workers (RUMW).
A cross sectional study with a multi-stage stratified sampling procedure was conducted in Shanghai during July 2012 to January 2013. In total, 5,318 RUMWs from 77 workplaces were involved. Work-place social capital was assessed using a validated and psychometrically tested eight-item measure. The Chinese version of Alcohol Use Disorders Identification Test (AUDIT) was used to assess hazardous drinking. Control variables included gender, age, marital status, education level, salary, and current smoking. Multilevel logistic regression analysis was conducted to test whether individual- and workplace-level social capital was associated with hazardous drinking.
Overall, the prevalence of HD was 10.6%. After controlling for individual-level socio-demographic and lifestyle variables, compared to workers in the highest quartile of individual-level social capital, the odds of HD for workers in the three bottom quartiles were 1.13(95%CI: 1.04–1.23), 1.17(95%CI: 1.05–1.56) and 1.26(95%CI: 1.13–1.72), respectively. However, contrary to hypothesis, there was no relationship between workplace-level social capital and hazardous drinking.
Higher individual-level social capital may protect against HD among Chinese RUMWs. Interventions to build individual social capital among RUMWs in China may help reduce HD among this population.
PMCID: PMC4264885  PMID: 25502013
8.  Workplace Social Capital and Mental Health among Chinese Employees: A Multi-Level, Cross-Sectional Study 
PLoS ONE  2014;9(1):e85005.
Whereas the majority of previous research on social capital and health has been on residential neighborhoods and communities, the evidence remains sparse on workplace social capital. To address this gap in the literature, we examined the association between workplace social capital and health status among Chinese employees in a large, multi-level, cross-sectional study.
By employing a two-stage stratified random sampling procedure, 2,796 employees were identified from 35 workplaces in Shanghai during March to November 2012. Workplace social capital was assessed using a validated and psychometrically tested eight-item measure, and the Chinese language version of the WHO-Five Well-Being Index (WHO-5) was used to assess mental health. Control variables included sex, age, marital status, education level, occupation status, smoking status, physical activity, and job stress. Multilevel logistic regression analysis was conducted to explore whether individual- and workplace-level social capital was associated with mental health status.
In total, 34.9% of workers reported poor mental health (WHO-5<13). After controlling for individual-level socio-demographic and lifestyle variables, compared to workers with the highest quartile of personal social capital, workers with the third, second, and lowest quartiles exhibited 1.39 to 3.54 times greater odds of poor mental health, 1.39 (95% CI: 1.10–1.75), 1.85 (95% CI: 1.38–2.46) and 3.54 (95% CI: 2.73–4.59), respectively. Corresponding odds ratios for workplace-level social capital were 0.95 (95% CI: 0.61–1.49), 1.14 (95% CI: 0.72–1.81) and 1.63 (95% CI: 1.05–2.53) for the third, second, and lowest quartiles, respectively.
Higher workplace social capital is associated with lower odds of poor mental health among Chinese employees. Promoting social capital at the workplace may contribute to enhancing employees’ mental health in China.
PMCID: PMC3880334  PMID: 24404199
9.  Historical Change in the Link between Adolescent Deviance Proneness and Marijuana Use, 1979–2004 
We examined historical change in the association between adolescent deviance proneness and marijuana use using 26 years (from 1979 through 2004) of national 12th grade data from the Monitoring the Future (MTF) study. “Deviance proneness” was measured using a latent factor model of behavioral and personality characteristics that underlie both substance use and antisocial disorders. Marijuana use outcomes were measured in terms of youths’ annual frequency of use, and youths’ degree of involvement with marijuana. Separate within-gender structural equation models were used to determine whether links between deviance proneness and marijuana use were consistently significant and invariant in magnitude across 13 2-year historical cohorts. Overall results affirmed the established association between adolescent deviance proneness and both the frequency of marijuana use as well as regular use. Among male youth, the size of the association between deviance proneness and marijuana use was significantly smaller at the cohort of lowest population prevalence (1991/92) compared to cohorts marking peaks in marijuana use prevalence, thus suggesting a “softening” historical trend. By contrast, the prediction of female marijuana use from deviance proneness was not consistently related to historical shifts in population prevalence of marijuana use. Study findings point to the utility of risk-focused prevention programming that targets early precursors of both antisocial and substance use disorders.
PMCID: PMC3544395  PMID: 18317927
Adolescent Marijuana Use; Historical Change; Deviance Proneness; Antisocial Behavior
10.  Investigating Ethnic Differences in Adolescent Alcohol Use and Peer Norms Using Semi-Continuous Latent Growth Models 
Aims: To investigate whether ethnic differences in vulnerability to peer norms supportive of alcohol use is a viable, partial explanation for the ethnic differences in reported prevalence and amount of alcohol use during high school. Methods: Survey data from a sample of 680 adolescents from Project STAR (Students Taught Awareness and Resistance) of the Midwestern Prevention Project were used. Hypotheses were tested using sequential, semi-continuous growth curve models. Results: Relative to Black adolescents, White adolescents reported greater peer alcohol use during middle school and were much more likely to consume alcohol during high school. General peer norms in seventh grade and middle school growth in alcohol use norms among close friends was predictive of a greater propensity to consume alcohol in ninth grade among White adolescents. Conclusion: Lower peer norms for alcohol use among Black adolescents might better account for differences between Black and White adolescents than the possibility that White adolescents are more vulnerable to peer norms.
PMCID: PMC3156885  PMID: 21478496
11.  Family and Neighborhood Fit or Misfit and the Adaptation of Mexican Americans 
In this study, a person-environment fit model was used to understand the independent and combined roles of family and neighborhood characteristics on the adjustment of adults and children in a sample of 750 Mexican American families. Latent class analysis was used to identify six qualitatively distinct family types and three quantitatively distinct neighborhood types using socioeconomic and cultural indicators at each level. The results showed that members of single-parent Mexican American families may be particularly at-risk, members of the lowest-income immigrant families reported fewer adaptation problems if they lived in low-income neighborhoods dominated by immigrants, members of economically successful immigrant families may be more at-risk in integrated middle class neighborhoods than in low-income neighborhoods dominated by immigrants, and members of two-parent immigrant families appear to be rather resilient in most settings despite their low socioeconomic status.
PMCID: PMC2715446  PMID: 19562479
family; goodness of fit; mental health; Mexican American; neighborhood
12.  A Person-centered Approach to Studying the Linkages among Parent–Child Differences in Cultural Orientation, Supportive Parenting, and Adolescent Depressive Symptoms in Chinese American Families 
This longitudinal study examined whether supportive parenting mediates relations between parent– child differences in cultural orientation (generational dissonance) and depressive symptoms with a sample of 451 first and second generation Chinese American parents and adolescents (12–15 years old at time 1). Using a person-centered approach, meaningful typologies of cultural orientation were derived for fathers, mothers, and adolescents. Overall, results provided support, though qualified, for the notion that generational dissonance is linked to depressive symptoms through decreased supportive parenting. In general, having a parent with a bicultural profile seemed to be most advantageous if adolescents similarly had a bicultural profile, whereas more American oriented adolescents with more Chinese oriented parents reported the least supportive parenting and most depressive symptoms. Directions for future research and the benefits of using a person-centered approach in research of acculturation and generational dissonance are discussed.
PMCID: PMC2923412  PMID: 20725611
Chinese American; Immigrants; Intergenerational cultural differences; Person-centered analysis; Depressive symptoms
13.  Cultural and Contextual Influences on Parenting in Mexican American Families 
Family stress theory can explain associations between contextual stressors and parenting. However, the theory has not been tested among Mexican Americans or expanded to include cultural-contextual risks. This study examined associations between neighborhood, economic, and acculturative stressors and parenting behaviors in a sample of 570 two-parent Mexican American families. Results support the negative impact of economic stress on parenting through parental depressive symptoms. Neighborhood stress influenced fathers’ depressive symptoms and parenting, but not mothers’. The effects of acculturative stress were inconsistent. Results suggest that contextual stressors common to Mexican American families impact parenting behaviors through parental depression.
PMCID: PMC2744115  PMID: 20126298
Culture; Economic hardship; Mexican American; Neighborhood; Parenting

Results 1-13 (13)