Public Health Reports®

With more sport utility vehicles (SUVs) on the road, public concern has been expressed about their influence on traffic safety. The present study examined changes in the mix of passenger vehicles between 1988 and 2004 and concurrent changes in driver fatality rates and vehicle incompatibility.

Vehicle registrations and driver deaths per registered vehicle were examined using data from R.L. Polk and Company and the Fatality Analysis Reporting System.

Between 1988 and 2004, SUVs comprised an increasingly larger proportion of registered passenger vehicles (5% of one- to three-year-old vehicles in 1988 vs. 22% in 2004), yet driver deaths per registered vehicle decreased 43% to 47% for all passenger vehicle types. Reductions in driver fatality rates were greater for two-vehicle crashes than for single-vehicle crashes and greater for two-vehicle frontal crashes than for two-vehicle side-impact crashes. Driver death rates declined more on rural roads than on urban roads, and this difference was most pronounced for SUVs. Among cars struck by other vehicles, driver death rates in front-to-front and front-to-side impacts decreased more when the striking vehicle was an SUV than a pickup or car.

Factors likely contributing to the overall reductions in fatality rates include advances in occupant protection, increases in average vehicle weight, increased availability of SUVs with car-based designs, and reductions in alcohol-impaired driving. Reductions of driver death rates in two-vehicle collisions between 1988 and 2004 are encouraging, but SUVs and pickups continue to pose a substantially higher risk to drivers of cars than when the striking vehicle is another car.

Survey instruments for evaluating public health preparedness have focused on measuring the structure and capacity of local, state, and federal agencies, rather than linkages among structure, process, and outcomes. To focus evaluation on the latter, we evaluated the linkages among individuals, organizations, and systems using the construct of “connectivity” and developed a measurement instrument.

Results from focus groups of emergency preparedness first responders generated 62 items used in the development sample of 187 respondents. Item reduction and factors analyses were conducted to confirm the scale's components.

The 62 items were reduced to 28. Five scales explained 70% of the total variance (number of items, percent variance explained, Cronbach's alpha) including connectivity with the system (8, 45%, 0.94), coworkers (7, 7%, 0.91), organization (7, 12%, 0.93), and perceptions (6, 6%, 0.90). Discriminant validity was found to be consistent with the factor structure.

We developed a Connectivity Measurement Tool for the public health workforce consisting of a 34-item questionnaire found to be a reliable measure of connectivity with preliminary evidence of construct validity.

To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated.

An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk.

Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR=17.0), accidental poisoning (RR=15.4), homicide by piercing objects (RR=15.4), and suicide by hanging (RR=13.5).

The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.

Studies continue to document that people with human immunodeficiency virus (HIV) experience discrimination in their interactions with the health-care system, which can have negative implications for maintaining continuity in care and outcomes. We explored the patient characteristics associated with perceived discrimination and whether these experiences are associated with health-care system quality ratings in a survey of severely disadvantaged people with HIV who are at great risk of inconsistent access to appropriate health care.

Five hundred and twenty-three participants were recruited from temporary housing facilities for people with HIV in the New York City area and administered a survey using audio computer-assisted self-interviewing technology.

Of the 207 participants (39.6%) who reported experiencing discrimination in the health-care system, the most common attributions were HIV infection (n=122, 59.8%), drug use (n=100, 49.8%), homelessness (n=71, 34.6%), and race/ethnicity (n=69, 35.2%). Length of time HIV infected, use of non-prescription opioids, white race, higher education, female gender, younger age, and poorer self-reported health status were all significantly associated with greater odds of perceived discrimination. After adjusting for participant characteristics, perceived discrimination was significantly associated with poorer participant ratings of quality of health care.

Members of this vulnerable population commonly report experiences of discrimination from within the health-care system and these experiences are associated with poor health-care ratings. These findings support the need for closer examination of the adequacy of cultural competency training within the HIV health-care delivery system to improve access to appropriate care for disadvantaged people.

Emerging evidence suggests that children are at higher risk for West Nile virus (WNV) exposure, but may have a lower risk for infection-related morbidity and mortality. Limited data exist regarding risk determinants of childhood WNV infection. We conducted a survey to analyze the differences between pediatric and adult behavior relevant to WNV exposure.

Residents of participating sampled households responded to a questionnaire that measured knowledge, attitudes, personal protective behaviors, and clinical history to evaluate the association between personal behavior and exposure to WNV.

Children were more likely to have high levels of outdoor exposure compared to adults (83% vs. 70%). Children were less likely to avoid going outdoors (4% vs. 13%) and to wear long sleeves or pants compared to adults (8% vs. 19%). Both groups were highly educated about WNV. Television, not health-care provider education, was the most common source of WNV information. Participants were more concerned about WNV infection than pesticide usage.

Our study demonstrates that children exhibit behaviors that could put them at greater risk for WNV infection and suggests that children could benefit from greater education about practices that can decrease WNV exposure to limit their risk for infection.

This study examines race variations in quality of care through the proxy of ambulatory care sensitive (ACS) conditions. Hospital admission rates for eight ACS conditions were examined for African American and white Medicare beneficiaries in North Carolina. Temporal variations for ACS were also examined.

Enrollment and inpatient claims files from the Centers for Medicare and Medicaid Services (CMS) for a 1999–2002 cohort who were aged 65 years or older in 1999 were examined. Descriptive statistics were computed for each year. Cochran-Mantel Haenszel tests were performed to assess differences in the admission rates for both individual and aggregate ACS conditions controlling for time. The Cochran-Armitage test for trend was used to evaluate changes in admission rates over time.

African Americans had higher admission rates for five of the eight ACS conditions. The highest rates were for diabetes among African Americans (odds ratio [OR]=2.86; 95% confidence interval [CI] [2.73, 2.99]) and adult asthma (OR=1.51; 95% CI [1.43, 1.61]). African Americans tended to have lower ACS admission rates than white patients for chronic obstructive pulmonary disease (OR=0.67; 95% CI [0.65, 0.69]); bacterial pneumonia (OR=0.86; 95% CI [0.84, 0.89]), and angina (OR=0.90; 95% CI [0.84, 0.97]).

Using the ACS proxy for quality of health care as applied to examining race and ethnicity is a promising approach, though challenges remain. Admissions for ACS conditions between African American and white patients differ, but it is unclear why. This exploratory study must lead to an examination of social, economic, historical, and cultural factors for preventive, remedial, and beneficial policy initiatives.

We developed a surveillance system to investigate asthma deaths in children and young adults.

A rapid asthma death notification and investigation system for Michigan was developed to identify interventions to prevent future deaths among people aged 2–34 years. Multidisciplinary panels to determine causal factors and recommend preventative actions reviewed information from death certificates, autopsies, next-of-kin interviews, and medical records. An annual report was disseminated to public health workers, health-care providers, insurers, and others.

Eighty-six asthma deaths in Michigan residents, aged 2–34, occurred from 2002–2004. Sixty-one next of kin were interviewed and medical records were obtained for 84 of the deceased. Summaries were prepared on each of the deceased and were reviewed by expert panels, which reached consensus on causal factors and potential preventive action for each death. Each year an annual report, which summarized the causal factors and potential preventive activity, was prepared.

This review has informed and catalyzed interventions to improve asthma care and management in Michigan. Factors leading to the review's success and future activities are discussed.

We examined racial misidentification of American Indians/Alaska Natives (AI/AN) reported to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) Reporting Systems (HARS) of five U.S. states and one county.

To identify AI/AN records with misidentified race, we linked HARS data from 1984 through 2002 to the Indian Health Service National Patient Information and Reporting System (NPIRS), excluding non-AI/AN dependents, using probabilistic matching with clerical review. We used chi-square tests to examine differences in proportions and logistic regression to examine the associations of racial misidentification with HARS site, degree of AI/AN ancestry, mode of exposure to HIV, and urban or rural location of residence at time of diagnosis.

A total of 1,523 AI/AN individuals was found in both NPIRS and HARS; race was misidentified in HARS for 459 (30%). The percentages of racially misidentified ranged from 3.7% (in Alaska) to 55% (in California). AI/AN people were misidentified as white (70%), Hispanic (16%), black (11%), and Asian/Pacific Islander (2%); for 0.9%, race was unspecified. Logistic regression results (data from all areas, all variables) indicated that urban residence at time of diagnosis, degree of AI/AN ancestry, and mode of exposure to HIV were significantly associated with racial misidentification of AI/AN people reported to HARS.

Our findings add to the evidence that racial misidentification of AI/AN in surveillance data can result in underestimation of AI/AN HIV/AIDS case counts. Racial misidentification must be addressed to ensure that HIV/AIDS surveillance data can be used as the basis for equitable resource allocation decisions, and to inform and mobilize public health action.