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Ryan GW, Kahl AR, Callaghan D, Kintigh B, Askelson NM. Locations of COVID-19 vaccination provision: Urban-rural differences. J Rural Health 2024; 40:476-482. [PMID: 37957524 PMCID: PMC11089067 DOI: 10.1111/jrh.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Our goal was to compare locations of COVID-19 vaccine provision in urban and rural communities over the course of the pandemic. METHODS We used the Iowa Immunization Registry Information System (IRIS) to identify the organizations providing COVID-19 vaccines (eg, pharmacies, public health departments, and medical providers). Proportions of first-dose vaccines by organization type and patient census-based statistical area were generated. We calculated Chi-square tests to assess differences among metropolitan, micropolitan, and noncore communities. FINDINGS IRIS data revealed that 64% (n = 2,043,251) of Iowans received their first COVID-19 vaccine between December 14, 2020, and December 31, 2022. For metropolitan-dwelling individuals, most first doses were administered at pharmacies (53%), with similar trends observed for micropolitan (49%) and noncore (42%) individuals. The second most common location for metropolitan individuals was medical practices (17%); public health clinics and departments were the second most common provider for micropolitan (26%) and noncore (33%) individuals. These trends shifted over time. In December 2020, hospitals were the most common vaccine provider for everyone, but by December 2022, medical providers were the most common source for metropolitan individuals, and pharmacies were most common for micropolitan and noncore individuals. CONCLUSIONS Trends in the type of vaccine provider differentiated metropolitan residents from micropolitan and noncore residents. For the latter groups, local public health departments played a more significant role. Across all groups, pharmacists emerged as a critical vaccine provider. Our findings can be used to plan for seasonal vaccine campaigns as well as potential future mass vaccination campaigns.
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Affiliation(s)
- Grace W Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Don Callaghan
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Bethany Kintigh
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
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Habel MA, Sullivan P, Hall C, Aral S. Remote Health: Optimizing the Delivery of Sexual Health Care. Sex Transm Dis 2022; 49:S1-S6. [PMID: 35312660 PMCID: PMC10197151 DOI: 10.1097/olq.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Habel
- From the Centers for Disease Control and Prevention, Division of STD Prevention
| | | | | | - Sevgi Aral
- From the Centers for Disease Control and Prevention, Division of STD Prevention
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Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America’s most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
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Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
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Kovar CL, Fazzone P, Bynum S. Current challenges and opportunities to providing sexually transmitted disease services in STD clinics: A public health leadership perspective. Public Health Nurs 2019; 36:638-644. [PMID: 31328818 DOI: 10.1111/phn.12645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess leaders' perceptions of challenges and opportunities to providing sexually transmitted disease (STD) services in public health departments. DESIGN AND SAMPLE Semi-structured interviews were conducted in 2017 with health directors and other designated leaders in 19 public health departments who have an STD clinic. Purposive sampling accounted for geographical differences, providing balanced representation of urban, suburban, and rural agencies in North Carolina. MEASUREMENT Audiotaped interviews were transcribed verbatim. All transcripts were independently coded, with cross comparison and agreement between researchers. Rigorous thematic and content analyses were performed. RESULTS Perceived stigma, funding constraints, and client-centered issues were identified as the greatest challenges to providing services. Opportunities to improve these services were offering comprehensive screening methods, quality improvement, and public health accreditation. Focused training on revenue and billing practices for staff was acknowledged as the most needed technical assistance. A "culture of free services", perceived by clients and staff, was revealed throughout several themes. CONCLUSIONS Leaders in publicly funded STD clinics face many challenges and opportunities to providing clinical services. Health directors often serve as change agents and improving the sexual health of communities remains a priority. Results of this study will assist in crafting future policy and practice for STD clinics in the public health sector.
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Affiliation(s)
- Cheryl L Kovar
- Advanced Nursing Practice & Education Department, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Patricia Fazzone
- Advanced Nursing Practice & Education Department, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Susan Bynum
- College of Nursing, East Carolina University, Greenville, North Carolina
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Meyerson BE, Davis A, Reno H, Haderxhanaj LT, Sayegh MA, Simmons MK, Multani G, Naeyaert L, Meador A, Stoner BP. Existence, Distribution, and Characteristics of STD Clinics in the United States, 2017. Public Health Rep 2019; 134:371-378. [PMID: 31112071 DOI: 10.1177/0033354919847733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Studies of sexually transmitted disease (STD) clinics have been limited by the lack of a national list for representative sampling. We sought to establish the number, type, and distribution of STD clinics and describe selected community characteristics associated with them. METHODS We conducted a 2-phased, multilevel, online search from September 2014 through March 2015 and from May through October 2017 to identify STD clinics in all 50 US states and the District of Columbia. We obtained data on clinic name, address, contact information, and 340B funding status (which requires manufacturers to provide outpatient drugs at reduced prices). We classified clinics by type. We also obtained secondary county-level data to compare rates of chlamydia and HIV, teen births, uninsurance and unemployment, and high school graduation; ratios of primary care physician to population; health care costs; median household income; and percentage of population living in rural areas vs nonrural areas. We used t tests to examine mean differences in characteristics between counties with and without STD clinics. RESULTS We found 4079 STD clinics and classified them into 10 types; 2530 (62.0%) clinics were affiliated with a local health department. Of 3129 counties, 1098 (35.1%) did not have an STD clinic. Twelve states had an STD clinic in every county, and 34 states had ≥1 clinic per 100 000 population. Most STD clinics were located in areas of high chlamydia morbidity and where other surrogate needs were greatest; rural areas were underserved by STD clinics. CONCLUSIONS This list may aid in more comprehensive national studies of clinic services, STD clinic adaptation to external policy changes (eg, in public financing or patient access policy), and long-term clinic survival, with special attention to clinic coverage in rural areas.
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Affiliation(s)
- Beth E Meyerson
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Alissa Davis
- 3 Columbia University School of Social Work, New York, NY, USA
| | - Hilary Reno
- 4 Division of Infectious Disease, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura T Haderxhanaj
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - M Aaron Sayegh
- 5 Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Megan K Simmons
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Gurprit Multani
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Lindsey Naeyaert
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Audra Meador
- 1 Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,2 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - Bradley P Stoner
- 6 Departments of Anthropology and Medicine, Washington University in St. Louis, St. Louis, MO, USA.,7 St. Louis STD/HIV Prevention Training Center, St. Louis, MO, USA
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Barger AC, Pearson WS, Rodriguez C, Crumly D, Mueller-Luckey G, Jenkins WD. Sexually transmitted infections in the Delta Regional Authority: significant disparities in the 252 counties of the eight-state Delta Region Authority. Sex Transm Infect 2018; 94:611-615. [PMID: 30150251 DOI: 10.1136/sextrans-2018-053556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Chlamydia, gonorrhoea and syphilis (primary and secondary) are at high levels in the USA. Disparities by race, gender and sexual orientation have been characterised, but while there are indications that rural poor populations may also be at distinct risk this has been subjected to little study by comparison. The federally designated Delta Regional Authority, similar in structure to the Appalachian Regional Commission, oversees 252 counties within eight Mississippi Delta states experiencing chronic economic and health disparities. Our objective was to identify differences in infection risk between Delta Region (DR)/non-DR counties and examine how they might vary by rurality, population density, primary care access and education attainment. METHODS Reported chlamydia/gonorrhoea/syphilis data were obtained from the Centers for Disease Control and Prevention AtlasPlus, county demographic data from the Area Health Resource File and rurality classifications from the Department of Agriculture. Data were subjected to analysis by t-test, χ2 and linear regression to assess geographical disparities in incidence and their association with measures of rurality, population and primary care density, and education. RESULTS Overall rates for each infection were significantly higher in DR versus non-DR counties (577.8 vs 330.1/100 000 for chlamydia; 142.8 vs 61.8 for gonorrhoea; 3.6 vs 1.7 for syphilis; all P<0.001) and for nearly every infection for every individual state. DR rates for each infection were near-universally significantly increased for every level of rurality (nine levels) and population density (quintiles). Regression found that primary care and population density and HS graduation rates were significantly associated with each, though model predictive abilities were poor. CONCLUSIONS The nearly 10 million people living in the DR face significant disparities in the incidence of chlamydia, gonorrhoea and syphilis-in many instances a near-doubling of risk. Our findings suggest that resource-constrained areas, as measured by rurality, should be considered a priority for future intervention efforts.
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Affiliation(s)
- Alexandra C Barger
- Medical Student, Southern Illinois Univeristy School of Medicine, Springfield, Illinois, USA
| | - William S Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christofer Rodriguez
- Population Science Research Specialist, Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - David Crumly
- Population Science Research Specialist, Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Georgia Mueller-Luckey
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
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US Public Sexually Transmitted Disease Clinical Services in an Era of Declining Public Health Funding: 2013-14. Sex Transm Dis 2018; 44:505-509. [PMID: 28703733 DOI: 10.1097/olq.0000000000000629] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We examined the infrastructure for US public sexually transmitted disease (STD) clinical services. METHODS In 2013 to 2014, we surveyed 331 of 1225 local health departments (LHDs) who either reported providing STD testing/treatment in the 2010 National Profile of Local Health Departments survey or were the 50 local areas with the highest STD cases or rates. The sample was stratified by jurisdiction population size. We examined the primary referral clinics for STDs, the services offered and the impact of budget cuts (limited to government funding only). Data were analyzed using SAS, and analyses were weighted for nonresponse. RESULTS Twenty-two percent of LHDs cited a specialty STD clinic as their primary referral for STD services; this increased to 53.5% of LHDs when combination STD-family planning clinics were included. The majority of LHDs (62.8%) referred to clinics providing same-day services. Sexually transmitted disease clinics more frequently offered extragenital testing for chlamydia and/or gonorrhea (74.7%) and gonorrhea culture (68.5%) than other clinics (52.9%, 46.2%, respectively; P < 0.05). The majority of LHDs (61.5%) reported recent budget cuts. Of those with decreased budgets, the most common impacts were fewer clinic hours (42.8%; 95% confidence interval [CI], 24.4-61.2), reduced routine screening (40.2%; 95% CI, 21.7-58.8) and reductions in partner services (42.1%; 95% CI, 23.6-60.7). One quarter of those with reduced STD budgets increased fees or copays for clients. CONCLUSIONS Findings demonstrate gaps and reductions in US public STD services including clinical services that play an important role in reducing disease transmission. Furthermore, STD clinics tended to offer more specialized STD services than other public clinics.
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A Survey of 25 North Carolina Health Departments/Districts on Knowledge, Attitudes, and Current Practices to Seeking Reimbursement From Third-Party Payers for Sexually Transmitted Disease Services. Sex Transm Dis 2018; 44:380-383. [PMID: 28499291 DOI: 10.1097/olq.0000000000000608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND North Carolina Administrative Code 10A Chapter 41A.0204 (a) states "local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient." Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown. Because of its high STD morbidity, the eastern region of North Carolina was targeted. METHODS Using a Qualtrics Survey developed to measure attitudes as well as knowledge and reimbursement practices, this descriptive study was performed with staff from 25 eastern North Carolina health departments/districts. Snowball sampling was used to allow for greater inclusion. Analysis of data was performed at the individual and agency level based on types of questions in the survey. RESULTS For knowledge, 87% of the respondents reported being aware of the possibility of reimbursement from third-party payers/commercial insurance carriers for STD services. In regard to current billing of these services, 20 health departments/districts (80%) reported they were billing these payers. When asked about their attitude of seeking reimbursement from commercial insurance, 92% reported it was acceptable or very acceptable. But when asked if STD services should remain a free service at the health department, 55% supported and 45% did not. CONCLUSIONS These data provide a knowledge base for assisting health departments/districts to move forward in improving STD services as well as maximizing reimbursement from third-party payers/commercial insurance carriers when possible.
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Cucciare MA, Han X, Timko C, Zaller N, Kennedy KM, Booth BM. Correlates of three-year outpatient medical care use among rural stimulant users. J Subst Abuse Treat 2017; 77:6-12. [PMID: 28476274 DOI: 10.1016/j.jsat.2017.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
Outpatient medical care (OMC) settings are a care context in which effective management of unhealthy substance use can occur. However, no studies have documented rates of OMC use and characteristics of OMC use among rural substance users. This study sought to examine the rates and frequency of OMC use in a sample of rural drug users over a three-year period. We also explored characteristics of participants associated with use of OMCs over time. Data were collected from June 2005 to September 2007 from a natural history study of 710 stimulant users living in rural communities. Participants were adults, not in drug treatment, and reporting recent methamphetamine, crack cocaine or powder cocaine use. Between 34 and 39% of participants reported any use of an OMC over the three-year follow-up period, with a mean average number of visits ranging from one to two at each follow-up. Having medical insurance, reporting any use of substance use disorder-related care (including formal substance use treatment or mutual-help groups), and higher Addiction Severity Index (ASI) medical and psychiatric composite scores were associated with greater odds of any OMC use and higher frequency of OMC use over time. Being male and having higher ASI alcohol and drug composite scores were associated with lower odds of any OMC use and lower frequency of OMC use. Our findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance, and the need for public health efforts to increase the use of OMCs among rural drug users not experiencing more severe medical or psychiatric health problems.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA.
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs (VA) Health Care System, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Nickolas Zaller
- College of Public Health, Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kristina M Kennedy
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Department of Psychology and Counseling, University of Central Arkansas, Conway, AR 72035, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Ditkowsky J, Shah KH, Hammerschlag MR, Kohlhoff S, Smith-Norowitz TA. Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States. BMC Infect Dis 2017; 17:155. [PMID: 28214469 PMCID: PMC5316151 DOI: 10.1186/s12879-017-2248-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15-24 for Chlamydia trachomatis infection compared with no screening. METHODS We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6,444,686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number of C. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair with C. trachomatis were calculated and compared. RESULTS Cost and benefit of screening relied on the prevalence of C. trachomatis; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity. CONCLUSIONS Considering a high prevalence region, prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated with C. trachomatis.
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Affiliation(s)
- Jared Ditkowsky
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Khushal H Shah
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
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Kozhimannil KB, Enns E, Blauer-Peterson C, Farris J, Kahn J, Kulasingam S. Behavioral and community correlates of adolescent pregnancy and Chlamydia rates in rural counties in Minnesota. J Community Health 2016; 40:493-500. [PMID: 25344773 DOI: 10.1007/s10900-014-9962-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15-19 year-old females were compared across Minnesota's 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455, USA,
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Using more activities to address health disparities: local health departments and their "top executives". JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:153-61. [PMID: 23358294 DOI: 10.1097/phh.0b013e318252ee41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Local health departments (LHDs) are expected to address health disparities. Little is known, however, about what factors influence the activities used by an LHD in addressing health disparities. The objective of this study was to examine factors such as an LHD's leader, jurisdiction, and organizational characteristics that could be considered to influence the approaches used within LHDs to address health disparities. DESIGN We used a cross-sectional, 2-level, mixed linear model with secondary LHD data nested within states. National data were used, depicting activities conducted by LHDs. STUDY POPULATION The sample consisted of the 2332 LHDs that responded to the National Association of County and City Health Officials's 2008 National Profile of LHDs Survey. MEASURES The activities used by LHDs in addressing health disparities were depicted as respondents indicating that they had employed 0 to 8 types of the activities listed in the Profile Survey in relation to addressing disparities. RESULTS Local health departments significantly vary in the number of types of activities used in addressing health disparities. Significant associations exist between more types of health disparities activities used by LHDs and LHDs having a "top executive" with more education, clinical training, and/or less than 5 years of experience as the LHD's top executive. Local health departments with a jurisdiction that is urban, with a higher percentage of black residents, with a higher percentage of Hispanic residents, with higher per capita LHD expenditures, and/or that has conducted a community health assessment in last 3 years were also significantly associated with higher numbers of types of health disparities activities used. CONCLUSIONS Local context and the characteristics of an LHD's top executive appear to be important factors related to the activities used to address health disparities across LHDs. A focus on the competencies and development of LHD leaders may be important in promoting LHD engagement in a wider range of approaches toward reducing disparities.
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