Injury fatalities among young children

Injuries and violence are the primary causes of death among young children in the United States. In particular, in 1982-84 motor vehicle injuries, fires, drowning, and homicide were the leading external causes of death at ages 1-4 years and 5-9 years, accounting for nearly 80 percent of all deaths from external causes. The purpose of this article is to analyze race and sex differentials in injury fatalities among young children. Race and sex differentials in injury mortality were measured in terms of relative risks, that is, race (black to white) and sex (male to female) mortality ratios. Race ratios for external causes ranged from 1.7 to 1.9 for children 1-4 and 5-9, while sex ratios were somewhat lower, 1.4 to 1.8. Although race and sex ratios were relatively small for passenger-related motor vehicle fatalities (0.8 to 1.2) the ratios for pedestrian-related injuries were considerably greater (1.5 to 2.0). Race ratios for deaths caused by fires and homicide were particularly large (3.4 to 4.3). Mortality differences were also measured in terms of excess mortality. For each age-race group more than 65 percent of the overall excess deaths among males were due to external causes of death. Pedestrian-related motor vehicle injuries and drownings accounted for the largest proportion of excess deaths among males. At ages 1-4, 53 percent of the overall excess deaths among blacks were due to external causes. Deaths caused by fires and homicide accounted for more than two-fifths of the excess in this age group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Characteristics of repeat trauma patients, San Diego County.

Data on 22,312 admissions to the San Diego County Trauma System were used to identify 185 trauma patients admitted repeatedly to trauma units. These patients were compared with the entire group of nonrepeating trauma patients admitted during the 80-month period of the study. In comparison with nonrepeaters, the repeaters were younger, were more often men, were more often Black, and were much more frequently victims of assault. Forty-eight percent of the repeaters were injured by the same general mechanism on both admissions.     

Under- and Over-Nutrition Among Refugees in San Diego County, California

Resettled refugees often arrive in their host country with little knowledge of nutrition or available food choices. We explored nutrition-related issues of recent refugee arrivals to San Diego County—the second largest California resettlement site. In-depth interviews (n = 40) were conducted with refugees, health care practitioners, and refugee service organizations. Content analysis identified nutrition-related themes. Unhealthy weight gain after arrival was the most common concern and was attributed to social pressures among adolescents, food choices and a more sedentary lifestyle. Conversely, undernutrition remained a concern due to poor diets. Factors influencing nutritional problems included continuation of past habits, acculturation, unfamiliarity with available foods and socio-economic influences. The nutritional concerns encountered by resettled refugees in San Diego are not unique to this group but are aggravated by their past experiences, and abrupt changes to food choices and behavior. Addressing contextual factors of poor food choices may prevent some of the long term health consequences of poor nutrition.     

Raccoons in San Diego County as Sentinels for West Nile Virus Surveillance

Objective

To investigate the potential of utilizing raccoons as sentinels for West Nile Virus (WNV) in an effort to guide public health surveillance, prevention, and control efforts.

Introduction

Since its detection in 1999 in New York, WNV spread westward across the continent, and was first detected in California in 2003 in Imperial County (1). In California and in many states, birds, especially corvids, are used as sentinel animals to detect WNV activity. Recent seroprevalence studies have shown WNV activity in different wild mammalian species (1–3); in the United States, WNV sero-prevalence in some studies in raccoons has ranged from 34–46% (3,4). In addition, it has been shown that after experimental infection, raccoons can attain high viral titers and shed WNV in their saliva and feces (5). Given their peridomestic nature, we investigated the feasibility of their use as sentinels for early warning of WNV and as indicators of WNV activity as a strategy to better localize WNV transmission foci in guiding vector control efforts.

Methods

Sick, injured or orphaned raccoons undergoing rehabilitation at Project Wildlife, one of the largest, non-profit wildlife rehabilitation organizations in the United States, located in San Diego County, were tested for WNV shedding. Project Wildlife team members who regularly care for sick, injured, or orphaned raccoons were trained to collect oral and fecal samples for viral testing during 2011 and 2012 upon raccoons’ arrival to Project Wildlife. Oral and fecal samples were tested using real-time PCR for the envelope gene of WNV.

Results

To date 71 raccoons have been tested for WNV and all PCR test results have been negative. Of the 71 raccoons tested from May 2011 to October 2011 and June 2012 to September 2012, 85.9% (n=61) had age classification data. The majority of these raccoons were young; 52.5% (n=32) were days or weeks old and 39.3% (n=24) were classified as juveniles. All raccoons were found primarily in urban settings at least 20 miles from the northern edge of the County.

Conclusions

While none of the raccoon samples tested in this study were found to be WNV positive, surveillance data from San Diego County suggests that WNV activity during this time period was extremely low. From January–October 2011, San Diego County Vector Control reported all negative results for WNV in dead birds, sentinel chickens, horses, and humans for WNV; only 1 mosquito pool from the northern border region of the County tested positive for WNV (6). Thus, despite WNV activity throughout the state of California, the virus did not appear to be circulating widely in San Diego County in 2011 (7). To date during the 2012 season, San Diego County reported all negatives for WNV in dead birds, sentinel chickens, mosquito pools, and horses; only one human case of WNV was identified in an asymptomatic male during a routine blood donation (6).Further evaluation is needed to determine if raccoons are useful sentinel species for WNV surveillance. Testing should continue to evaluate if raccoons may serve as a more effective early warning sentinel for WNV than birds which can travel long distances from the exposure site, and to determine if raccoons may allow better localization of WNV activity.     

Tracking care in San Diego

Standardizing care cost-effectively, while carefully tracking individual patients' progress through the care continuum, has challenged health systems around the country. In an excerpt adapted from a new book, the author, the operations strategist at ScrippsHealth, describes how one of the nation's leading integrated delivery organizations has answered the call.     

Prevention of tobacco use among adolescents in public schools in San Diego County, U.S.A.

Summary Project S.H.O.U.T. (which stands for Students Helping Others Understand Tobacco) is a tobacco-use prevention project funded by the United States National Cancer Institute for preventing the use of cigarettes and smokeless tobacco (snuff and chewing tobacco) in public schools in San Diego County, California. Based on principles of behavior modification. Project S.H.O.U.T. teaches students how to anticipate and overcome negative peer pressure to use tobacco and reinforces them for having done so. Preliminary results indicate that the prevalence of tobacco use among students receiving peer pressure resistance skills training was somewhat but not statistically significantly lower than the control group after one year of intervention. In addition, students in a third lottery condition, who were reinforced for simply not using tobacco, showed lower prevalence rates compared to controls. Additional support for the efficacy of the intervention program was provided by the refusal skills assessment test, which indicated that students exposed to the intervention were able to refuse tobacco offers more effectively than the control students. Our results indicate that tobacco use prevention experts should do more than provide decision-making and behavioral skills for resisting tobacco use, but should also reinforce the non-use of tobacco.

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Prävention von Tabakgenuss bei Jugendlichen in öffentlichen Schulen San Diegos, USA

Zusammenfassung Das Projekt S.H.O.U.T. (Abkürzung für «Students Helping Others Understand Tobacco») ist eine Initiative zur Raucherprävention, die vom US-amerikanischen Krebsforschungsinstitut (National Cancer Institute) gefördert wird und die den Einstieg in das Rauchen von Zigaretten und andere Formen des Tabakgenusses (Schnupftabak und Kautabak) in öffentlichen Schulen des Bezirks San Diego, Kalifornien, verhindern soll. Gestützt auf die Grundsätze der Verhaltensmodifikation vermittelt das Projekt S.H.O.U.T. Schülern, wie sie einen sozialen Druck von Gleichaltrigen, der negative Folgen haben würde, erkennen, ihm ausweichen und wie sie ihre Widerstandshaltung stabilisieren können. Erste Ergebnisse lassen erkennen, dass nach einem Jahr der Intervention die Prävalenz des Tabakgenusses bei Schülern, die eine Unterweisung in Techniken des Widerstands gegen den sozialen Druck von Gleichaltrigen erhalten haben, etwas, aber nicht statistisch signifikant, niedriger als in der Kontrollgruppe war. Die Prävalenzrate (verstanden als Tabakgenuss in der vergangenen Woche) blieb in den Interventionsschulen stabil bei 7,3%. Die Prävalenzrate in den Kontrollschulen stieg von 3,5 auf 8,2 %. Ausserdem waren die Prävalenzraten von Schülern, die in ihrem Verhalten, auf den Genuss von Tabak einfach zu verzichten, bestätigt worden waren, niedriger als in den Kontrollgruppen. Diese Ergebnisse zeigen, dass Präventionsexperten sich nicht einfach mit der Vermittlung von Techniken der Entscheidung und des Verhaltens in bezug auf Tabakkonsum zufrieden geben und auch die Ablehnung jedes Tabakkonsums verstärken sollten. Die Wirksamkeit des Interventionsprogramms konnte ebenfalls durch einen Test zur Entwicklung von Ablehnungsverhalten erhöht werden, der erkennen liess, dass Schüler, die unmittelbar von der Intervention angesprochen wurden, erfolgreicher Aufforderungen zum Tabakkonsum ablehnen konnten als die Schüler in der Kontrollgruppe. Unsere Befunde zeigen auch, dass sowohl gegen Zigarettenrauchen als auch die «rauchfreien» Formen des Tabakgenusses in einem Programm erfolgreich angegangen werden kann.

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Prévention de la consommation de tabac chez des adolescents dans les écoles publiques du comté de San Diego, USA

Résumé Le projet S.H.O.U.T. («Students Helping Others Understand Tobacco») est un projet financé par l'Institut américain de recherche sur le cancer (United States National Cancer Institute) qui s'intéresse à la prévention, en milieu scolaire, de la consommation de tabac, sous forme de cigarettes mais aussi de tabac à priser et à mâcher. Ce projet se fonde sur l'apprentissage de comportements nouveaux: l'intervention consiste à apprendre aux enfants à anticiper et résister aux offres de tabac puis à les conforter dans cette attitude de résistance aux pressions du groupe social. Les résultats préliminaires montrent que, si l'on compare les enfants ayant subi cet entraînement à un groupe témoin, la prévalence de la consommation de tabac est, après une année, inférieure, mais pas statistiquement différente, pour ces premiers. De plus, les élèves d'un troisième groupe qui étaient simplement récompensés s'ils prouvaient leur abstinence, présentent une prévalence inférieure à celle du groupe témoin.Par ailleurs, tous les élèves ont subi un test qui mesure les capacités à refuser. Manifestement, les élèves du groupe d'intervention savent refuser de manière bien plus habile et done plus efficace que ceux du groupe contrôle.Nos résultats indiquent done qu'il est possible, grâce à de tels programmes d'intervention, de modifier le comportement des enfants et, ainsi, de les amener à restreindre leur consommation de tabac.

     

Correlates of Tanning Facility Prevalence within San Diego County, California Census Tracts

Adolescents frequenting indoor tanning facilities may have an increased risk of skin cancer. The high level of indoor tanning by this age group may be due, in part, to the large number of tanning facilities in US cities. This study examined how facilities are distributed throughout one large county. Based on ecological models, it was predicted that tanning facilities are more likely to be located within certain neighborhoods based on the neighborhood’s distributions of demographic factors, including income, educational attainment, race/ethnicity, age, and sex. We also explored whether selected aspects of the built environment, including the numbers of high schools and fitness centers, would predict the number of tanning facilities. The number of tanning facilities within 605 census tracts of San Diego County was examined through geographic information systems mapping. Results from multivariate Poisson log-linear regression indicated that higher numbers or proportions of the following variables within a census tract were significantly, positively correlated with the number of tanning facilities: fitness centers, teenagers 15–19 years, females 15–24 years, females 25–29 years, and non-Hispanic Whites. Results from additional analyses using a 1000-foot buffer zone around each census tract boundary showed that higher relative distributions of the following variables were significantly, positively correlated with the number of tanning facilities: high schools, fitness centers, females 15–24 years, females 25–29 years, and non-Hispanic Whites. These findings suggest a relationship exists between the numbers of tanning facilities and certain built-environmental and demographic characteristics within census tracts. Determining this relationship is important for developing future interventions.     

Fire fatalities among children: an analysis across Philadelphia's census tracts

OBJECTIVE: This study investigates the possible causes of high levels of residential fire deaths to children younger than 15 years of age in Philadelphia from 1989 to 2000. METHODS: The authors analyzed 246 deaths from 146 residential fires by census tract in Philadelphia using both individual level data and aggregate level data drawn from the records of the Fire Marshall's Office. Death rates by age and sex were calculated using the 1990 Census. Data on fires from official records were combined with aggregate level data by census tract from the 1990 Census and analyzed using logistic regression. Newspaper articles on the fires analyzed were used to identify residences with possible fire code violations. The authors used data from the Philadelphia Bureau of Licenses and Inspections to provide evidence of code violations. RESULTS: The statistically significant variables that resulted from the logistic regression were census tracts in the highest quartile for low income households, census tracts in the highest quartile for single-parent households with children younger than age 18, census tracts in the highest quartile for houses built before 1939, and the number of children younger than 15 years of age in a census tract. CONCLUSION: Population characteristics by census tract are useful in identifying risk factors for residential fire deaths of children. Census tracts identified as at highest risk can provide fire prevention units with opportunities to take preventative measures such as the distribution of smoke detectors, and the education of residents about the dangers of careless smoking and planning for the rescue of children in the event of a fire.     

Reproductive outcomes among Mexico-born women in San Diego and Tijuana: testing the migration selectivity hypothesis

Mexican immigrants to the United States have better reproductive outcomes than do U.S.-born non-Latina whites. Explanations offered for this epidemiologic paradox include (1) poor outcomes among Mexican women may be hidden by their return to Mexico; (2) Mexican women may have a higher fetal death rate that alters the pattern of live birth outcomes; (3) Mexican women may have socioeconomic characteristics which, if properly measured, would explain the outcome; (4) Mexican women may have personal characteristics which would explain the outcome, if properly measured; (5) there may be ameliorative or salutogenic protective effects of culture; and (6) migration may be selective of healthier women who are thus more prone to positive outcomes. We test these explanations, with an emphasis on the last one, using a data set that combines reproductive histories and birth outcomes for Mexico-born women delivering in San Diego, California and Mexican women delivering in Tijuana, Mexico. These data are compared with U.S.-born Latinas and U.S.-born non-Latina Whites. Multivariate logistic regression analysis suggests that when controlling for birth history (stillbirths and miscarriages), socioeconomic characteristics (education and prenatal visits), personal characteristics (age, parity, time in area, history of family problems), and health characteristics (history of smoking, alcohol use, drug use, anemia, vaginal bleeding, urinary infection), the adjusted odds of a positive birth outcome (measured as a live birth of 2500 grams or more) is highest for women delivering in Tijuana, implying that migrants may not be so selective when compared to the country of origin. The number of prenatal visits was an important explanatory variable.     

Perceived susceptibility to HIV infection among Asian and Pacific Islander women in San Diego

Recent reports indicate that AIDS is increasing among Asian and Pacific Islander populations. Data from 249 women sampled from nine Asian and Pacific Islander communities in San Diego County from 1993 to 1995 were examined to determine what factors contributed to perceived susceptibility to HIV infection and having had an HIV test. Thirteen percent of women sampled were classified as high risk for HIV infection, while half of the women reported perceived susceptibility to HIV. Years in the United States and ethnicity appeared to be effect modifiers of the relationship between risk behaviors and perceived susceptibility. In the multivariate model, high school education or greater, age of 30 or more, participation in risk behaviors, and knowing an HIV-positive person were significantly associated with perceived susceptibility. Reliability of self-reported sexual behavior was somewhat low, while the reliability of data relating to injection drug use and needle sharing was high.