Academic literature on the topic 'California. Health Education-Risk Reduction'

California has made substantial progress since 1991 in reducing its teen birth rate, and its rate reduction now leads the nation. Yet more than 50,000 Californian teens continue to give birth each year, and many more became pregnant. And due to changing demographics and the recent reversal in the last decade’s poverty rate declines, California’s improvements are at risk. The No Time for Complacency (NTFC) initiative is a policy advocacy intervention designed to promote effective statewide teen pregnancy prevention policy and funding in California. This initiative employs legislative-district data analysis to provide a politically compelling organization of teen birth data, cost analyses to heighten the societal relevance of teen births, policy analysis to identify promising and effective state policies, and media advocacy to focus attention on these issues in all regions of the state. The process and results described show how it was possible to achieve impacts on state-level health policy and program funding.

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p<.001), 2) reduction of subject reported medical utilization from baseline (p<.05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

Objective Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California. Methods We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment. Results Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non–US-born persons. Conclusions By focusing on the non–US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.

AbstractObjective:To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.Design:Cross-sectional telephone surveys using a validated 24 h dietary assessment.Setting:Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.Participants:Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.Results:Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.Conclusions:The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

Lay Summary A major problem in the United States is the overconsumption of high sodium foods. These foods often put people at higher risk of hypertension, heart disease, and stroke. Recent public health efforts have tackled this problem by making it easier to select/purchase healthier, lower sodium foods in different settings. Hospital employees are one such group that has been the focus of these interventions. Presently, little is known about what explains sodium-related dietary behaviors among hospital employees. To address this gap, we used data from a survey of hospital staff who were exposed to sodium reduction interventions in the workplace to examine how their knowledge, attitudes, and self-reported health status affected their sodium consumption. A key finding was being in “good health” and having the belief that salt intake matters for health predicted decreased sodium consumption among the survey participants. These and other study findings provide context and insights into ways in which further sodium reduction could be achieved among at-risk hospital employees.

Micronutrients are dietary components important for health and physiological function, and inadequate intake of these nutrients can contribute to poor health outcomes. The risk of inadequate micronutrient intake has been shown to be greater among low-income Hispanics and postpartum and lactating women. Therefore, we aimed to determine the risk of nutrient inadequacies based on preliminary evidence among postpartum, Hispanic women. Risk of micronutrient inadequacy for Hispanic women (29–45 years of age) from the Southern California Mother’s Milk Study (n = 188) was assessed using 24 h dietary recalls at 1 and 6 months postpartum and the estimated average requirement (EAR) fixed cut-point approach. Women were considered at risk of inadequate intake for a nutrient if more than 50% of women were consuming below the EAR. The Chronic Disease Risk Reduction (CDRR) value was also used to assess sodium intake. These women were at risk of inadequate intake for folate and vitamins A, D, and E, with 87.0%, 93.4%, 43.8%, and 95% of women consuming less than the EAR for these nutrients, respectively. Lastly, 71.7% of women consumed excess sodium. Results from this preliminary analysis indicate that Hispanic women are at risk of inadequate intake of important micronutrients for maternal and child health.

SUMMARYPeriodic outbreaks of West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and to a lesser extent, California serogroup viruses (CSGV), have been reported in parts of Canada in the last decade. This study was designed to provide a broad assessment of arboviral activity in Quebec, Canada, by conducting serological surveys for these arboviruses in 196 horses, 1442 dogs and 485 humans. Sera were screened by a competitive enzyme linked immunosorbent assay and positive samples confirmed by plaque reduction neutralisation tests. The percentage of seropositive samples was 83·7%, 16·5%, 7·1% in horses, 18·8%, 0·6%, 0% in humans, 11·7%, 3·1%, 0% in adult dogs and 2·9%, 0·3%, 0% in juvenile dogs for CSGV, WNV and EEEV, respectively. Serological results in horses and dogs appeared to provide a meaningful assessment of risk to public health posed by multiple arboviruses.

Homeless gay and bisexual (G/B) young men have multiple risk factors that increase their risk of contracting hepatitis B virus (HBV) and human immunodeficiency virus (HIV). This study used baseline information from structured instruments to assess correlates of knowledge to HIV and HBV infection from 267 young (18-39 year old) G/B active methamphetamine, cocaine, and crack-using homeless men enrolled in a longitudinal trial. The study is designed to reduce drug use and improve knowledge of hepatitis and HIV/AIDS in a community center in Hollywood, California. Regression modeling revealed that previous hepatitis education delivered to G/B men was associated with higher levels of HIV/AIDS and hepatitis knowledge. Moreover, higher HIV/AIDS knowledge was associated with combining sex and drinking alcohol. Associations with hepatitis B knowledge was found among G/B men who were engaging in sex while under the influence of marijuana, who were receiving support from non–drug users, and who had been homeless in the last 4 months. Although being informed about HIV/AIDS and hepatitis did not preclude risky sexual and drug use behavior, knowledge about the dangers of concurrent sex with substance use is important. As higher levels of knowledge of hepatitis was associated with more moderate drug use, early access to testing and teaching harm reduction strategies remain critical to reduce exposure and infection of HBV and HIV in this population.

Background: Injury and illness incidence rates continue to be higher in healthcare facilities than in the manufacturing environment despite improvement efforts implemented by various organizations. The prevention of workplace injury and illness is a challenge for facilities due to reasons including exposure to body fluids, infectious diseases, and patient handling activities. The purpose of this project was to reduce workplace safety-related incidents and prevent employee injuries through leadership involvement in employment of preventive, directive, and corrective controls. Methods: A tertiary medical center in California experienced 114 accepted injury claims in 1 year. As a response to the problem, the medical center developed a safety management system consisting of a process for engagement between leadership and staff members/employees to increase accountability and reduce injury risks. Findings: The medical center achieved a 59% reduction from 114 to 67 injury claims over a period of 2 years and a two-point increase in engagement scores from both leaders and staff members. Conclusion/Application to Practice: The development of a safety culture starts with leadership behavior, establishment of clear safety processes, and hazard mitigation activities. Workplace safety is a shared responsibility between frontline staff managers and leadership within an organization. Senior leaders must serve as role models to promote a speak-up culture to support safe work practices.

In July 1980, the Barren River District Health Department (BRDHD), serving eight counties (combined population approximately 204,000) in Southcentral Kentucky, was selected as a demonstration site under the auspices of the federal Health Education Risk Reduction (HERR) Program. With continued HERR funding for eight years, the BRDHD developed several successful health promotion projects. Major components of these projects include: 1) community health promotion, which serves to identify high -risk groups in the community and provide them with health education-health promotion services, 2) school health education which included the development of a preschool health education curriculum, 3) teacher education workshop, which instructs primary and secondary public school teachers in health education methods, 4) smoking cessation. and 5) a large industrial wellness program. This study reports on an eight year program evaluation of the HERR demonstration. Overall, the program evaluation suggests an increase in health knowledge and some attitude and behavior change for many of the participants ii BRDHD programs.

The purpose of this study was to investigate the behavioral impact of knowledge regarding the relationship between breast cancer, vitamin D supplementation, and sunlight exposure considering levels of self-efficacy and response-efficacy. The study was based on protection motivation theory, which attributes behavior change to cognitive processes related to perceived threats and has demonstrated efficacy in promoting breast cancer risk-reducing behaviors. The study employed a quasi-experimental research design based on a survey using SurveyMonkey. Participants were New York City-residing women ranging in age from 25 to 74 who were recruited via an invitation from SurveyMonkey. Correlation analysis and linear regression analysis were performed on the data extracted from the survey in order to better understand the relationship of the variables in this study, and to test if any of the independent variables were significant predictors of vitamin D intake through supplementation and sunlight exposure. The results of this analysis showed that knowledge regarding the reduction in risk of breast cancer from sunlight exposure and through vitamin D supplementation was not related to changes in behavior involving increases in sunlight exposure and vitamin D intake through supplementation. Further, the results showed that those participants with higher levels of self-efficacy and response-efficacy regarding sunlight exposure and vitamin D supplementation had an increased amounts of vitamin D intake through supplementation on a daily basis. The results of this study can be used to help medical professionals understand the complexity involved in how their clients may or may not take action to reduce the potential for reducing the risk of breast cancer.

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical record (EMR) alert system with an additional bone health education in the patient instruction menu can improve participation by 11 health care providers (HCPs). Prior to the participants receiving the fact sheet, the knowledge, health beliefs, and perceived risks for developing osteoporosis were measured using the Revised Osteoporosis Knowledge Test (ROKT) and the Osteoporosis Health Belief Scale (OHBS). Although 87% of participants identified menopause as a major osteoporosis risk factor, fewer women (33%) knew that surgical removal of the ovaries was also a risk factor and half agreed or strongly agreed that calcium and exercise can prevent osteoporosis. After receiving the fact sheet, the participants had an average confidence score of 62% on the Osteoporosis Self-Efficacy Scale (OSES) for engaging in exercise and an average confidence score of 65% for adhering to calcium intake guidelines. Furthermore, the EMR alert system facilitated 100% documentation by HCPs. These results indicated the fact sheet can motivate premenopausal women to engage in osteoporosis preventive behaviors. Importantly, the EMR reminder with education fact sheet can facilitate the active involvement of HCPs in patient education.

The purpose of this study was to conduct a community health risk assessment of the city of Long Beach, California specific to the 90813 ZIP code by utilizing an adaptation of the Catholic Health Association of the United States (2013) model for community health assessment to identify the most imperative risk factors for the chronic homeless population in the 90813 ZIP code of Long Beach. Data on three domains (physical health, mental health, and housing) measuring 16 risk factors were gathered from both archival data and major public sources. Data from Long Beach 90813 ZIP code were compared to data from Los Angeles County, California, and the United States. Risk factors that are the utmost concerning for the community appeared to be difficulties in obtaining health care, infectious diseases, both ER and hospitalization rates due to alcohol abuse and high poverty rate. Efforts to reduce the amount of both sheltered and unsheltered chronic homeless individuals should target all three domains. Recommendations for evidence-based programs and interventions to reduce the most salient risk factors are provided.

The purpose of this quantitative study was to examine possible risk factors that predict asthma among adult, foreign-born African Americans in California. A total of 794 foreign-born African Americans (87 asthma cases) were included from the 2017-2018 California Health Interview Survey database. Data analysis included both descriptive and inferential statistical methods including chi-square analysis and multiple logistic regression techniques. The socioeclogical model was used to help understand and interpret the findings. The dependent variable was asthma status and the independent variables were the risk factors (tobacco smoking, alcohol use, health insurance, income level, and education level). Confounders included in the analysis were age, gender, and marital status. Findings yielded no statistically significant relationship between asthma status and tobacco smoking (p = 0.19, x2 = 1.74, OR = 0.59, 95% CI = 0.27-1.30), alcohol use (p = 0.92, x2 = 0.01, OR = 0.98, 95% CI = 0.61-1.58), health insurance (p = 0.63, x2 = 0.23, OR = 0.85, 95% CI = 0.44-1.65), income level (p = 0.99, x2 = 0.00, OR = 0.99, 95% CI = 0.44-2.24), or education level (p = 0.47, x2 = 0.52, OR = 1.51, 95% CI = 0.49-4.59). Although this study did not find significant associations between asthma and study variables, study limitations, mainly the small sample size, may have prevented the detection of small associations. Future research should involve a larger sample size to investigate whether the findings reported remain true. This study is a step in the exploration of the problem and has the potential to promote positive social change by increasing asthma awareness among foreign-born African Americans in California and among public health policy makers.

Rural communities across the United States suffer from multiple health disparities that range from access to care to awareness of medical information. These disparities are characterized by increased incidence of illnesses, mortality rates, lower quality of life, and lower life expectancy when compared to the general urban population. Several risk factors have been identified that play a direct role in these characteristics. These include geographic isolation, lower socioeconomic status, higher rates of health risk behaviors, and limited job opportunities, and less health education. Hawkins County Tennessee is one such rural community that suffers from these disparities. The leading cause of death in Hawkins County is cardiovascular disease (CVD). Due to the nature of disease, early life long modifiable risk factors play a critical role in its development. Health education and awareness of the disease is also a key factor in the disease's effects in the community. Studies have shown that early life healthcare awareness is an “important determinant of adult health status.” This led us to examine the current state of cardiovascular disease awareness and perception among teens in the community. To examine the current perception of CVD in Hawkins country we created an assessment for ninth grade students attending Cherokee Highschool during their health class block. We also aimed to assess the effectiveness of an interactive interventional educational program targeted at both educating the technical knowledge surrounding CVD and at reducing modifiable risk factors that lead to CVD. The interactive educational program was designed and given to students (n=82; 47 Male 35 Female) across 5 class period in two sections (Cardiovascular health and Nutritional & Physical health) that were taught one week apart. Students underwent a Pre-test/survey that examined four areas of interest: perception & technical knowledge of CVD, perception of physical activity, perception of nutrition and diet, and current family health. After completing the program students were then given an identical post-test/survey. Result means were compared between Pre and Post survey using Independent sample T-test. Analysis showed that technical understanding of CVD and of modifiable risk factor significantly increased across all areas (P

Background: College settings are likely environments for Black women to contract STIs (including HIV) or experience unintentional/unwanted pregnancies. Effective prevention strategies for this population include dialogue and activities that focus on gender, maturity, cultural barriers, personal strength, and information needs. However, technological advancements (including virtual reality) and innovation are limited in prevention efforts. Methods: Four 90-minute focus group sessions were conducted in a convenience sample of Black college females (ages 18 years or older) and a research-intensive public institution in the southeast. A series of surveys were distributed during each audio-recorded focus group session. A mixed-method approach to data analysis was based on applications of the Health Belief Model constructs to three principal research questions: (1) Q1: How do Black college females perceive the importance of sexual risk topics? (2) What are the experiences and attitudes of Black college females regarding the use of VR for education and training versus video game entertainment (i.e. “gaming)? and (3) Among Black college females, what sexual risk topics are considered most relevant to a VR education and training platform? Results: Each of four study cohorts enrolled between 2-6 participants each (n=15). Participant ages ranged from 18-48 (x̅=28.6, σ=9.2) years within age groups of 18-24 years (60%, n=9), 25-34 years (26.7%, n=4), and 35 years or above (13.3%, n=2). The majority of participants (86.7%, n=13) were enrolled as full-time students, and resided in various off-campus locations (73.3%; n=11). Assessments of sexual risk topic importance were reported based on aggregated Survey 1 Lickert scale values. The majority of participants equally viewed the topics of HIV and STI status as important, mostly important, or very important. Other notable concerns include sex with drug/alcohol use, risk of intimate partner violence, and sexual communication (e.g. partners and peers. Despite the lack of formal virtual reality knowledge, the majority of participants reported experience with VF technology via “gaming” (e.g. SIMS). They also concluded that a virtual reality platform for sexual health education and training should involve comprehensive approaches to HIV/STI and unintentional pregnancy via use of barrier methods, including birth control, as well as facilitation of sexual communication. Discussion: This research represents a unique approach to the identification of sexual health risk importance for HIV/STI transmission, as well as unintentional pregnancy, in Black college females. Although a successful demonstration of feasibility, this research is formative in nature – results should be interpreted as preliminary. However, methods and concepts presented in this thesis hold the potential for scientific contribution in prevention research, clinical practice, and other fields of study.

The purpose of this project was to design a series of self-directed learning modules for enrollees in the Women, Infants, and Children (WIC) program in Riverside County, California. The WIC Program is a supplemental nutrition program that, among other things, provides participants with nutrition education to help them understand the health benefits of choosing more nutritious food. This project features information concerning the problem of food insecurity, the nutrition education of low-income women and children in the WIC program, and the characteristics of adult learners. The objective was to examine the WIC participants' comprehension and willingness to use self-directed learning modules as a nutrition education supplement.

Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle.
School of Nursing

A healthy community should have a safe and hygienic environment, with access to basic well-being maintaining facilities and services. Key messages for education programmes related to water management, indoor environment, waste management, health promoting behaviour, and disaster health risk reduction are presented in this chapter. It also aims to share some common health communication and education that might be useful to improve bottom-up resilience for health and disaster health risk reduction in rural communities. Examples from the Ethnic Minority Health Project will also be employed to illustrate how bottom-up resilience towards health and disaster risk in these rural communities might be established.

This chapter critiques some of the assumptions about the causes and solutions for obesity using anthropological and historical understandings of class and ethnic differences in Mexico. It unpacks Mexico’s policy response to obesity and diabetes, including its much lauded soda tax and poverty reduction policies, and demonstrates how a progressive and aggressive policy response has been stunted in ways that favor transnational food corporations, while deflecting the blame for diet-related illness onto individuals, especially women, and historically marginalized poor and indigenous populations. The chapter addresses the idea that better health and wellness can be achieved for the Mexican population through greater education and socialization into healthful ingredients and cooking styles, narrowly defined.

Nowadays, colorectal cancer prevention strategies play an essential role in reducing the incidence and mortality of the cases. A well-designed and establishment of the clinical pathway of screening programme needed in all country. Types of screening tools used may vary between the country with the use of FOBT and colonoscopy. The standard guideline related to screening programme such as for high-risk group should be emphasized more as compared to the low-risk group. The uptake of screening for CRC should be highlighted more as the program have showed a significantly reduction of the cases and mortality. The barrier of CRC screening uptake mainly due to poor awareness, discomfort, low physician recommendation, low socioeconomic and improper screening programme. Therefore others prevention strategies beside screening program such as health education and interactive intervention strategies need to be empower.

The habits and health of mothers and children have lifelong significance to the well-being of a nation and the world. Healthy People 2010, a statement of national health objectives, aims to increase the quality and years of healthy life and to eliminate health disparities. It includes maternal, infant, and child health as focus areas. Early recognition and detection of problems, followed by treatment and ongoing assessment, can lead to considerable reductions in preventable morbidity and mortality for women and children. Preconception counseling and early prenatal care may improve pregnancy outcomes through risk assessment, risk reduction, and patient education. Newborn assessment begins immediately after birth (Apgar score, physical examination). Screening for metabolic diseases is a part of public health programs throughout the United States. Sudden infant death syndrome is the leading cause of postnatal death. The cause is likely multifactorial and involves biological vulnerability and environmental stressors. Assessment of normal developmental milestones should occur routinely to detect developmental delays. Adolescence is when life-long health habits are established. It is an opportunity to introduce preventive health care issues by addressing risk-taking behaviors.

The literature on prevention of substance abuse is extensive, diverse, uneven, and difficult to summarize. It encompasses intensive reviews of drug education research in general, well-documented experiments with specific school-based interventions, more cursory articles promoting a program but lacking any outcome data, pamphlets advertising curricula, and assorted other materials. This range reflects the fuzziness of the subject of substance abuse prevention and the specialized interests of those who work on it. Some efforts focus only on preventing cigarette smoking, others on alcohol abuse, a few include all substance-related behaviors. In programs directed toward alcohol abuse, there is no agreement on whether the goal should be abstinence or responsible decision making. There is little agreement about whether programs should focus only on substance abuse or deal with more general issues related to the predictors of substance use, such as family bonding and school failure. One school of thought adheres to the position that substance abuse issues should be dealt with in the context of comprehensive health education. Another approach to the prevention of substance abuse takes us away from school-based programs into the area of public policy. This view suggests that behavioral change will result from enforcing restrictive laws and policies and creating broader media efforts aimed at the whole society rather than youth. Many people attribute the decline in cigarette smoking to drastic shifts in public opinion about its social acceptability and safety following the release of a Surgeon General’s report 25 years ago that documented the negative health consequences of smoking. It is true that the changes in behavior even among adolescents took place in the late 1970s, prior to the initiation of most smoking prevention programs in schools in the early 1980s. Teen smoking behavior has changed much less during this decade than the prior one. The Advocacy Institute has proposed a number of priority policy actions to prevent smoking which include creating smoke-free workplaces and public spaces, increasing excise taxes on cigarettes (assuming a 10 percent increase in tax produces a 12 percent reduction in smoking!), compelling cigarette manufacturers to assume liability for smoke-caused deaths and diseases, neutralizing or reducing cigarette advertising and promotion, and restricting sales to minors.

Suboptimal adherence to prescribed cardiovascular medicines is highly prevalent, associated with increased morbidity and mortality, and costly to manage. Adherence is defined by the three phases of initiation, implementation, and discontinuation. Up to one in six patients prescribed a statin do not initiate treatment and less than 60% of patients persist with therapy at 2 years. Even among patients who engage with the dosing regimen, about 10% of scheduled doses are missed on any given day. There is no evidence of significant differences in persistence across different classes of cardiovascular medicines, but persistence is worse in the context of primary prevention, compared with secondary prevention. The relative risk of development of cardiovascular disease in patients with good versus poor adherence is 0.85 and 0.81 for statins and antihypertensive medications, respectively. The consequences of variable dose implementation may be tempered by the use of drugs which are forgiving to variable dosing, that is, drugs whose pharmacological activity persists despite the occasional late or missed dose. The use of specific interventions that involve electronic reminders, pharmacist-led interventions, and healthcare professional education of patients may be an effective strategy to improve adherence to statins, and to achieve corresponding decreases in low-density lipoprotein cholesterol. Improving adherence to preventative cardiovascular medicines could result in savings of over £109 million (€126 million) per year in the United Kingdom alone, and could lead to a 35% reduction in the risk of all-cause mortality.

This guidebook is inspired by 20 years of collaborative work to improve school climate and student well- being. Working with government leaders, district administrators, and school personnel in the United States and abroad, the authors have extensive experience in designing and implementing monitoring systems that fit local needs and in showing how results can be used to improve schools. These various monitoring models already in use can help education policymakers and administrators gain a better understanding of how these systems can empower schools and guide decisions about programs and interventions. The overarching message of this guidebook is that methods of monitoring should be well integrated into the process of leading a school, just as academic assessment is. Viewed together, both academic and nonacademic data can provide the information that school leaders need to create safer, more successful schools. The California School Climate, Health, and Learning Survey is a comprehensive set of surveys that includes the: . . . California Healthy Kids Survey (CHKS) California School Climate Survey for staff (CSS) California School Parent Survey (CSPS) . . . The CHKS is a youth risk and resilience survey given to students in the 5th, 7th, 9th, and 11th grades. The survey gathers feedback from students on issues such as school connectedness, safety, violence and victimization, substance use, and physical and mental health. There is a core survey that covers all of those topics to some extent as well as supplemental modules that ask more detailed questions on specific topics. The CSSS is for teachers, administrators, and all other school staff (e.g., secretaries, security guards, bus drivers). It asks about multiple aspects of school climate and needs for professional development. The CSPS focuses on parent perceptions. It asks many questions that parallel those presented to students and staff. In addition, parents describe how they perceive the ways that the school engages and involves them in the school.

Selecting factors suitable to use in a regression model is often a complicated process: the researcher strives to retain all theoretically important factors while avoiding high correlations among independent variables. This chapter models cardiac disease and compares the explanatory ability of component-based multivariate regression models, created through the use of principal component analysis (PCA), with that of direct variable-based, multivariate regression models. The variable-based demographic and socio-economic model contains education, sex, and 3 age factors; in contrast, the component-based model contains age as well as several modifiable risk factors: education, income, family, and housing factors. Moreover, the latter model also has statistically higher explanatory power. Components made through data reduction techniques may not always be interpretable, but, given closer examination of individual components, a component-based model becomes more interpretable. Further, all important factors will potentially be present in models. As such, component-based modelling can be a useful tool for research and public health planning. A key limitation of this work, to be addressed in future research, is the use of a variable (cardiac catheterisation procedures) that remains a crude proxy for cardiovascular disease. More effective analysis will be performed as data becomes available. Exploration into the relationship of factor and their spatial patterns will also be considered.

From primary prevention to end-of-life care, AIDS psychiatry can make significant contributions to preventing risk behaviors and HIV transmission, mitigating suffering, and improving adherence to risk reduction and medical care. Early in the epidemic, stigma and discrimination magnified suffering and excluded persons known to have HIV and AIDS from many settings in the United States and throughout the world. Such treatment of persons with AIDS was described (Cohen, 1989) as a new form of discrimination called “AIDSism.” As we approach the end of the third decade of the HIV pandemic, in most countries education, training, and experience have mitigated AIDSism, and persons with HIV and AIDS are now seen in varieties of medical and nonmedical settings. The multimorbid medical and psychiatric illnesses associated with HIV infection have complicated the care of persons with HIV and AIDS. A primary care guideline for the care of persons with HIV is available in print (Aberg et al., 2009) and online and is updated regularly at: http://www.journals.uchicago.edu/page/cid/IDSAguidelines.html. AIDS psychiatrists, psychosomatic medicine psychiatrists, as well as child, adult, and geriatric psychiatrists and other mental health professionals are in a unique position to intervene and provide both preventive and treatment interventions for children, adolescents, and adults who are vulnerable to, infected with, or affected by HIV infection. Psychiatrists generally make long-term and trusting relationships with their patients and take complete histories including sexual histories and substance use histories. Primary physicians, pediatricians, obstetricians, and HIV specialists as well as parents and teachers may also have unique opportunities to intervene throughout the life cycle. In this chapter, we provide a list of settings where educational opportunities abound and can lead to an improved understanding of how to prevent HIV transmission. These settings are summarized in Table 1.1. Since a full description of every setting with potential for intervention is beyond the scope of this chapter, we provide more specific descriptions of settings where providing education and easy access to testing, condoms, and drug and alcohol treatment can be therapeutic and lifesaving.

Training and education using simulation has been used extensively in many high risk industries including aviation, nuclear power, military and rail. Repeated exposure to simulated crises and events has meant that, for example, airline crews are well prepared to face a rare disaster when it happens in real life. The use of simulation and simulators in medicine, to train and educate healthcare professionals has gained increasing attention in recent years and many simulation centres have now been set up in the UK. The Bristol Medical Simulation Centre, which opened in 1997, was the first training centre of its kind in the UK. There are now over 70 similar centres in the UK and many more with manikins in simpler settings, and hundreds of centres throughout the world [Department of Health 2010]. These offer a similar concept to that which the high risk industries use, where training for medical emergencies using sophisticated manikins are used in realistic medical settings, and task trainers are used to teach, for example, practical surgical skills. Many potential accidents in medicine are due to human error and communication problems [(Kohn et al. 1999, Department of Health 2009)]. Simulators can help train teams to function optimally using human factors style teaching. Simulation could also be a practical solution to several current educational issues. These include the challenges faced by educational institutions in securing clinical placements, the decrease in social acceptance of trainees learning on patients, the drive to maximise patient safety, and the dramatic decrease in training time being available to junior doctors due to the reduction in hours through the European Working Time Directive. The simulations centres consist of a number of different designated rooms. Simulated operations and team training can be carried out in the operating room. This room is made as close as possible to the modern operating room. It contains real equipment such as ventilators, defibrillators, patient monitors, trolleys and drip stands. A control room is next to the operating room, with a one way viewing window. This is where the manikin is controlled and where the simulation training is viewed and video recorded.

ABSTRACT Background: In addition to unsuccessful policies to prepare communities for disaster reduction, the high risk of earthquakes and their harmful consequences indicate that more consideration should be given to social factors in this regard. All community shelters are vulnerable to disasters, especially children, so efforts are needed to determine disaster preparedness factors for elementary school students in Denpasar City. This study aimed to analyzed of earthquake preparedness measures in students at elementary school, Denpasar, Bali. Subjects and Methods: This was a descriptive study conducted at an elementary school in Denpasar from January to September. A sample of 350 elementary school students in Denpasar whose schools have a disaster preparedness school (SSB) program selected by purposive sampling. The inclusion criteria were elementary school students grades 5 and 6 in Denpasar City, who can read fluently and are willing to be research respondents. The exclusion criteria were respondents who refused to be research subjects. The data were collected by 40 questions, where knowledge was 10 items, attitude was 10 items, facilities and infrastructure were 10 items, and IEC was 10 items. The data was analyzed by descriptively Results: The preparedness factors of elementary school students in facing earthquake disasters were still low. There were five earthquake preparedness factors for elementary students in Denpasar, namely (1) experience, (2) knowledge, (3) attitude, (4) facilities and (5) infrastructure, and IEC. The dominant knowledge variable of elementary school students is less than 233 (63.7%), the prevalent attitude variable is negative 244 (64%), the prevalent facilities and infrastructure variable are less than 215 (61.4%), and 300 (85.7%) dominant information and education communication. Conclusion: It is essential to be able to improve these preparedness factors with a variety of continuous education and training for elementary students, and health workers should work together with regional disaster management agency to establish disaster prepared schools in Denpasar City. Keywords: preparedness factors, students, and earthquake Correspondence: Yustina Ni Putu Yusniawati. Institute of Technology and Health, Bali. Jl. Tukad Balian no. 180 Renon Denpasar-Bali. Email: yustinaindrayana@gmail.com. Mobile: 087860000191 DOI: https://doi.org/10.26911/the7thicph.01.24

Since 1981, the Community Environmental Monitoring Program (CEMP) has involved stakeholders directly in its daily operation and data collection, as well as in dissemination of information on radiological surveillance in communities surrounding the Nevada Test Site (NTS), the primary location where the United States (US) conducted nuclear testing until 1992. The CEMP is funded by the US Department of Energy’s National Nuclear Security Administration, and is administered by the Desert Research Institute (DRI) of the Nevada System of Higher Education. The CEMP provides training workshops for stakeholders involved in the program, and educational outreach to address public concerns about health risk and environmental impacts from past and ongoing NTS activities. The network includes 29 monitoring stations located across an approximately 160,000 km2 area of Nevada, Utah and California in the southwestern US. The principal radiological instruments are pressurized ion chambers for measuring gamma radiation, and particulate air samplers, primarily for alpha/beta detection. Stations also employ a full suite of meteorological instruments, allowing for improved interpretation of the effects of meteorological events on background radiation levels. Station sensors are wired to state-of-the-art dataloggers that are capable of several weeks of on-site data storage, and that work in tandem with a communications system that integrates DSL and wireless internet, land line and cellular phone, and satellite technologies for data transfer. Data are managed through a platform maintained by the Western Regional Climate Center (WRCC) that DRI operates for the U.S. National Oceanic and Atmospheric Administration. The WRCC platform allows for near real-time upload and display of current monitoring information in tabular and graphical formats on a public web site. Archival data for each station are also available on-line, providing the ability to perform trending analyses or calculate site-specific exposure rates. This configuration also allows for remote programming and troubleshooting of sensors. Involvement of stakeholders in the monitoring process provides a number of benefits, including increased public confidence in monitoring results, as well as decreasing costs by more than 50 percent from when the program was managed entirely by U.S. federal employees. Additionally, the CEMP provides an ideal platform for testing new environmental sensors.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.