Academic literature on the topic 'Colorado. Public Board of Health'

Background The proliferation of technology galvanizes providers, researchers, and entrepreneurs to revolutionize health care and care delivery with diverse audiences. Digital health provides promise in improving health outcomes; however, the pace of technology requires rapid research to remain relevant in the marketplace. User experience (UX) research provides critical information about patient/client preferences while rigorous research trials demonstrate digital health efficacy. Despite the need for such research, the recruitment and enrollment process for digital health research remains time consuming and expensive, particularly when engaging underrepresented populations. Developed in the Colorado School of Public Health, the mHealth Impact Registry is a newly launched platform designed for rapid and responsive recruitment of participants for digital health research studies. While the use of registries in research is robust, the application in digital health research is quite limited. Objective This poster illustrates the development and testing of the mHealth Impact Registry’s Web-based platform, health status survey, mobile app, and participant database to reach underrepresented populations in digital health research. Methods Formative methods used a user centered approach to document user preferences for Registry design followed by iterative testing to ensure usability and navigability. Results End-user feedback was captured from multiple stakeholder groups (ie, Patient and Family Research Advisory Panel and mHealth Community Advisory Board) to refine recruitment strategy (ie, letters, video development). A health status survey was developed in both English and Spanish using the online software (ie, Qualtrics) that informs the back-end database. A detailed requirements document outlined technical and functional requirements for the mobile app (ie, iOS and Android) and Web-based platform (ie, Wordpress and Amazon Web Services). Conclusions Due to the need for rapid, rigorous, and inclusive research in digital health, a registry containing a pool of diverse participants would not only accelerate the recruitment and enrollment process but would also help to improve the reach and engagement of digital health solutions for underrepresented populations. The mHealth Impact Registry would house diverse participants, supporting quick enrollment and active participation in studies for which they are eligible. Improving the accessibility of participants and the speed of enrollment has promise in ensuring digital health solutions are relevant upon dissemination and commercialization.

Background: Acalabrutinib is a highly selective, covalent irreversible Bruton tyrosine kinase inhibitor with minimal activity against other kinases. Acalabrutinib has demonstrated durable responses as a single agent or combined with O in treatment-naïve (TN) CLL. Here, interim results are presented for the multicenter, open-label Phase 3 ELEVATE-TN study (NCT02475681), which evaluated the efficacy and safety of acalabrutinib + O vs acalabrutinib alone vs O + Clb in pts with TN CLL. Methods: Eligible pts had TN CLL requiring treatment per iwCLL criteria and were aged ≥65 y or <65 y with coexisting conditions (CIRS score >6, creatinine clearance <70 mL/min). Pts were randomized 1:1:1 to receive oral acalabrutinib (100 mg twice daily continuously) alone or combined with intravenous O (1000 mg on Days 1, 2 [split 100/900], 8, and 15 of Cycle 2, and Day 1 of subsequent 28-day cycles for a total of 6 cycles), or O plus oral Clb (0.5 mg/kg on Days 1 and 15 of each 28-day cycle for 6 cycles). Pts were stratified by del(17p) status, ECOG status (≤1 vs 2), and geographic region. The primary endpoint was independent review committee (IRC)-assessed progression-free survival (PFS) with acalabrutinib + O vs O + Clb. Key secondary endpoints included IRC-assessed PFS with acalabrutinib vs O + Clb, IRC-assessed overall response rate (ORR), overall survival (OS), and safety. Minimal residual disease (MRD) in peripheral blood or bone marrow was assessed in pts with investigator-assessed complete response (CR)/CR with incomplete marrow recovery (CRi). Crossover to acalabrutinib monotherapy was allowed for pts in the O + Clb arm with IRC-confirmed progression. Results: From 9/14/2015-2/8/2017, 535 pts were randomized to the acalabrutinib + O (n=179), acalabrutinib (n= 179), or O + Clb (n=177) arms. The median age was 70 y (range, 41-91); 69% had high- and 12% had very high-risk CLL IPI scores. At a median follow-up of 28 mo, acalabrutinib + O significantly prolonged PFS vs O + Clb (median not reached [NR] vs 22.6 mo; HR 0.10, 95% CI 0.06-0.18, P<0.0001), reducing the risk of progression or death by 90% (Figure). Acalabrutinib (median NR) also prolonged PFS vs O + Clb (HR 0.20, 95% CI 0.13-0.31, P<0.0001). Estimated 30-mo PFS rates with acalabrutinib + O, acalabrutinib, and O + Clb were 90%, 82%, and 34%, respectively. PFS improvement with acalabrutinib + O or acalabrutinib vs O + Clb was consistent across subgroups examined including del(17p) (HR [95% CI]; 0.13 [0.04-0.46]; 0.20 [0.06-0.64]). Median OS was not reached in any arm; (HR [95% CI]; acalabrutinib + O vs O + Clb, 0.47 [0.21-1.06], P=0.0577; acalabrutinib vs O + Clb, 0.60 [0.28-1.27], P=0.1556). In the acalabrutinib + O, acalabrutinib, and O + Clb arms, the estimated 30-mo OS rates were 95%, 94%, and 90%, respectively. Five pts (3%) in the acalabrutinib + O arm, 11 pts (6%) in the acalabrutinib arm, and 55 pts (31%) in the O + Clb arm had received a next therapy; 45 pts (25%) in the O + Clb arm crossed over to the acalabrutinib monotherapy arm. IRC-assessed ORR was higher with acalabrutinib + O (94%; 95% CI, 89.3%-96.5%) vs O + Clb (79%; 95% CI, 71.9%-83.9%; P<0.0001); the ORR with acalabrutinib monotherapy was 85%. CR rates were higher with acalabrutinib + O (13%) vs O + Clb (5%); there was 1 CR in the acalabrutinib monotherapy arm. MRD data will be presented. The median treatment duration was 27.7 mo for acalabrutinib + O (range, 2.3-40.3) and acalabrutinib (range, 0.3-40.2) and 5.6 mo (range, 0.9-7.4) for O + Clb. Common adverse events (AEs) are shown in the Table. AEs were similar between the acalabrutinib-containing arms. Infusion reactions were less frequent with acalabrutinib + O (13%) than with O + Clb (40%). AEs led to treatment discontinuation in 20 pts (11%) on acalabrutinib + O, 16 pts (9%) on acalabrutinib, and 25 pts (14%) on O + Clb. With >2 y of follow-up, 79.3% of pts in both the acalabrutinib-containing arms remain on single-agent acalabrutinib. AEs of interest (acalabrutinib + O or acalabrutinib vs O + Clb) were atrial fibrillation (any grade: 3% or 4% vs 1%), bleeding (any grade/Grade ≥3: 43%/2% or 39%/2% vs 12%/0%), and hypertension (Grade ≥3: 3% or 2% vs 3%). Conclusions: Acalabrutinib + O and acalabrutinib monotherapy significantly improved PFS vs O + Clb, with tolerable safety in pts with TN CLL. Despite cross over for disease progression in the O + Clb arm, a trend toward improved OS was observed in both acalabrutinib arms, though longer follow-up is needed. Disclosures Sharman: AbbVie: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria, Research Funding; TG Therapeutics: Consultancy, Honoraria, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding; Acerta: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Research Funding. Banerji:CIHR: Research Funding; LLSC: Research Funding; Research Manitoba: Research Funding; CCMF: Research Funding; CancerCare Manitoba/University of Manitoba: Employment; CAPhO: Honoraria; BIOGEN: Other: Licensing fee; Dana-Farber Cancer Institute: Other: Licencing fee; Gilead: Consultancy, Honoraria, Research Funding; Astra-Zeneca: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Roche: Honoraria, Licensing fee, Research Funding; Abbvie: Consultancy, Honoraria. Herishanu:Janssen: Honoraria; AbbVie: Honoraria; Roche: Honoraria. Munir:Gilead: Honoraria; Janssen: Honoraria; Novartis: Honoraria; Roche: Honoraria; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sunesis: Consultancy; Pharmacyclics: Other: TBC; Acerta: Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria; AbbVie: Honoraria. Walewska:Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Travel grant, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees, Other: Travel grant, Speakers Bureau; Takeda: Other: Travel grant; Novartis: Other: travel grant. Follows:Abbvie: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Speakers Bureau. Karlsson:Skane University Hospital: Employment. Ghia:AbbVie: Consultancy, Honoraria, Research Funding; Acerta/AstraZeneca: Consultancy, Honoraria; Juno/Celgene: Consultancy, Honoraria; Sunesis: Consultancy, Honoraria, Research Funding; Novartis: Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy; ArQule: Consultancy, Honoraria; BeiGene: Consultancy, Honoraria; Dynamo: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding. Corbett:Celgene: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Tauranga Hospital: Employment; Pathlab Waikato: Equity Ownership. Walker:Peninsula Health (public hospital): Employment; Alfred health (public hospital): Employment; Roche: Other: Travel grant. Jurczak:Incyte: Research Funding; Takeda: Research Funding; Sandoz: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Research Funding; TG Therapeutics: Research Funding; Loxo: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Research Funding; Roche: Research Funding; Gilead: Research Funding; Celgene: Research Funding; MorphoSys: Research Funding; Celtrion: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Servier: Research Funding. Salles:Epizyme: Consultancy, Honoraria; BMS: Honoraria; Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis, Servier, AbbVie, Karyopharm, Kite, MorphoSys: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Roche, Janssen, Gilead, Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Educational events; Autolus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Other: Educational events. Janssens:Novartis: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Sanofi: Consultancy, Speakers Bureau; Celgene: Speakers Bureau; abbvie: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; idem consultancy: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau. Cymbalista:AstraZeneca: Honoraria; Janssen: Honoraria; Sunesis: Research Funding; Roche: Research Funding; Gilead: Honoraria; Abbvie: Honoraria. Wierda:Juno Therapeutics: Research Funding; Janssen: Research Funding; Cyclcel: Research Funding; KITE pharma: Research Funding; Loxo Oncology Inc.: Research Funding; Genentech: Research Funding; Xencor: Research Funding; Acerta Pharma Inc: Research Funding; Pharmacyclics LLC: Research Funding; Sunesis: Research Funding; AbbVie: Research Funding; Miragen: Research Funding; Oncternal Therapeutics Inc.: Research Funding; Gilead Sciences: Research Funding; GSK/Novartis: Research Funding. Coutre:Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Astra Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Acerta: Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Research Funding; BeiGene: Other: Travel, Accommodations, Expenses & Data Safety Monitoring Committee; Genentech: Consultancy. Pagel:AstraZeneca: Consultancy; Gilead Sciences: Consultancy; Pharmacyclics: Consultancy. Skarbnik:Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Verastem Oncology: Honoraria, Research Funding, Speakers Bureau; Kite Pharma: Honoraria, Speakers Bureau; Gilead Sciences: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; Acerta: Research Funding; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Genentech: Honoraria, Speakers Bureau; CLL Society: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Speakers Bureau; Novartis: Speakers Bureau. Kamdar:AstraZeneca: Consultancy; University of Colorado: Employment; Celgene: Consultancy; Seattle Genetics: Speakers Bureau; Pharmacyclics: Consultancy. Woyach:Janssen: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding; AbbVie: Research Funding; Karyopharm: Research Funding; Loxo: Research Funding; Morphosys: Research Funding; Verastem: Research Funding. Izumi:AstraZeneca: Equity Ownership; Acerta Pharma: Employment, Equity Ownership, Patents & Royalties: Acalabrutinib patents. Munugalavadla:Acerta Pharma: Employment; Gilead Sciences: Equity Ownership; AstraZeneca: Equity Ownership. Patel:Acerta Pharma: Employment, Equity Ownership; AstraZeneca: Equity Ownership. Wang:Acerta Pharma: Employment; AstraZeneca: Equity Ownership. Wong:Acerta Pharma: Employment. Byrd:Genentech: Research Funding; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Novartis: Other: Travel Expenses, Speakers Bureau; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau; Ohio State University: Patents & Royalties: OSU-2S; Ohio State University: Patents & Royalties: OSU-2S; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; Genentech: Research Funding; Pharmacyclics LLC, an AbbVie Company: Other: Travel Expenses, Research Funding, Speakers Bureau; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; TG Therapeutics: Other: Travel Expenses, Research Funding, Speakers Bureau; Genentech: Research Funding; Acerta: Research Funding; Acerta: Research Funding; Acerta: Research Funding; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; Ohio State University: Patents & Royalties: OSU-2S; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; Janssen: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; BeiGene: Research Funding; BeiGene: Research Funding; BeiGene: Research Funding; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau; Gilead: Other: Travel Expenses, Research Funding, Speakers Bureau.

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.Disclosures: NoneFunding: None

England came to have a nation-wide administrative system for public health in the 1870s. It consisted of the local councils which were designated as sanitary authorities and the Local Government Board (LGB) as the central department. This thesis explores how public health reform was pursued under this administrative system, by tracing the career of Arthur Newsholme (1857-1943), who served as Medical Officer of Health (MOH) for Brighton, 1888-1908, and as Medical Officer to the LGB, 1908-19. The main aim of the thesis is to examine the activities in which Newsholme was involved and his views, in order to consider the development of public health activities, or state medicine, in relation to the traditional notions of government and society in England, that underlay the administrative system such as 'minimal government', , local self-government' or 'voluntarism'. The first half of the thesis deals with public health reform in Brighton during Newsholme's years of office as local MOH. Particular attention is paid to how the scope of public health administration was decided through interactions between the MOH and the local council as a representative body of the community, and to how voluntary efforts were involved in its extension. The second half deals with Newsholme's administrative ideas and activities in the process of, and after, becoming the country's leading health official. By the time of his assumption of office at the LGB, Newsholme envisaged a comprehensive state medical service as the ultimate medical ideal. The thesis examines how he tried to pursue this ideal by means of reconciling it with traditional ideas of government. Special attention is paid to Newsholme's difference from his fellow reformers such as the Webbs and George Newman, particularly in respect of their recognition of the framework of centralllocal relations that underlay the administrative system, and concerning how reforms should or could be proceeded with by means of central bureaucratic initiatives.

Mental illness is not only the leading cause of disability among adults, but there is also an emerging public health crisis in childhood mental illness. A majority of parents do not recognize symptoms of psychological disorder in their children, and current policies and programs for mental health service delivery are not sufficiently responsive to the early help-seeking dynamics of families. Using a concurrent mixed methods design, this study explored how parents in the Pikes Peak region of Colorado learned to recognize their child's mental illness. Phenomenological interviews, augmented by poetic inquiry and quantitative measurements, were used to discover factors that inhibited or enhanced five mothers' recognitions. These factors were then evaluated using a frequency distribution analysis and a rank-order correlation. The phenomenon of recognition was, for these mothers, a process of waiting to hear that â??normalâ?? had stopped, wherein they miscategorized symptoms as normal behaviors in a passing developmental phase. Prior experience with mental illness appeared to significantly decrease both the length of time and the level of distress necessary for recognition. Ultimately, recognition did not occur until someone in their social network validated their concerns and provided explicit confirmation, which galvanized them to seek treatment. Governance network collaborations can facilitate positive social change by standardizing guidance on how to differentiate symptoms of a disorder from normal childhood development. Public policies and programs such as universal mental health screening, mental health literacy, and more supportive and responsive school policies can foster dialogue for parental recognition in Colorado and throughout the country.

The relationship between mental health and public health has been debated for decades. But when services are delivered through publically funded mental health clinics, it clearly becomes a public health endeavor. One of the latest trends in mental health service delivery is the recovery concept. Developed in the 1990’s, the recovery concept represents a paradigm shift where successful treatment is defined by self-awareness, self-care, and self-fulfillment. Furthermore, patients are encouraged to assess their own progress in the recovery process. There are currently nine unique assessment tools to measure recovery progress, including the Mental Health Recovery Measure (MHRM), which was used in this study. The current study followed the implementation of the recovery model in the DeKalb Community Service Board (DeKalb CSB). DeKalb CSB has 12 locations that serve 10,000 patients with mental illness, substance abuse, and developmental disabilities each year. Only patients with primary diagnoses of mental health or substance abuse disorders were considered for this study. Implementation of the MHRM began in December 2008 and included all DeKalb CSB patients, however only new DeKalb CSB patients were considered for this study. During 13 months of data collection 960 clients completed 2 assessments and 196 completed 3 assessments. A new consumer is defined as someone who has just completed the intake process and has no record of previous service at DeKalb CSB. The current study examined trends in MHRM data in the DeKalb CSB population; and offered recommendations for future implementation.

Consumer Operated Service Providers (COSPs) are programs that are directed and administratively controlled by mental health consumers for their peers. As such, many mental health consumers have been placed in the position of serving on a COSP and often with unclear descriptions and no training. As a result, there is often a disconnect between the will of the board and the vision of the executive director, leading to tension and the possibility of failed mission. Using servant leadership as the guide, the goal of this case study was to explore the experiences of executive directors who operate Consumer Operated Service Providers (COSPs) in Texas that specialize in mental health recovery support services to better understand how they work with mental health consumers serving as their governing board members. Data were collected through semi-structured interviews with 7 executive directors of COSPs in Texas. Interview data were inductively coded, then subjected to a thematic analysis procedure. Findings revealed that the concept of servant leadership is commonly used to empower board members and create healthy working relationships between boards and executive directors, particularly around the area of motivating board members to engage with the organization. It was also revealed that the existence of COSPs, in conjunction with traditional governing boards, provides a good balance and perspective relative to strategic planning activities and fundraising. Positive social change implications include recommendations to executives of COSPs to more adequately mobilize and train consumer board members in order to achieve organizational goals that often include consumer focused care and treatment for a wide range of mental health issues.

Introduction: Adult obesity is a significant public health problem, increasing chronic disease and resulting in health and economic implications. The worksite environment provides a setting for comprehensive Worksite Health Promotion programs that can benefit employees and employers. However, the literature identifies barriers to implementation of WHP programs and achievement of positive outcomes. The purpose of this study was to determine if a DeKalb County Board of Health Employee Wellness Policy that provides work breaks during the workday for employees to engage in wellness activities has resulted in actual use of the break and employee perceived benefits. The study also examined barriers to use of the wellness break. Methods: In collaboration with the DeKalb County Board of Health, a cross-sectional study of 187 employees across eight locations was conducted. The survey instrument included both quantitative and qualitative questions and was administered electronically or in person via group administration. Results: Of survey respondents, 74% knew about the Employee Wellness Policy, 57% understood policy guidelines, and 41% had ever used wellness breaks. Respondents most often reported using wellness breaks for physical activity, most often for walking/jogging. A majority of employees using wellness breaks reported positive outcomes including: increased physical activity (64.4%), weight loss (65.2%), increased productivity (79.5%), improved work relationships (86%), increased work morale (64.4%), and increased overall positive outlook (69.9%). Barriers to utilization included: lack of time, lack of knowledge, lack of encouragement from management, and clinical setting. Management employees were significantly more likely to know about the policy and understand policy guidelines compared to non-management employees. Clinical employees were significantly less likely to ever use wellness breaks and less likely to feel their manager supports the policy. Conclusion: Sampled employees participating in wellness breaks perceive health and work-related benefits; however barriers have prevented some employees from utilizing the breaks. Quantitative and qualitative data may inform wellness policy changes for improved utilization and outcomes. Findings related to self-reported employee outcomes provide some support for a discretionary paid work break policy in the workplace.

A mix of economic interests, humanitarianism, and political concerns over future regional security and stability drove twentieth century attempts to counter indigenous morbidity and depopulation in the Pacific. However, chronic under-resourcing impeded colonial health developments. An opportunity for change came in 1913, when the International Health Board of the Rockefeller Foundation negotiated with the British Colonial Office for joint programmes to control hookworm disease in Britain's tropical dependencies. After surveying the health situation and potential for work in the Pacific region in 1916, a short-lived campaign followed in Fiji (1917-1918). The American philanthropy then focused on Australia, where co-operative hookworm programmes advanced the objectives of the Foundation and increased Federal involvement in public health while and also served the interests of "White Australia". Under Dr. Sylvester Lambert, work in the Island Pacific resumed in 1920, to promote the health and economic viability ofindigenous labour in the Australian territories of Papua and New Guinea. Plantation interests supported survey and treatment work in the British Solomon Island Protectorate, and in 1922 the Fiji campaign re-opened. Lambert expanded the International Health Board's involvement from initial hookworm survey and treatment programmes in the British and New Zealand dependencies in the South Pacific, into other aspects of public health and medical services: water supplies and latrines; a bacteriological laboratory in Suva; hospital expansion; and medical education. Integrating local initiatives, Lambert advocated a Unified Pacific Medical Service, in which key elements were centralisation., rationalisation and affordability. The most radical aspect of his plan was the development of a Central Medical School for the Pacific territories, to provide targeted professional training for indigenous medical practitioners who had a crucial (although still subservient) role in economic service delivery and the diffusion of biomedical understanding among local communities. Also controversial - and Jess successful - were attempts to improve the career opportunities and standard of European Medical Officers, by creating a single medical service for the British Pacific dependencies. Attempts to achieve these goals influenced the shape and outcome of health and medical services which developed in the different island communities by 1939, when Lambert's retirement signalled an end to active Rockefeller Foundation involvement. This thesis examrnes the ways in which colonial administrations, medical staff, the Rockefeller Foundation, labour and mission interests, and Pacific Islanders interacted in the introduction of the dramatically new medical concepts and practices of western science (and specifically tropical medicine) and their effect on indigenous populations.

Community coalitions have had successful reductions in adolescent substance abuse, and the legalization of marijuana presents an opportunity for these coalitions to re-evaluate their current methods and messages for preventing adolescent marijuana usage. Using the theory of planned behavior, the purpose of this qualitative study was to determine how legalization of marijuana for recreational purposes affects the methods and messages of coalitions and how the coalition members perceive their efforts to reduce adolescent marijuana usage post-legalization in Colorado. Participants were obtained by recommendations from the executive director in each of four coalitions. A purposive sample of 12 coalition members was interviewed via telephone and recorded. Data from the transcripts were analyzed, coded, and repeated as necessary until themes arose. The major themes suggested that programs alone were inadequate to change adolescents' perception of marijuana, despite the current success of the methods and messages expressed by coalition members. Recommendations included continuing current programs despite legalization, partnering with marijuana retail shops, engaging youth through multiple tactics, developing relationships with youth, and improving parent education to help prevent adolescent marijuana usage. These themes could shape the development of programs that guide adolescents into making better choices, which could ultimately lead to positive social change.

The purpose of this study was to examine the behavior, attitudes, and knowledge regarding tobacco use of students enrolled in orientation courses in Tennessee community colleges. The six community colleges selected for the study were members of the Tennessee Board of Regents system that offered mandatory orientation courses. Data were collected by use of the College Tobacco Behavior, Attitude, and Knowledge Survey . A response rate of (72.5%) from 700 students was analyzed. Three research questions guided the study and 17 null hypotheses were formulated and tested at the.05 alpha level of significance. Data were analyzed by using t -tests, crosstabs, analysis of variance, Chi-square, and Pearson's r correlation coefficients. Results of the study revealed that, of those students who ever smoked regularly, differences in age and ethnicity were found and no differences were found between males and females. There was no difference between males and females and when they first started smoking cigarettes regularly; however, differences were found among students of varying ethnicities. There was no relationship between students' age and how many days they smoked; however, differences were found between males and females and ethnicities. There was no relationship regarding students' age and no difference between males and females and how many days they used smokeless tobacco. There were differences between smokers' and nonsmokers' attitudes pertaining to a smokefree campus, a designated smoking area indoors, and that a tobacco awareness program would be beneficial to college students. There was no relationship between knowledge score and age, and no difference between males and females, and smokers and nonsmokers regarding their knowledge score. However, differences in knowledge scores were found among students of different ethnicities.

Maternal depression during pregnancy can have a negative impact on the developing child. Numerous studies have focused on postpartum depression and the influences on infant outcomes; however, there are limited data on pregnancy-related depression. The problem addressed in this study was the inadequacy and insufficiency of depression screening during the pregnancy period and access to quality-related health services for women. The purpose of this quantitative retrospective study was to test social cognitive theory on low birth weight and prenatal care adherence to pregnancy-related depression in women residing in Colorado. This research measured an association between pregnancy-related depression and both low birth weight prevalence and prenatal care adherence. Secondary analysis of archived data included data from Colorado vital statistics and the 2016 Colorado Pregnancy Risk Assessment Monitoring System. Data were analyzed using Chi-square analysis and multiple logistic regression. The findings showed that pregnancy-related depression was statistically significant of very low birth weight. I reported a summary of findings on p. 68. Biopsychosocial variables were significant to pregnancy-related depression. Pregnancy-related depression was significant in prenatal and postpartum depression. The implications of these findings for social change include the potential to support improved depression screening strategies during pregnancy that may contribute to transformation within the community by promoting more efficient and accessible healthcare for women.

AbstractWhile the subset of introduced species that become invasive is small, the damages caused by that subset and the costs of controlling them can be substantial. This chapter takes an in-depth look at the economic damages non-native species cause, methods economists often use to measure those damages, and tools used to assess invasive species policies. Ecological damages are covered in other chapters of this book. To put the problem in perspective, Federal agencies reported spending more than half a billion dollars per year in 1999 and 2000 for activities related to invasive species ($513.9 million in 1999 and $631.5 million in 2000 (U.S. GAO 2000)). Approximately half of these expenses were spent on prevention. Several states also spend considerable resources on managing non-native species; for example, Florida spent $127.6 million on invasive species activities in 2000 (U.S. GAO 2000), and the Great Lakes states spend about $20 million each year to control sea lamprey (Petromyzon marinus) (Kinnunen 2015). Costs to government may not be the same as actual damages, which generally fall disproportionately on a few economic sectors and households. For example, the impact of the 2002 outbreak of West Nile virus exceeded $4 million in damages to the equine industries in Colorado and Nebraska alone (USDA APHIS 2003) and more than $20 million in public health damages in Louisiana (Zohrabian et al. 2004). Zebra mussels (Dreissena polymorpha) cause $300–$500 million annually in damages to power plants, water systems, and industrial water intakes in the Great Lakes region (Great Lakes Commission 2012) and are expected to cause $64 million annually in damages should they or quagga mussels (Dreissena bugensis) spread to the Columbia River basin (Warziniack et al. 2011).

Along the Colorado Plateau’s high-standing Mogollon Rim in northern Arizona’s Coconino National Forest stands a small patch of big trees that matured well before Europeans came to North America. Massive ponderosa pines, and even pinyon pines and western junipers, tower above the forest floor, shutting out all but the most shade-tolerant competitors. Few places like this one still exist anywhere in the United States, even on national forest lands. A tourist hoping to see all the diversity that earliest European arrivals found commonplace in the western landscape must seek out a wide scattering of isolated enclaves across the region. Western forests no longer contain the grand glades and lush thickets that our forerunners encountered because most woodlands, especially those owned by the public, largely serve a wide variety of human purposes, as campsites or home sites, board-feet of lumber, potential jobs, recreational playgrounds, and even temples of the spirit. We also rely on forests to maintain habitat for endangered species and seed banks for restoring depleted biodiversity—and to provide us with clean air and water, stable hillside soils, and flood control in wet years. Forests must perform these roles while being consumed, fragmented by roads, and heavily eroded. But there is no guarantee that these most beloved and iconic of natural resources can sustain such a burden. Federal, state, and local government agencies oversee and regulate western U.S. forest lands and their uses, trying to manage the complex and only partly understood biological interactions of forest ecology to serve public needs. But after nine decades of variable goals, and five decades of encroaching development, western woodlands are far from healthy. Urban pollution and exotic tree diseases, some brought by humans, are killing pines, firs, and oaks. Loggers have more than decimated the oldest mountainside forests—most valuable for habitat and lumber alike—with clearcutting practices that induce severe soil erosion. Illegal clearings for marijuana farms are increasing.

Corporate-backed philanthropic groups have become increasingly involved in political processes in the past ten years. The Koch Brothers’ and their political advocacy groups, have become particularly prominent players. Their influence extends beyond high-profile state-level elections and increasingly have begun investing in municipal affairs of small cities and towns, such as school board elections like Kenosha, Wisconsin and Jefferson County, Colorado in the US. This chapter asks, why do groups like Americans for Prosperity care about small-town school board elections? This chapter highlights two particularly significant local examples in the United States: school board elections in Kenosha, Wisconsin, in 2014 and Jefferson County, Colorado in 2015. Through documentary analysis of school board records, news reports, and district evaluations, in both Wisconsin and Colorado, we chronicle the political contest for control of each school board. Our findings illustrate the ideological and political project of corporate, conservative influence in public education in the United States.

This chapter studies Article IX of the Colorado Constitution, on public schools. Sections 1 and 15 establish the basic structure for administration of the state’s schools. Section 1 provides for an elected State Board of Education. Section 15 authorizes the general assembly to create school districts “of convenient size” and provides for an elected board of education for each, which “have control of instruction in the public schools of their respective districts.” Section 16 forbids the legislature and the State Board of Education from prescribing public school textbooks. Section 2 requires free public schools open to all residents between ages six and twenty-one. Sections 3, 4, 5, 9, and 10 concern the state public school fund and trust lands. Section 17 sets minimum levels of financial support for schools. Section 8 bans the teaching of sectarian tenets or doctrines in public schools and the use of religious criteria in hiring teachers or admitting students. Section 11 empowers the general assembly to require school attendance or education by other means.

Public health is focused on health at the population level. This broad focus allows public health officials to use strategies and tools that differ from those used by health care providers, who focus on individual patients. Determinants of health include access to education, safe working environments, and safe and reliable sources of nutrition. Community empowerment aims to create sustainable change through vocational training, health education, policy changes, and other actions. Quarantine, incarceration, or forced treatment can be used by public health agencies if they provide proof of danger to the community. Licensure authorizes an agency to create rules that regulate the activities of the professional or entity; medical examinations can be mandated. The ethical principles of nonmaleficence and beneficence are the same for public health and medicine. Ethics in public health also consider the needs of the population and how that may interfere with individual freedoms. Various types of cost analyses can be performed to determine where best to apply available public health funds.