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PubMed2006

Deaths from violence in North Carolina, 2004: how deaths differ in females and males.

OBJECTIVE: To identify gender differences in violent deaths in terms of incidence, circumstances, and methods of death. DESIGN: Analysis of surveillance data. SETTING: North Carolina, a state of 8.6 million residents on the eastern seaboard of the US. SUBJECTS: 1674 North Carolina residents who died from violence in the state during 2004. METHODS: Information on violent deaths was collected by the North Carolina Violent Death Reporting System using data from death certificates, medical examiner reports, and law enforcement agency incidence reports. RESULTS: Suicide and homicide rates were lower for females than males. For suicides, females were more likely than males to have a diagnosis of depression (55% v 36%), a current mental health problem (66% v 42%), or a history of suicide attempts (25% v 13%). Firearms were the sole method of suicide in 65% of males and 42% of females. Poisonings were more common in female than male suicides (37% v 12%). Male and female homicide victims were most likely to die from a handgun or a sharp instrument. Fifty seven percent of female homicides involved intimate partner violence, compared with 13% of male homicides. Among female homicides involving intimate partner violence, 78% occurred in the woman's home. White females had a higher rate of suicide than African-American females, but African-American females had a higher rate of homicide than white females. CONCLUSIONS: The incidence, circumstances, and methods of fatal violence differ greatly between females and males. These differences should be taken into account in the development of violence prevention efforts.

Adolescent↗

PubMed1995

The North Carolina Breast Cancer Screening Program: foundations and design of a model for reaching older, minority, rural women.

Breast cancer screening programs do not reach all women at the same rate. Screening mammography use varies according to sociodemographic characteristics; mammography utilization is highest among women in their fifties but then decreases with age. In North Carolina, breast cancer is a particular burden for Black and lower-income women. Black women are more likely to be diagnosed with late stage disease, and their rate of breast cancer mortality is higher than it is for White women even though the incidence in White women is greater. Older, Black, and low-income women are less likely to obtain screening by mammography and clinical breast examination. The Black-White gap is even more pronounced among rural women, in part because they are more likely to be poor. The North Carolina Breast Cancer Screening Program (NC-BCSP) was established to increase the rate of regular mammography screening by an absolute 20% in 3 years among older Black women ages 50 and older in five rural counties in the eastern part of the state. In this paper, we describe the genesis of this comprehensive community intervention model, highlighting the behavioral science constructs, health education principles, and theories of behavioral and organizational change that form its conceptual foundation. NC-BCSP's theoretical foundations include the social ecological perspective, the PRECEDE model of health promotion, the Health Belief Model of individual change, and the "stages of change" transtheoretical model. We also review the experiences and lessons learned from two previous outreach initiatives in North Carolina that provided valuable "lessons" in the development of the NC-BCSP intervention model. In the second half of the paper, we describe the actual NC-BCSP interventions, activities, and evaluation tools, citing specific examples of how the underlying theories are implemented. NC-BCSP's goal goes beyond individual behavior change to raise low mammography screening rates among Black women in rural North Carolina. Its ultimate objective is to create linkages across agencies, and between agencies and communities, that will endure after the research project ends.

Adult↗

PubMed1990

Ciguatera fish poisoning: an outbreak associated with fish caught from North Carolina coastal waters.

Ten persons who had eaten at a seafood meal in North Carolina had gastrointestinal and neurologic symptoms suggestive of ciguatera fish poisoning. In five persons, the neurologic morbidity lasted 30 days or longer. The meal included barracuda, dolphin fish (mahimahi), and yellow-fin tuna, all of which were caught in North Carolina coastal waters. Analysis of food-specific attack rates implicated the barracuda as the probable cause of the outbreak. We believe this is the first suspected or confirmed report of ciguatera fish poisoning associated with consumption of fish harvested from mainland US coastal waters outside of Florida. Physicians treating patients with a syndrome resembling ciguatera fish poisoning should inquire about consumption of fish not only from areas where the disease is endemic but also from the southeastern US.

Adult↗

PubMed1993

Who meets the special health care needs of North Carolina schoolchildren?

In January 1991, 135 school districts and six specialty schools in North Carolina were surveyed to obtain data regarding the performance of specific health-related procedures in the school setting. Results indicate a patchwork approach to meeting the special health care needs of these children, and that a variety of school personnel as well as parents and health professionals are involved in coordinating and performing the procedures. Teachers and teacher assistants perform these health-related procedures 44% of the time. Registered nurses coordinate the care, including assessment, care planning, and supervision to assure continued competence of the care provider and safety for the student less than 45% of the time. Some 13 school districts reported having no school nurse services. Efforts have begun to legislate a statewide policy with appropriations for a registered nurse to provide an initial evaluation of the student's needs, develop care plan, and provide ongoing supervision of services to assure that safe, appropriate care is being provided to all students with special health-related needs in North Carolina.

Adolescent↗

PubMed1995

Smokeless tobacco use among American Indian women--southeastern North Carolina, 1991.

Rates of smokeless tobacco use among U.S. adults are highest for young males, American Indians/Alaskan Natives, persons residing in the South or rural areas of the country, and those of low socioeconomic status (1). In addition, the prevalence of smokeless tobacco use has been reported to be high in tobacco-producing regions, including rural North Carolina and Kentucky (2,3). In southeastern North Carolina, reports from physicians and dentists suggested a high prevalence of smokeless tobacco use in the local American Indian population, the Lumbee--particularly among women and children. In response to these reports, the Department of Family and Community Medicine at the Bowman Gray School of Medicine of Wake Forest University analyzed data from a National Cancer Institute-sponsored cervical cancer prevention program to estimate the prevalence of smokeless tobacco use during 1991 among Lumbee women aged > or = 18 years residing in Robeson County, North Carolina (1990 population: 105,179).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Characterization of Lyme disease spirochetes isolated from ticks and vertebrates in North Carolina.

Borrelia burgdorferi isolates obtained from numerous locations and from different hosts in North Carolina, were compared to previously characterized strains of the Lyme disease spirochete and other Borrelia spp. The spirochete isolates were confirmed to be B. burgdorferi sensu stricto based on immunofluorescence (IFA) using a monoclonal antibody to outer surface protein A (Osp A [H5332]) and polymerase chain reaction (PCR) using a species-specific nested primer for a conserved region of the gene that encodes for flagellin. In addition, the isolates tested positive in Western blots with species-specific monoclonal antibodies for outer surface protein A and OspB (84c), and the genus-specific, monoclonal antibody to flagellin (H9724). Infectivity studies with several of these isolates were conducted using Mus musculus and Oryzomys palustris and the isolates exhibited markedly different levels of infectivity. This study demonstrates that B. burgdorferi sensu stricto is present and naturally transmitted on the Outer Banks and in the Coastal Plain and Piedmont regions of North Carolina.

Animals↗

PubMed1992

Counseling practices of primary-care physicians--North Carolina, 1991.

Because 80% of the U.S. population visits a physician each year (1), physicians are an important source for health education. In particular, physicians have unique opportunities to influence and modify health-risk behaviors of their patients. During 1991, the North Carolina Department of Environment, Health, and Natural Resources (DEHNR), the University of North Carolina at Chapel Hill, and CDC conducted a survey of nonmilitary primary-care physicians practicing in North Carolina regarding counseling and referral practices. This report summarizes results of this survey, including estimates of the proportion of primary-care physicians who counsel and/or refer for treatment patients who smoke, abuse drugs or alcohol, or have diet- or nutrition-related problems.

Adult↗

PubMedDate not supplied

Rubella outbreaks among Hispanics in North Carolina: lessons learned from a field investigation.

OBJECTIVE: To describe the epidemiology and the lessons learned from two simultaneous, but unrelated, outbreaks of rubella in North Carolina affecting mostly Hispanic immigrants of Mexican origin. METHODS: A case and contact investigation was conducted at industrial work sites and Hispanic communities between March 26 and June 15, 1996, using both structured and informal interviews. Active surveillance was conducted at hospitals, clinical laboratories, primary care physicians' offices, local health departments, and migrant health centers to identify additional cases. Rubella specific IgM testing was performed by the North Carolina State Laboratory to confirm cases. Vaccination clinics were conducted in communities and at work sites with a large Hispanic population in affected counties to reduce the number of susceptible persons. RESULTS: Eighty-three confirmed cases of rubella were reported: 75 cases from the first outbreak and 8 from the second. The mean age of cases from both outbreaks was 24 and 20 years, respectively. Only three cases occurred among children under five years of age, two in the first outbreak and one in the second. Seventy-one (95%) cases in the first outbreak and all 8 cases in the second outbreak were Hispanics; 21 (28%) cases from the first and 3 (37%) from the second outbreak were females, and a total of 65 (78%) cases from both outbreaks were industrial workers. Six women with confirmed cases in the first outbreak were pregnant at the time of exposure. No females cases were pregnant in the second outbreak. CONCLUSIONS: The outbreaks in North Carolina confirmed the persistent susceptibility to rubella in Hispanics and persons migrating from countries where the rubella vaccine is not used for routine childhood vaccination. The ultimate goal of rubella vaccination programs is to prevent fetal infection and congenital rubella syndrome (CRS). Thus, to eliminate rubella from the United States, efforts should focus on understanding new emerging patterns of disease transmission and vaccinating susceptible adults in settings where they congregate.

Adolescent↗

PubMed2003

Infant mortality, low birth weight, and prematurity among Hispanic, white, and African American women in North Carolina.

OBJECTIVES: The study was undertaken to compare Hispanic birth outcomes with those of white and African American women in North Carolina and to examine variables associated with adverse birth outcomes among Hispanic women. STUDY DESIGN: Retrospective comparison of birth outcomes by ethnicity/race, from linked birth/infant death certificates in North Carolina (1993-1997) was conducted. Multivariate, binary logistic regression and chi(2) analysis were used to examine relationships between available medical and sociodemographic index values and composite birth outcomes among Hispanic women. RESULTS: Infant mortality rates were lowest among Hispanic women. Low birth weight and prematurity rates were similar to those of white women and lower than those of African American women. Variables significantly related to healthy composite birth outcomes among Hispanic women included higher education, no preterm delivery history, prenatal care, marriage, and no daily tobacco use. CONCLUSION: Hispanic birth outcomes in North Carolina were better than those of African American women and similar to those of white women, despite use of prenatal care and socioeconomic characteristics similar to African American women.

Adult↗

PubMed1991

Indoor 222Rn levels in New York State, North Carolina, and South Carolina.

Results are presented from approximately 9000 Rn measurements made in New York state, North Carolina, and South Carolina. The estimated statewide geometric mean concentrations were 28.1 Bq m-3 and 55.8 Bq m-3 for basements in New York state, 27.5 Bq m-3 for living rooms and 108.9 Bq m-3 for basements in North Carolina, and 25.0 Bq m-3 for living rooms in South Carolina.

Air Pollutants, Radioactive↗

PubMed2002

Effect of the North Carolina State Children's Health Insurance Program on Beneficiary Access to Care.

BACKGROUND: In the fall of 1998, North Carolina implemented its State Children Health Insurance Program, North Carolina Health Choice for Children (NCHC). This stand-alone, fee-for-service program quickly enrolled large numbers of children and has been considered one of the State Children Health Insurance Program success stories. OBJECTIVE: To explore the perceptions of parents of children enrolled in NCHC regarding their children's access to health care services before and after enrollment in the NCHC. DESIGN AND SETTING: Qualitative and quantitative data analyses are combined to assess program effectiveness. Two waves of surveys were fielded. A baseline survey asked parents of children newly enrolled in NCHC questions about their child's health experiences before enrollment in NCHC. Parents who responded with baseline data were resurveyed 1 year later to collect information on their child's experiences while insured by NCHC. PARTICIPANTS: Parents of 987 children newly enrolled in NCHC in the summer of 2000, randomly chosen within 3 age group strata. RESULTS: The NCHC has been successful in improving access to health care for low-income children. Parents reported that the program helped make health services financially accessible to their children, enabling them to get needed physician's care, eyeglasses, or prescription drugs. A significantly higher percentage of children received care in the private sector, increasing from 62% to 75% for well-child care visits and 67% to 78% for acute care. The percentage of children with unmet medical needs dropped significantly from 20% to just 2% after enrollment in NCHC. The improvement in access to care is much more striking for the older age groups and for children who were uninsured prior to NCHC enrollment (rather than those who graduated from Medicaid into the program). Despite these gains, there are still substantial numbers of children who are not receiving age-appropriate well-child care. CONCLUSION: The NCHC has successfully improved access to care for its enrollees.

Adolescent↗

PubMed2003

Passage of 100% tobacco-free school policies in 14 North Carolina school districts.

Though comprehensive tobacco-free school policies constitute an important component of state tobacco control efforts, little research exists about their adoption process. In the past two years, efforts occurred in North Carolina to increase the number of school districts adopting 100% tobacco-free school policies. As part of the North Carolina Youth Empowerment Study (NC-YES), researchers developed a school tobacco policy interview guide to conduct interviews with 40 key people (e.g., school board member, principal, etc.) in each of 14 school districts that adopted a 100% tobacco-free school policy by the end of 2001. Results showed seven districts adopted their school policy in the past two years. Seven themes emerged: 1) Catalysts: Local adult and youth "champions" facilitated policy change; 2) Process of Adoption: Most school policies were adopted with an administrator or other adult initiating the change, but youth involvement increased in recent years; 3) Methods of Adoption: Advocates personalized health concerns by focusing on children and role modeling by adults; 4) Political Leadership: Governors of North Carolina, through letters to school districts and a policy summit, played an important role in stimulating policy change; 5) Barriers to Adoption: Concerns expressed before policy adoption, about teacher attrition or inability to enforce the policy, did not occur as feared; 6) Enforcement Issues: A key to policy enforcement involved being consistent, supportive, and firm; and 7) Economics of Tobacco Farming/Manufacturing: Though a local tobacco economy did little to influence policy adoption, districts that adopted policies were not located in counties with heavy tobacco production. Public health advocates may use this information to encourage school districts to adopt 100% tobacco-free school policies.

Adult↗

PubMed2001

Stressful life events and physical abuse among pregnant women in North Carolina.

OBJECTIVES: This study estimates the prevalence of stressful life events and physical abuse among North Carolina women prior to infant delivery, and examines potential associations between abuse and the other stressors. METHODS: Data were from the North Carolina Pregnancy Risk Assessment Monitoring System, a statewide representative survey of over 2,600 postpartum women. The survey assessed women's sociodemographic characteristics and their experiences of physical abuse and 13 other stressful life events before delivery. The prevalences of each life event and abuse were estimated. Logistic regression modeled the probability of women having high levels of stressful life events in relation to physical abuse and sociodemographics. RESULTS: Most women were married, white, high school graduates, aged 20 or older. The most common stressful life events were residential moves, increased arguing with husbands/partners, family member hospitalizations, financial hardship, and deaths of loved ones. Fourteen percent of women had high levels of stressful events (5 or more), and almost 9% were physically abused. Abuse was positively associated with increased arguing with husbands/partners, physical fighting, having someone close with an alcohol/drug problem, becoming separated/divorced, and financial hardship. Logistic regression analysis showed that a high level of stressful life events was significantly more likely among women abused both before and during pregnancy (OR = 11.94) and among women abused before but not during pregnancy (OR = 14.19). CONCLUSIONS: The high frequency of multiple stressful events and abuse in women's lives suggests that women's care providers should ask their patients about these issues, and offer appropriate referral/interventions to those in need.

Adolescent↗

PubMed1995

222Rn in water: a study of two sample collection methods, effects of mailing samples, and temporal variation of concentrations in North Carolina groundwater.

The U.S. Environmental Protection Agency has proposed a drinking water standard for 222Rn in public water supplies. When promulgated, operators of public water supplies will be required to determine water 222Rn concentrations. Most likely, water samples will be collected and mailed to laboratories for analyses. Additionally, it is probable that homeowners will test private well water in a similar manner by collecting water samples and mailing them to a laboratory for 222Rn analyses. In anticipation of these actions, this study was conducted to evaluate two methods of water sample collection and to evaluate the potential losses of 222Rn from water samples mailed to a laboratory. Thirdly, temporal variations in 222Rn concentrations in several groundwater supplies in North Carolina were examined. Water supplies at four sites in eastern North Carolina and five sites in western North Carolina were sampled over a 7-mo period beginning in the fall of 1993 and continuing through the spring of 1994. Samples were analyzed using a liquid scintillation method. This study showed that a "slow-flow" method is not only suitable for sample collection, but may be the preferable method for water sample collection since slow-flow collection resulted in less 222Rn loss than was observed during syringe collection, i.e., the water 222Rn concentrations in samples collected by the slow-flow method were generally higher. Further, based on this study, mailing water samples to a laboratory for analysis should not have a substantial effect on the measured 222Rn concentrations. Consequently, water samples can be collected by the slow-flow method by water supply operators, as well as homeowners, and mailed to laboratories for 222Rn analyses with reasonable assurance that the samples have not suffered significant 222Rn loss. Temporal variations in water 222Rn concentrations were observed in this study. One factor complicating the study of temporal variations in 222Rn concentrations was the striking influence that inconstant water usage and inadequate well purging prior to sample collection had on 222Rn loss from the water.

Evaluation Studies as Topic↗

PubMed2004

Health care experiences of African American teen women in eastern North Carolina.

BACKGROUND AND OBJECTIVES: Women, especially women of color, are a vulnerable population in eastern North Carolina. This study investigated the health care experiences of Southern, rural, African American adolescent women. METHODS: Four focus groups were conducted in three counties in eastern North Carolina in the spring of 2000. A total of 44 teen women ages 16-19 participated; 38 were African American. RESULTS: Participants emphasized the following themes: (1) seeking help for sexual health, (2) obtaining health information from sources other than the doctor, (3) gender and race preferences, (4) communication with physicians, and (5) good and bad doctors' visits. CONCLUSIONS: To provide quality care to African American teenage women, it is critical to listen and understand their experiences. Most importantly, medical educators must be cognizant of cultural issues and how they can impede as well as enhance patient care. This study supports the need to educate students, residents, and practicing physicians on how to provide culturally sensitive and competent care.

Adolescent↗

PubMed1998

Treatment options, selection, and satisfaction among African American and white men with prostate carcinoma in North Carolina.

BACKGROUND: In the U.S., prostate carcinoma mortality is greatest among African Americans. In North Carolina, the state with the fourth largest population of African Americans, the prostate carcinoma mortality rate is 2.5 times greater among African Americans than among whites and is the highest reported rate for any state in the nation. To explore potential reasons for the racial differential in mortality, a study was undertaken to determine whether differences related to treatment existed between African American and white men who were diagnosed with prostate carcinoma during the period 1994-1995. METHODS: Cases were selected from 16 institutions within a region comprising 63 contiguous counties where the overall population was >20% African American. A stratified design was employed to accrue subjects into groups of even size according to race and disease stage (n = 231). A telephone survey was conducted, which assessed treatment options discussed by patients with their physicians, treatment(s) received, factors influencing treatment, satisfaction with treatments discussed and options given, and sociodemographic information. RESULTS: All measures related to treatment were consistently associated with stage at diagnosis (P < 0.001) rather than other variables measured (i.e., race, age, income, comorbidity, education, and residential status). Furthermore, most subjects reported that their physicians presented several treatment options (65%), that they were satisfied with the options presented (90%), and that the physician was the most important factor influencing their treatment decision (57%). CONCLUSIONS: These data suggest that African American and white men in North Carolina receive comparable treatment for prostate carcinoma. Therefore, efforts to reduce the racial disparity in mortality should be directed toward lessening the high incidence of later stage disease at diagnosis and exploring potential biologic differences that may increase the risk of more aggressive disease among African Americans.

Aged↗

PubMed1998

A quantitative analysis of dental radiography quality assurance practices among North Carolina dentists.

OBJECTIVE: The purpose of this study was to assess the level of compliance with dental radiography quality assurance recommendations on the part of dental practitioners in the state of North Carolina and to determine whether the age of the practice was an influential factor affecting compliance. STUDY DESIGN: On-site survey inspections by state officials using measurement devices and questionnaires were used to assess x-ray machine parameters and gather information about quality assurance practices in private offices in the state of North Carolina. RESULTS: There were approximately three intraoral units per facility, with an average entrance skin exposure of 267 mR per bitewing radiograph. There were no significant differences associated with the age of the practice in quality assurance practices except with respect to the type of processor used: dentists who had been in practice for more than 20 years used manual processing more frequently than those who had been in practice for less than 20 years (p = 0.001). CONCLUSIONS: Most practices showed a high level of compliance with equipment function requirements. North Carolina dentists are making an effort to comply with the American Academy of Oral and Maxillofacial Radiology recommendations. However, the use of faster film and rectangular collimation was much less than expected. Only 9% of the participants reported using E-speed film exclusively, and only 7.33% reported using rectangular collimation.

Dentists↗

PubMed2000

Socioeconomic distress and health status: the urban-rural dichotomy of services utilization for people with sickle cell disorder in North Carolina.

Research on sickle cell disorder has not focused attention on the socioeconomic background and geographic distribution of people with the disease. This study examines 1,189 persons with sickle cell disorder in North Carolina during 1991 to 1995. Three indices were developed using clients' medical, psychosocial and socioeconomic characteristics for the purpose of analyzing the urban-rural difference in treatment for sickle cell disease. The study observed a wide disparity in these indices between urban and rural population groups. Also, differences were observed in the utilization of services and clients' health status. The findings suggest that utilization of services is directly related to socioeconomic condition facing clients and clinic distance from clients. They further suggest that people in rural areas who have high distress levels and are far from clinics have limited access to health care. The limited availability of medical and health care in rural areas, as well as other support systems calls for an increase in community based healthcare services. These findings should be of particular interest to the state level sickle cell disorder program in North Carolina and other areas with a large rural population. Enhanced support for all persons with sickle cell disorder in North Carolina, particularly those in rural areas, is critical.

Adolescent↗