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PubMed2001

Where children sit in cars: the impact of Rhode Island's new legislation.

OBJECTIVES: This study evaluated the impact of Rhode Island's legislation requiring children younger than 6 years to sit in the rear of motor vehicles. METHODS: Roadside observations were conducted in Rhode Island and Massachusetts in 1997 and 1998. Multivariate regression was used to evaluate the proportion of vehicles carrying a child in the front seat. RESULTS: Data were collected on 3226 vehicles carrying at least 1 child. In 1998, Rhode Island vehicles were less likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant changes in child passenger seating behavior occurred in Massachusetts during that period. CONCLUSIONS: Rhode Island's legislation seems to have promoted safer child passenger seating behavior.

Age Factors↗

PubMed1999

The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island.

OBJECTIVES: The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. METHODS: Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. RESULTS: Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). CONCLUSIONS: Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care.

Adolescent↗

PubMed2003

Genetic diversity and temporal variation in the cyanophage community infecting marine Synechococcus species in Rhode Island's coastal waters.

The cyanophage community in Rhode Island's coastal waters is genetically diverse and dynamic. Cyanophage abundance ranged from over 10(4) phage ml(-1) in the summer months to less then 10(2) phage ml(-1) during the winter months. Thirty-six distinct cyanomyovirus g20 genotypes were identified over a 3-year sampling period; however, only one to nine g20 genotypes were detected at any one sampling date. Phylogenetic analyses of g20 sequences revealed that the Rhode Island cyanomyoviral isolates fall into three main clades and are closely related to other known viral isolates of Synechococcus spp. Extinction dilution enrichment followed by host range tests and PCR restriction fragment length polymorphism analysis was used to detect changes in the relative abundance of cyanophage types in June, July, and August 2002. Temporal changes in both the overall composition of the cyanophage community and the relative abundance of specific cyanophage g20 genotypes were observed. In some seawater samples, the g20 gene from over 50% of isolated cyanophages could not be amplified by using the PCR primer pairs specific for cyanomyoviruses, which suggested that cyanophages in other viral families (e.g., Podoviridae or Siphoviridae) may be important components of the Rhode Island cyanophage community.

Bacteriophages↗

PubMed2003

Arbovirus surveillance in Rhode Island: assessing potential ecologic and climatic correlates.

During 1995-2000, mosquitoes were collected from sites throughout Rhode Island and tested for the presence of arboviruses. Mosquito trapping was done weekly from June to October with CO2-baited light traps. In all, 186,537 mosquitoes belonging to 7 different genera were collected, of which Coquillettidia perturbans was most abundant. A total of 6,434 pools were processed for arbovirus isolation, from which 193 arboviral isolations were made. These included 109 Highlands J, 71 eastern equine encephalomyelitis, 1 California encephalitis serogroup, 2 Jamestown Canyon, 3 Cache Valley, and 9 Flanders viruses. Our isolations of Flanders virus represent the 1st reported occurrence of this virus in Rhode Island. After the 1999 sudden occurrence of the West Nile virus (WN) in the New York City area, a dead-bird surveillance program was started to test for this virus. Although no isolations of WN were made from mosquitoes, 87 virus isolations were made from a total of 330 wild birds tested. All the WN-infected birds were either American crows or blue jays. Isolation of WN from dead birds marked the 1st documented appearance of this virus in Rhode Island. Significant interannual variation of arbovirus activity in Rhode Island prompted us to examine if climate-associated factors such as rainfall and temperature correlate with virus activity. Total rainfall amounts from May to June were higher than normal in 1996 and 1998. These years showed significantly higher arbovirus activity. Deviations from normal temperature showed low correlation with arbovirus activity during the 6-year study period. Therefore, precipitation appeared to be more important than temperature in predicting arbovirus activity in Rhode Island.

Animals↗

PubMedDate not supplied

Decreased breast cancer tumor size, stage, and mortality in Rhode Island: an example of a well-screened population.

BACKGROUND: Since the 1980s, Rhode Island has achieved one of the highest mammography screening rates in the nation. The objective of this study was to determine the effect of high mammography rates on breast cancer presentation and outcomes. METHODS: Using the Rhode Island Cancer Registry, the incidence of DCIS and invasive cancer, tumor size, stage, rate of BCS and mortality from breast cancer were determined from 1987 to 2001. RESULTS: Over 80% of Rhode Island women report routine mammography. From 1987 to 2001, there were 1,660 cases of DCIS and 11,301 cases of invasive breast cancer. Although the overall incidence of invasive cancer was stable, the median diameter decreased from 2 cm to 1.5 cm with a significant decrease in the incidence of stage III and IV cancers. There was an increase in BCS for women 50 to 64 years of age with stage I and II disease and for women older than 65 years with stage I disease. Disease-specific mortality decreased by 25%. CONCLUSIONS: High mammography rates in Rhode Island are associated with smaller and earlier-stage breast cancers. This largely accounts for the decreased mortality from breast cancer and the increased rate of BCS.

Adult↗

PubMed1981

Evaluation of the Rhode Island child restraint law.

In Rhode Island, a law went into force July 1, 1980, requiring drivers to transport children who are in the front seats of vehicles in properly used child restraints. In the fourth month of the law, restraint use and travel in rear seats had increased moderately; the net result was an increase in proper restraint use in rear seats (11 to 23 per cent) and a decrease in unrestrained, front seat travel (41 to 26 per cent). (Am J Public Health 1981;71:742-743.)

Child↗

PubMed2006

Cultivating systemic capacity: the Rhode Island tobacco control enhancement project.

This paper describes the Rhode Island Tobacco Control Enhancement Project (TCEP), a state-university-community technical assistance system. TCEP was developed under the auspices of the Rhode Island Department of Health's Tobacco Control program and was designed to build capacity among nine community-based organizations to mount comprehensive tobacco control interventions in five diverse communities within the state. This paper: (1) provides a description of community mobilization; (2) presents a logic model for planning and decision making used by state-university-community partners; (3) describes training, technical assistance services and implementation; and, (4) describes the evaluation and program improvement activities used to support on-going project development.

Comprehensive Health Care↗

PubMedDate not supplied

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.

Adult↗

PubMed1984

A distributional assessment of Rhode Island's Catastrophic Health Insurance Plan (CHIP).

Since 1975, Rhode Island has operated a government-sponsored catastrophic health insurance program that is consistent in spirit with several of the national health insurance proposals. An important but often overlooked effect of such a program is its effect on the distribution of income. Actual claims data for the years 1975-79 are available for the Rhode Island program permitting direct estimation of an average benefit per family and an average tax burden per family in each of 12 income classes. This permits an assessment of the program's redistributional effects.

Cost Allocation↗

PubMed1990

Framework for the Rhode Island response to the injury problem.

Injuries are the fourth leading cause of death in Rhode Island as well as the US and are responsible for the greatest amount of premature death. Recent years have brought more national attention to the role of public health in injury prevention. The Rhode Island Department of Health has been involved in a variety of injury control research, programs and legislation. In 1989, the Injury Prevention Program was funded through a grant from the Centers for Disease Control to coordinate and implement injury control programs in the Department. Injury prevention priorities are set on the basis of mortality and morbidity data. An analysis of Rhode Island death certificate data from 1979 to 1988 reveals that motor vehicle crashes, suicides, falls, and homicides are the leading causes of injury deaths. Age patterns vary for each cause, but males predominate in all categories of injury deaths. Activities to reduce injuries are underway or planned. Physicians will play key roles in this effort.

Adolescent↗

PubMedDate not supplied

Rhode Island's child protective service system.

Rhode Island has found that an adaptation of the Illinois child protective services system has successfully enabled it to improve its protective service, giving primacy to children's rights while minimizing intrusion on family privacy.

Child↗

PubMed1986

Cigarette smoking behavior among Rhode Island physicians, 1963-83.

A survey of practicing physicians in Rhode Island revealed a cigarette smoking rate of only 8.3 per cent in 1983. This represents a continuation of the consistent decrease seen in the percentage of physician smokers in each such survey since 1963. Under age 30, the rate was only 4.5 per cent. An exponential model suggests that the overall rate for Rhode Island physicians will be below 3 per cent by the year 2000.

Adult↗

PubMed1990

Physician reporting of adverse drug reactions. Results of the Rhode Island Adverse Drug Reaction Reporting Project.

The Food and Drug Administration, Rockville, Md, contracted with the Rhode Island Department of Health, Providence, to conduct a project to increase reporting of suspected adverse drug reactions through physician education. Voluntary reporting, an important part of postmarketing surveillance that signals potential problems with marketed drugs, historically has been underused by physicians. After 2 years, there was a more than 17-fold increase in reports submitted directly from Rhode Island compared with the yearly average before initiation of the project. Increases in the total numbers of reports were paralleled by significant increases in the numbers of reports of severe reactions. Similar increases were not experienced nationally. Physicians in Rhode Island were surveyed before and 2 years after interventions began to determine changes in knowledge and attitudes about reporting of adverse drug reactions. Significant gains in knowledge and positive attitudes toward the reporting system occurred. We conclude that physicians can be stimulated to increase their reporting of suspected reactions, thereby improving the viability of the federal reporting system.

Attitude of Health Personnel↗

PubMed2002

Genetic variants of Ehrlichia phagocytophila, Rhode Island and Connecticut.

Primers were used to amplify a 561-bp region of the 16S rRNA gene of Ehrlichia phagocytophila from Ixodes scapularis ticks and small mammals collected in Rhode Island and Connecticut. DNA sequences for all 50 E. phagocytophila-positive samples collected from 1996 through 1998 in southwestern Connecticut were identical to the sequence reported for E. phagocytophila DNA from confirmed human cases. In contrast, the sequences from 92 of 123 E. phagocytophila-positive Rhode Island samples collected from 1996 through 1999 included several variants differing by 1-2 nucleotides from that in the agent infecting humans. While 11.9% of 67 E. phagocytophila-positive ticks collected during 1997 in Rhode Island harbored ehrlichiae with sequences identical to that of the human agent, 79.1% had a variant sequence not previously described. The low incidence of human ehrlichiosis in Rhode Island may in part result from interference by these variant ehrlichiae with maintenance and transmission of the true agent of human disease.

Animals↗

PubMed2003

Rhode Island Disaster Initiative.

In summary, RIDI is a multi-year research project to identify and develop solutions to some of the challenges posed by disaster response, with a focus on WMD incidents. September 11, 2001, changed the RIDI timeline with increased pressure to produce tangible results and recommendations rapidly. Phase 1 was an effort to identify problems and potential solutions through vulnerability assessment, literature review and expert panel discussion. Many disaster response "solutions" may fail because of a rush to use untested equipment or processes. RIDI is working cooperatively with other Rhode Island disaster experts to avoid these failures. Informed by Phase 1, RIDI Phase 2 will carefully and progressively test potential "solutions" during research trial disaster drills. Only after research can RIDI identify best practices in disaster response. As RIDI progresses to Phase 3, the demonstration project phase, specific improvements are expected in Rhode Island's readiness for disaster. A main feature of Phase 3 is use of a RIDI demonstration vehicle to bring identified solutions to the scene as requested by Rhode Island EMS agencies. Together with others working to improve Rhode Island readiness for disaster threats, RIDI hopes to improve the outcome for patients and providers in Rhode Island as they face the current disaster threats.

Computer Systems↗

PubMed1998

Survey of risk reduction and pollution prevention practices in the Rhode Island automotive refinishing industry.

In 1996 a survey of pollution prevention, environmental control, and occupational health and safety practices was conducted in the Rhode Island automotive refinishing industry sector. In conjunction with project partners, the Rhode Island Department of Environmental Management developed a multidimensional survey instrument to identify risk reduction opportunities. Investigators sought to characterize the range of environmental and industrial hygiene control employed by Rhode Island facilities for the purposes of focusing state technical and compliance assistance efforts. Data were collected on a diverse range of subject areas including work force demographics; source reduction; potential health hazards; worker protection and safety; solid and hazardous waste management; and air pollution control. Nearly one-half of the shops employ three or fewer people, and in many cases, spray painters double as body repair technicians thereby increasing their potential exposure to workplace contaminants. While nearly all of the shops reported that they use spray painting booths, only 38% own booths the more effective downdraft design. Based on the self-reported data, recently promulgated state air pollution control regulations (requiring the use of compliant coatings, enclosed or modified spray gun cleaners, and high-volume, low-pressure, spray guns) appear to be effective at motivating companies toward source reduction. A range of risk reduction opportunities were identified as input material changes, technology changes, and improved operating practices. Better methods of risk communication; a professional licensing requirement; and targeted training, compliance, and technical assistance would help to achieve greater levels of risk reduction in this mature, high-hazard industry.

Adult↗

PubMed1988

Cause-specific mortality among male textile workers in Rhode Island.

Cause-specific mortality patterns among male textile workers in Rhode Island who died during the period 1968-1978 were examined using the proportionate mortality ratio (PMR) method. Textile worker decedents were identified by the usual occupation and industry statements on Rhode Island death certificates. A statistically significant PMR elevation was observed for nonmalignant respiratory disease (NMRD) among male textile workers (PMR = 110; Observed deaths [Obs] = 433; 95% confidence interval (CI) = 102-120). The PMRs for NMRD by specific textile occupation and by type of textile manufacturing generally exhibited the pattern expected for work-related mortality owing to textile dust exposure. High PMRs were observed among carding, lapping, and combing operatives, the decedents who probably had the highest dust exposure (PMR = 166; Obs = 24; CI = 114-243), and among operatives most likely to have worked in cotton manufacturing (PMR = 137; Obs = 47; CI = 104-179). This is the first report of excess mortality from NMRD among male textile workers in the United States. This finding is consistent with previous evidence that exposure to cotton dust can cause disabling chronic lung disease. Also noteworthy were statistically significant elevated PMRs for cancers of the rectum and esophagus among decedents who had been engaged in textile dyeing and finishing. Owing to the lack of direct information about occupational exposures and smoking habits of the decedents and uncertainties in classifying decedents by type of textile manufacturing, this investigation should be viewed as being exploratory in nature.

Adult↗

PubMed2005

From concept to practice: using the School Health Index to create healthy school environments in Rhode Island elementary schools.

INTRODUCTION: The prevalence of childhood obesity is increasing, and schools are ideal places to support healthy eating and physical activity. In 2000, the Centers for Disease Control and Prevention (CDC) developed the School Health Index, a self-assessment and planning tool that helps schools evaluate and improve physical activity and nutrition programs and policies. Although many state education agencies, health departments, and individual schools have used the School Health Index, few systematic evaluations of the tool have been performed. We examined the physical activity and nutrition environments in Rhode Island's public elementary schools with high and low minority student enrollments and evaluated a school-based environmental and policy intervention that included implementation of the School Health Index. METHODS: As part of a CDC Division of Nutrition and Physical Activity cooperative agreement awarded to the Rhode Island Department of Health, we conducted a needs assessment of 102 elementary schools and implemented an intervention in four inner-city elementary schools. In phase 1, we analyzed the Rhode Island Needs Assessment Tool (RINAT), a telephone survey of principals in approximately 50% of all Rhode Island public elementary schools in the state during the 2001-2002 school year (n = 102). Comparisons of the nutrition and physical activity environments of schools with low and high minority enrollment were calculated by cross-tabulation with the chi-square test. In phase 2, we used process and outcome evaluation data to assess the use of the School Health Index in creating healthier environments in schools. Our intervention--Eat Healthy and Get Active!--involved implementing three of the eight School Health Index modules in four Rhode Island elementary schools. RESULTS: Survey data revealed that schools with high minority enrollment (student enrollment of > or =10% black, > or =25% Hispanic, or both) offered few programs supporting healthy eating and physical activity (P < .05). Schools with high and low minority enrollment both offered nonnutritious foods and beverages. Process evaluation data revealed that 1) principals play a pivotal role on School Health Index teams, 2) schoolwide validation of a team's small successes is crucial for sustaining a commitment to healthy lifestyle policies and programs, and 3) external facilitators are essential for implementation success. Outcome data showed that all schools developed at least one policy or environmental strategy to create a healthy school environment. Only two schools implemented immediate changes. CONCLUSION: Needs assessment, external facilitation, and evaluation are the foundation for sustainable school-based policies. Although the School Health Index is universally perceived as a user-friendly assessment tool, implementation is likely to be less successful in schools with low staff morale, budgetary constraints, and inconsistent administrator support.

Child↗