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PubMedDate not supplied

A federal agency's role in fulfilling the public health core functions: the childhood lead poisoning prevention program model.

The Institute of Medicine identified 3 core functions of public health: assessment, policy development, and assurance. Federal, state, and local public health agencies all have an obligation to provide these vital functions to ensure conditions in which people can be healthy. However, the few publications that provide core function applications only focus on applications at the local or state levels. The Centers for Disease Control and Prevention's Childhood Lead Poisoning Prevention Program uses a comprehensive public health approach. This article describes the Centers for Disease Control and Prevention's leading role in applying the core public health functions to prevent childhood lead poisoning.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Decision-making of Chinese caregivers for adult out-of-home placement.

BACKGROUND: In the light of the existence of lengthy waiting lists for out-of-home placements, this study examines the factors affecting the decision to apply or not to apply for this facility in a city traditionally characterized by a cultural and policy emphasis on family responsibility and by relatively low levels of welfare commitment to residential services. METHOD: A sample of 321 people responsible for providing care for adults with moderate to severe intellectual disability (ID) from 22 service units of seven non-governmental organizations in Hong Kong was surveyed by means of a structured questionnaire. RESULTS: The non-application group reported better emotional ties with the people with ID and greater confidence in their caregiving skills, but also tended to be caring for more challenging people with poorer health and higher or more frequent levels of self-harm behaviour than the application group who exhibited higher levels of worry and fear. Discriminant analysis successfully predicted 80% of non-application cases, while logistic regression revealed that decline in perceived competence to care, absence of other health problems and at least one parent of the client having long-term illness were better predictors of the decision to apply than handicap-specific characteristics of the people with ID themselves. CONCLUSION: The implications of this finding are discussed, and consideration given to the possibility of developing policies designed to strengthen and treasure family values while not detracting from the importance of providing proper community support.

Adult↗
PubMed1988

Accommodation for elderly persons in newly industrializing countries: the Hong Kong experience.

The newly industrializing countries seem set to follow many developed countries with a rapid growth in numbers of elderly people. This will throw considerable strain on their resources, particularly in the provision of services and accommodation for this group in society. Hong Kong is a leader amongst the newly industrializing countries, both in terms of its aging population (more than 11 percent of its people are now over 60 years of age) and in terms of economic growth. It has, however, only relatively recently embarked upon a comprehensive and integrated program to provide a wide range of accommodation for the elderly. This includes sheltered housing within Hong Kong's well-known public housing schemes, old people's homes, care-and-attention homes, and infirmaries. The private sector has also been growing rapidly in the 1980s with a considerable recent increase of old people's homes. A voluntary code of conduct for this sector was introduced in late 1986, but concerns remain about the quality of care and the rapid growth of private homes in the territory. The approaches to the provision of accommodation for the elderly are set in the context of Hong Kong's overall social policy development. Whilst the experience of relatively wealthy Hong Kong may not prove to be of relevance for the majority of Third World countries, it is argued that it may provide a model for other newly industrializing countries.

Adult↗
PubMed2000

The real and the nominal? Making inflationary adjustments to cost and other economic data.

Given the scarcity of cost data for health interventions, there has been substantial use of a relatively small number of existing studies to underpin policy development formulation. Intervention-specific cost and cost-effectiveness data have been used to plan overall budgets, to assess the relative efficiency of different interventions and to consider the resource requirements for programme implementation at both the local and national levels. Cost and cost-effectiveness comparisons have been made between these studies and general sources such as the World Bank's World Development Report 1993. At the same time, information on key health sector variables, such as annual health expenditures, has been systematically compiled for more than two decades. The question of possible inflationary effects is becoming increasingly important as the original data on which these numbers are based ages. For example, cost figures from the mid-1980s require a 60% inflationary adjustment simply to maintain their real value in current dollars. This paper looks at methods to adjust cost data to account for inflation and discusses the difference between real or constant and nominal or current values. These methods are also used to make inflationary adjustments to other types of economic data such as income.

Cost-Benefit Analysis↗
PubMed2003

Assessment of potential risk levels associated with U.S. Environmental Protection Agency reference values.

The U.S. Environmental Protection Agency (U.S. EPA) generally uses reference doses (RfDs) or reference concentrations (RfCs) to assess risks from exposure to toxic substances for noncancer health end points. RfDs and RfCs are supposed to represent lifetime inhalation or ingestion exposure with minimal appreciable risk, but they do not include information about the estimated risk from exposures equal to the RfD/RfC. We used results from benchmark dose modeling approaches recently adopted for use in developing RfDs/RfCs to estimate the risk levels associated with exposures at the RfD/RfC. We searched the U.S. EPA Integrated Risk Information System (IRIS) database and identified 11 chemicals with oral RfDs and 12 chemicals with inhalation RfCs that used benchmark dose modeling. For assessments with sufficient model information, we found that 16 of 21 (76%) of the dose-response models were linear or supralinear. We estimated the risk from exposures at the established RfDs and RfCs for these chemicals using a linear dose-response curve to characterize risk below the observed data. Risk estimates ranged from 1 in 10,000 to 5 in 1,000 for exposures at the RfDs, and from 1 in 10,000 to 3 in 1,000 for exposures at the RfCs. Risk estimates for exposures at the RfD/RfC values derived from sublinear dose-response curves ranged from 3 in 1,000,000,000 to 8 in 10,000. Twenty-four percent of reference values corresponded to estimated risk levels greater than 1 in 1,000; 10 of 14 assessments had points of departure greater than the no-observed-adverse-effect levels. For policy development regarding management of cancer risks, the U.S. EPA often uses 1 in 1,000,000 as a de minimis risk level. Although noncancer outcomes may in some instances be reversible and considered less severe than cancer, our findings call into question the assumption that established RfD and RfC values represent negligibly small risk levels.

Benchmarking↗
PubMedDate not supplied

Appropriateness of acute medical admissions and length of stay.

OBJECTIVE: To use the Appropriateness Evaluation Protocol (AEP) to assess the extent of inappropriate utilisation of hospital beds by acute medical patients. To determine whether clinicians viewed the AEP decisions as valid. DESIGN: Retrospective review of the medical records of a 10% random sample of 8,210 patients admitted as medical emergencies. An objective independent review instrument (AEP) was used to assess the medical necessity for hospitalisation at admission and on each subsequent day. To test the validity of the screening instrument, a subsample of the reviewed records was further assessed by a panel of physicians. SETTING: A district general hospital in the West Midlands region of England. SUBJECTS: Eight hundred and twenty-one adult patients admitted to general medicine during one calendar year. MAIN OUTCOME MEASURES: Proportions of admissions and days of care for which inpatient medical care was judged appropriate. Reasons for inappropriate utilisation and potential bed-days that could be saved by the development and use of alternative services were also considered. Validity of the AEP was tested by assessing agreement between the majority decision of an expert panel and the criterion-based AEP decision. RESULTS: AEP identified 51/821 (6%) admissions and 2,195/4,885 (45%) days of care as inappropriate. Over half the patients had a hospital stay in which at least half the days were judged inappropriate. The commonest reason for inappropriate days was remaining in hospital after the medical purpose for admission had been accomplished. This accounted for 38% of inappropriate days reviewed. In validity testing there was a high level of agreement between the physicians and the AEP, with kappa values greater than 0.80 for admissions and days of care. CONCLUSIONS: The AEP is a valid and useful instrument for assessing the utilisation of acute medical beds in a NHS hospital. In this study acute medical admissions were largely appropriate at the time of admission but a substantial proportion of subsequent days of care was considered inappropriate by AEP criteria. Most inappropriate utilisation was due to organisational issues within the hospital. As a result of this study, several service and policy developments were identified that should improve the efficiency of bed utilisation at the hospital.

Adolescent↗
PubMedDate not supplied

Survey of leadership skills needed for state and territorial health officers, United States, 1988.

As part of efforts to develop training and career development experiences to enhance leadership skills among public health officials, the Public Health Foundation, Association of State and Territorial Health Officials, National Association of County Health Officials, United States Conference of Local Health Officers, and Public Health Practice Program Office, Centers for Disease Control and Prevention, conducted a training needs assessment survey in 1988. Fifty-five State and territorial health officers were asked about potential knowledge, skills, and abilities (KSAs) that a prospective or new health officer might require in performing his or her job. Thirty-eight health officers returned completed questionnaires, a 69 percent response rate. For each KSA, respondents assigned scores from 1 (low) to 5 (high) to three different variables: the KSA's importance to job, as an initial ability of a new health officer, and as a desired ability for someone in that job. Of 78 KSAs, those scoring in the top 25 percent for importance to job were identified, and individual composite scores were calculated using the formula: (importance to job) x (desired ability minus initial ability). The top 10 mean composite scores ranged from 7.55 to 10.40 and were in five competence areas: public image (working with the community) (3 KSAs); policy development and program planning (3 KSAs); interpersonal skills (2 KSAs); agency management (1 KSA); and legal issues (1 KSA). These skills are not commonly acquired in schools of medicine or public health. Public health agencies should develop programs to assure that persons with leadership potential are identified early and given guided experiences and mentors, as well as specific training and education. Additional studies of public health officers are needed to develop and strengthen leadership KSAs among new health officers.

Administrative Personnel↗
PubMed2005

Modelling the spread of foot-and-mouth disease in Australia.

Preparedness for an incursion of an exotic animal disease is of key importance to government, industry, producers and the Australian community. An important aspect of Australia's preparedness for a possible incursion of foot-and-mouth disease is investigation into the likely effectiveness and cost-efficiency of eradication strategies when applied to different regional outbreak scenarios. Disease modelling is a tool that can be used to study diseases such as foot-and-mouth disease to better understand potential disease spread and control under different conditions. The Australian Government Department of Agriculture, Fisheries and Forestry has been involved with epidemiologic simulation modelling for more than 10 years, and has developed a sophisticated spatial model for foot-and-mouth disease (AusSpread) that operates within a geographic information system framework. The model accommodates real farm boundary or point-location data, as well as synthesised data based on agricultural census and land use information. The model also allows for interactions between herds or flocks of different animal species and production type, and considers the role that such interactions are likely to play in the epidemiology of a regional outbreak of foot-and-mouth disease. The user can choose mitigations and eradication strategies from those that are currently described in Australia's veterinary emergency plan. The model also allows the user to evaluate the impact of constraints on the availability of resources for mitigations or eradication measures. Outputs include a range of maps and tabulated outbreak statistics describing the geographic extent of the outbreak and its duration, the numbers of affected, slaughtered, and, as relevant, vaccinated herds or flocks, and the cost of control and eradication. Cost-related outputs are based on budgets of the value of stock and the cost of mitigations, each of which can be varied by the user. These outputs are a valuable resource to assist with policy development and disease management.

Animals↗
PubMed2004

Developing integrated health and social care services for older persons in Europe.

PURPOSE: This paper is to distribute first results of the EU Fifth Framework Project 'Providing integrated health and social care for older persons-issues, problems and solutions' (PROCARE-http://www.euro.centre.org/procare/). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to retrieve a number of experiences, model ways of working and demonstration projects in the participating countries which are currently being analysed in order to learn from success-or failure-and to develop policy recommendations for the local, national and European level. THEORY: The paper draws on existing definitions of integrated care in various countries and by various scholars. Given the context of an international comparative study it tries to avoid providing a single, ready-made definition but underlines the role of social care as part and parcel of this type of integrated care in the participating countries. METHODS: The paper is based on national reports from researchers representing ten organisations (university institutes, consultancy firms, research institutes, the public and the NGO sector) from 9 European countries: Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, and the UK. Literature reviews made intensive use of grey literature and evaluation studies in the context of at least five model ways of working in each country. RESULTS: As a result of the cross-national overview an attempt to classify different approaches and definitions is made and indicators of relative importance of the different instruments used in integrating health and social care services are provided. CONCLUSIONS: The cross-national overview shows that issues concerning co-ordination and integration of services are high on the agenda in most countries. Depending on the state of service development, various approaches and instruments can be observed. Different national frameworks, in particular with respect to financing and organisation, systemic development, professionalisation and professional cultures, basic societal values (family ethics), and political approaches have to be taken into account during the second phase of PROCARE during which transversal and transnational analysis will be undertaken based on an in-depth analysis of two model ways of working in each country. DISCUSSION: Far from a European vision concerning integrated care, national health and social care systems remain-at best-loosely coupled systems that are facing increasing difficulties, given the current challenges, in particular in long-term care for older persons: increasing marketisation, lack of managerial knowledge (co-operation, co-ordination), shortage of care workers and a general trend towards down-sizing of social care services continue to hamper the first tentative pathways towards integrated care systems.

Journal Article↗
PubMed1995

Surveillance methods for central venous access device-associated infections in Canadian pediatric hospitals.

The most common complication of central venous access device (CVAD) use is infection, which occurs in 3 to 48% of hospitalized patients. It is recommended that regular surveillance of adverse events with CVADs be conducted, expressed as a proportion of 1000 device days and reviewed and acted upon by the institution's infection control committee. In the process of developing a CVAD program the authors attempted to determine the standard of practice at other Canadian pediatric hospitals. A telephone survey of infection control practitioners (ICPS) or CVAD nurses in 15 university-affiliated Canadian pediatric hospitals was conducted using a standard questionnaire. Fourteen hospitals (93%) conduct surveillance for infections associated with CVADS. One program, a pilot project, follows mechanical complications of CVAD use. Eleven centres conduct comprehensive surveillance; in three, selected patients are followed. Only three programs have sufficient staff to follow out-patients. Definitions for CVAD infections varied widely. A positive blood culture from the catheter is sufficient for diagnosis in eight of the 14 centres (57%); the rest use Centers for Disease Control and Prevention (CDC) or modified CDC criteria. In the four centres where CVAD line days are collected on most or all patients, multiple personnel other than the ICP assist in data collection. Four hospitals report number of infections per 100 discharges, four report absolute number of infections and two use more than one denominator. Surveillance methods rely largely on paper-based chart and microbiology record review; no hospital had access to computerized patient data for direct data retrieval. Eight centres have CVAD committees for policy development, and all 15 have or are developing hospital-wide protocols for CVAD use. Canadian pediatric hospitals recognize the importance of CVAD infections, but it appears that insufficient resources are available to meet recommended data collection methods. Interhospital comparison of rates is not possible at present because of variation in definitions and denominators and in types of patients surveyed.

Catheterization, Central Venous↗
PubMed2004

Job embeddedness: a theoretical foundation for developing a comprehensive nurse retention plan.

OBJECTIVE: Using a new construct, job embeddedness, from the business management literature, this study first examines its value in predicting employee retention in a healthcare setting and second, assesses whether the factors that influence the retention of nurses are systematically different from those influencing other healthcare workers. BACKGROUND: The shortage of skilled healthcare workers makes it imperative that healthcare providers develop effective recruitment and retention plans. With nursing turnover averaging more than 20% a year and competition to hire new nurses fierce, many administrators rightly question whether they should develop specialized plans to recruit and retain nurses. METHODS: A longitudinal research design was employed to assess the predictive validity of the job embeddedness concept. At time 1, surveys were mailed to a random sample of 500 employees of a community-based hospital in the Northwest region of the United States. The survey assessed personal characteristics, job satisfaction, organizational commitment, job embeddedness, job search, perceived alternatives, and intent to leave. One year later (time 2) the organization provided data regarding voluntary leavers from the hospital. RESULTS: Hospital employees returned 232 surveys, yielding a response rate of 46.4 %. The results indicate that job embeddedness predicted turnover over and beyond a combination of perceived desirability of movement measures (job satisfaction, organizational commitment) and perceived ease of movement measures (job alternatives, job search). Thus, job embeddedness assesses new and meaningful variance in turnover in excess of that predicted by the major variables included in almost all the major models of turnover. CONCLUSIONS: The findings suggest that job embeddedness is a valuable lens through which to evaluate employee retention in healthcare organizations. Further, the levers for influencing retention are substantially similar for nurses and other healthcare workers. Implications of these findings and recommendations for recruitment and retention policy development are presented.

Adult↗
PubMed2005

Teaching evidence-based public health to public health practitioners.

PURPOSE: The purpose of the Evidence Based Public Health (EBPH) course is to train public health practitioners to utilize a comprehensive approach for program development and evaluation from a scientific perspective, including principles of scientific reasoning and systematic uses of data and information systems. The increasing technical sophistication of public health problems and approaches emphasizes the importance for an evidence-based approach to developing policy and interventions. METHODS: The training methods used highlight the linkages between data systems and program/policy initiatives. Participants learn to access and interpret existing data systems and methods of using data to impact specific policies or decision-makers. From 1992 through mid-2004 the EBPH course was offered a total of 20 times, in Missouri, nationally and internationally. In March 2002, the workshop was taped and pressed into a 16-CD set that public health workers can use as a self-teaching program in their own homes and offices. The group exercises from the classroom workshop have been adapted into individual self-guided applications, and background readings are included in the set. RESULTS: Compiled results of course evaluations indicate average ratings for course satisfaction ranging from 8.50 to 10.00 on a scale from 1 to 10. Satisfaction with course instructors ranged between 8.00 and 10.00 on the same scale. Ninety-four to ninety-six per cent of participants reported that they would use the course in their day-to-day work. Qualitative comments from participants at the time of and after the course show that the material is applied in a variety of ways. CONCLUSIONS: The EBPH course is making a valuable contribution in strengthening the application of scientific methods to public health practice. To expand the offerings of this training, a train-the-trainer component for the EBPH course is being developed, to be made available in 2005.

Curriculum↗
PubMed1998

Exploring the possibility of sexual-behavioural primary prevention interventions for cervical cancer.

Consistent causal and risk factors for cervical cancer indicate that primary prevention may be beneficial for cervical cancer prevention. However, social or behavioural primary prevention strategies are seldom discussed in the prevention literature. This paper uses thematic analyses of interviews with key informants involved with cervical cancer prevention policy development in New Zealand to explore the possibility of sexual-behavioural primary prevention. While many informants perceived primary prevention to be important, others were cautiously accepting or opposed to it. Many concerns were raised that highlighting a preventable (sexually transmitted) causal factor might lead to blame and stigma around cervical cancer and reduce participation in cervical screening. Much of the support for primary prevention depended on it being conducted (indirectly) in the context of young people's sexual health education. Positions on primary prevention appeared to be informed by common presumptions about what happens in the 'real world' and the commonality of human papilloma virus in the general population. We contend that the possible health benefits from sexual-behavioural strategies for cervical cancer primary prevention need further exploration.

Attitude to Health↗
PubMed2004

Updating the evidence that physical activity is good for health: an epidemiological review 2000-2003.

Developing policy and strategic initiatives to increase population levels of physical activity (PA) requires constant referral to the epidemiological evidence base. This paper updates the evidence that PA confers a positive benefit on health, using research studies in the peer-reviewed scientific literature published between 2000-2003. Areas covered include updates in all-cause mortality and in cardiovascular disease prevention, diabetes, stroke, mental health, falls and injuries, and in obesity prevention. Recent evidence on PA and all-cause mortality replicates previous findings, and is consistent with current Australian moderate PA recommendations. Recent papers have reinforced our understanding of the cardiovascular protective effects of moderate PA, with new evidence that walking reduces the risk of CVD and, in two studies, at least as much as vigorous activity. The evidence base for protective effects of activity for women, older adults and for special populations has strengthened. Cancer prevention studies have proliferated during this period but the best evidence remains for colon cancer, with better evidence accumulating for breast cancer prevention, and uncertain or mixed evidence for the primary prevention of other cancers. Important new controlled-trial evidence has accumulated in the area of type 2 diabetes: moderate PA combined with weight loss, and a balanced diet can confer a 50-60% reduction in risk of developing diabetes among those already at high risk. Limited new evidence has accumulated for the role of PA in promoting mental health and preventing falls.

Cardiovascular Diseases↗
PubMed2003

Tobacco industry strategy to undermine tobacco control in Finland.

OBJECTIVE: To identify and explain tobacco industry strategy in undermining tobacco control measures in Finland and results of these interferences in tobacco policy development during the 1980s and early 1990s. METHODS: Tobacco industry documents, which have been publicly available on the internet as a result of litigation in the USA, were analysed. Documents were sought by Finland and by names of organisations and tobacco control activists. Documents were accessed and assessed between September 2000 and November 2002. Tactics of the tobacco industry activities were categorised as presented by Saloojee and Dagli. RESULTS: The international tobacco companies utilised similar strategies in Finland as in other industrial markets to fight tobacco control and legislation, the health advocacy movement, and litigation. These activities slowed down the development and implementation of the Tobacco Act in Finland. However, despite the extensive pressure, the industry was not able to prevent the most progressive tobacco legislation in Europe from being passed and coming into force in Finland in 1977 and in 1995. CONCLUSION: Denying the health hazards caused by tobacco-despite indisputable scientific evidence-decreased the credibility of the tobacco industry. Strategy of denial was falsely chosen, as health advocacy groups were active both in society and the parliamentary system. The strong influence of the tobacco industry may have in fact increased the visibility of tobacco control in Finland as the litigation process was also drawing attention to negative health effects of tobacco. Therefore the tobacco industry did not manage to convince public opinion. However, the tobacco industry did obtain experience in Finland in how to object to tobacco control measures.

Finland↗
PubMed2005

Primary care teams: New Zealand's experience with community-governed non-profit primary care.

Community-governed non-profit primary care organisations started developing in New Zealand in the late 1980s with the aim to reduce financial, cultural and geographical barriers to access. New Zealand's new primary health care strategy aims to co-ordinate primary care and public health strategies with the overall objective of improving population health and reducing health inequalities. The purpose of this study is to carry out a detailed examination of the composition and characteristics of primary care teams in community-governed non-profit practices and compare them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. The study used data from a representative national cross-sectional survey of general practitioners in New Zealand (2001/2002). Primary care teams were largest and most heterogeneous in community-governed non-profit practices, which employed about 3% of the county's general practitioners. Next most heterogeneous in terms of their primary care teams were practices that belonged to an Independent Practitioner Association, which employed the majority of the country's general practitioners (71.7%). Even though in absolute and relative terms the community-governed non-profit primary care sector is small, by providing a much needed element of professional and organisational pluralism and by experimenting with more diverse staffing arrangements, it is likely to continue to have an influence on primary care policy development in New Zealand.

Community Participation↗
PubMedDate not supplied

Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: an interview study of national and institutional stakeholders.

BACKGROUND: Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost-effectiveness is generally inconclusive and provides a suboptimal basis for policy development. AIM: To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders. METHODS: Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript. RESULTS: A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a sample of clinicians drawn from hospitals with variable use of blood-saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that 'enthusiasts' were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices/procedures. CONCLUSIONS: Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an 'enthusiast'. Critical review of the evidence for effectiveness or cost-effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence-based medicine principles to play a greater role in policy decisions in this area.

Blood Donors↗
PubMed1990

Tracking the spread of the HIV infection epidemic among young adults in the United States: results of the first four years of screening among civilian applicants for U.S. military service.

Because the period from infection to clinically apparent disease is long, variable, and changing as new therapies are developed and applied, AIDS data are inadequate for tracking current values of critical parameters of HIV infection epidemics: prevalence of infection, rate of acquisition of new infections (incidence rate), and direction and rate of change of infection incidence over time (acceleration). These "vital signs" of infection epidemics can be tracked using serial cross-sectional seroprevalence data, however. From October 1985 through September 1989, more than 2.3 million applicants for U.S. military service were screened for antibody to HIV. The overall seroprevalence was 1.31 per 1,000 (3,014/2,300,675). Seroprevalences were highest near urban centers of the AIDS epidemic and were independently associated with age, race/ethnicity, and gender. Based on age seroprevalence trends, it was crudely estimated that at least one of 2,000 young men and one of 7,000 young women are infected with HIV annually in the U.S. Infection incidence rates, estimated from age and temporal trends, were estimated to be highest among black males (1.40/1,000/year) and lowest among white females (0.03/1,000/year). Poisson regression analysis of seroprevalence trends suggested that infection incidence rates accelerated among black females during the first 3 years of screening. Since selection factors undoubtedly changed over the period, estimates based on these data probably underestimate actual values in the general population, particularly near urban AIDS epicenters. Nonetheless, even crude estimates of these critical values, particularly among adolescents and young adults, are useful to guide policy development, to allocate resources, and to monitor program effects.

Acquired Immunodeficiency Syndrome↗