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PubMedDate not supplied

Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina.

OBJECTIVE: School-based health centers (SBHCs) in North Carolina offer limited reproductive health care services. We investigate sexually active students' willingness to seek these services at SBHCs if available and predictors of willingness to seek services. METHODS: Cross-sectional survey of 949 sexually experienced students in 2 middle and 5 high schools in North Carolina in 1994. Bivariate and multivariate analyses tested the influence of sociodemographic characteristics, risk of pregnancy/sexually transmitted infections (STIs), and past health care utilization on willingness to use SBHCs for sexuality-related services. RESULTS: Participants were 52% female, 52% black, and median age at first coitus was 13.0 years. Many (49%) had sex at least once a month. Most (52%) reported inconsistent contraception use. One-fifth (18%) of females had been pregnant; 10% of males reported getting a partner pregnant. Seventy-five percent had used SBHCs. Most reported they would use SBHCs for information to protect against pregnancy and STIs (58%), pregnancy testing (51%), and birth control (48%) if available. Females were more likely than males to report they would use these services (adjusted odds ratio = 3.4, 95% confidence interval = 1.9-6.7), especially those receiving free lunch (adjusted odds ratio = 2.9, 95% confidence interval = 1.2-6.8]) and those with inconsistent use of contraception. We found no association between past health care and willingness to use SBHC services. CONCLUSIONS: Most sexually experienced students report they would use their SBHC for reproductive/STI services if they were available. Absence of these services in SBHCs represents a missed opportunity to provide health care to adolescents who are at substantial risk of pregnancy and STIs.

Adolescent↗
PubMed1997

Trends in fatal occupational injuries and industrial restructuring in North Carolina in the 1980s.

OBJECTIVES: This study examined the relationship between changes in employment in North Carolina in the 1980s and fatal occupational injury rates. METHODS: Unintentional fatal occupational injuries (n = 1989) in North Carolina between 1978 and 1991 were identified via the medical examiner's system. RESULTS: Overall fatal injury rates declined during the 1980s, but rates increased 9.6% per year among manufacturing industries that declined in employment size; rates fell among service sector and manufacturing industries that grew. CONCLUSIONS: Increasing occupational fatal injury rates accompanied the decline in workforce in North Carolina's traditional, labor-intensive manufacturing industries during the 1980s, while service sector and expanding manufacturing industries have experienced declining fatal injury rates.

Accidents, Occupational↗
PubMed2002

The elimination of anonymous HIV testing: a case study in North Carolina.

In May 1997, anonymous human immunodeficiency virus testing in publicly funded clinics was eliminated throughout North Carolina. There were concerns that this decision would disenfranchise testers with certain behavioral profiles. North Carolina's counseling and testing system was used to evaluate the effect of this policy change. A 10.3 percent decline in overall testing and a 21.7 percent decline among men who had sex with other men were identified in the year following the policy change. However, between 13 and 24 months after the policy change, the number of tests administered returned to near pre-policy levels. Understanding North Carolina's experience can assist others considering similar policy changes.

AIDS Serodiagnosis↗
PubMed1996

Effects of North Carolina's mandatory safety belt law on children.

OBJECTIVES: To assess the effect of the North Carolina law mandating that all front seat passengers use a safety belt on children 4 through 15 years of age. METHODS: North Carolina collision reports, completed by local police or the state highway patrol for crashes with greater than $500 worth of damage, were analyzed using time series analysis on the monthly percentage of deaths and serious injuries between January of 1980 and February of 1994. RESULTS: Following the 1985 implementation of the law, children 4 to 15 years of age experienced a 42% decline in deaths and serious injuries. CONCLUSIONS: The mandatory safety belt law in North Carolina has been associated with a decline in deaths and serious injuries. Additional research in needed to assess the seat belt behaviors of this age group as well as the specific effects of seat belt use using outcome measures more precise than those available in police crash reports.

Accidents, Traffic↗
PubMed2005

HIV transmission among black women--North Carolina, 2004.

In 2003, women constituted 28% of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases in the United States; approximately 69% of those cases were among non-Hispanic black women. Heterosexual transmission is now the most commonly reported mode of HIV transmission among women. In North Carolina, black women make up a growing proportion of newly reported HIV infections and, in 2003, the HIV-infection rate for black women in North Carolina was 14 times higher than that for white women. Despite this disparity, few epidemiologic studies have examined HIV transmission among black women in the United States, particularly those residing in southern states. In August 2004, the North Carolina Department of Health (NCDOH) invited CDC to assist in an epidemiologic investigation of HIV transmission among black women in North Carolina. This report summarizes the results of that investigation, which indicated that the majority of HIV-positive and HIV-negative sexually active black women in North Carolina reported HIV sexual risk behaviors. These findings underscore the need for enhanced HIV-prevention strategies in this population.

Adult↗
PubMedDate not supplied

EMS knowledge and skills in rural North Carolina: a comparison with the National EMS Education and Practice Blueprint.

INTRODUCTION: Many state and local emergency medical services (EMS) systems may wish to modify provider levels and their scope of practice to align their systems with the recommendations of the National Emergency Medical Services Education and Practice Blueprint. To determine any changes that may be needed in a typical EMS system, the knowledge and skills of EMS providers in one rural area of North Carolina were compared with the knowledge and skills recommended in the National Emergency Medical Services Education and Practice Blueprint. METHODS: A survey listing 175 items of patient care-oriented knowledge and skills described in the National Emergency Medical Services Education and Practice Blueprint was developed. EMS providers from five rural eastern North Carolina counties were asked to identify on the survey those items of knowledge and skills they believed they possessed. The skills and knowledge selected by the respondents at the five different North Carolina levels of certification were compared with the knowledge and skills listed for comparable provider levels delineated by the National Emergency Medical Services Education and Practice Blueprint. The proportions of the recommended skills reported to be possessed by the respondents were compared to determine which North Carolina certification levels best correlate with the Blueprint. RESULTS: One hundred forty-five EMS providers completed the survey. The proportion of recommended skills and knowledge reported to be possessed by Emergency Medical Technicians (EMTs) ranked significantly lower than did the skills and knowledge reported to be possessed by respondents at other levels in five of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Defibrillator-level personnel ranked lower than did those reported to be possessed by respondents at other levels in seven of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Intermediates ranked lower than did those reported to be possessed by respondents at other levels in nine of the 10 Blueprint elements. The proportion of recommended skills and knowledge reported to be possessed by EMT-Advanced Intermediates ranked lower than were the skills and knowledge reported to be possessed by respondents at other levels in two of the 10 Blueprint elements. Finally, the proportion of recommended skills and knowledge reported to be possessed by EMT-Paramedics ranked lower than were those reported to be possessed by respondents at other levels in one of the 10 Blueprint elements. CONCLUSION: In North Carolina, combining the EMT and EMT-Defibrillator levels and eliminating the EMT-Intermediate level would create three levels of certification, which would be more consistent with levels recommended by the Blueprint. The results of this study should be considered in any effort to revise the levels of EMS certification in North Carolina and in planning the training curricula for bridging those levels. Other states may require similar action to align with the National Emergency Medical Services Education and Practice Blueprint.

Certification↗
PubMed1998

Predictors of crop diversification: a survey of tobacco farmers in North Carolina (USA).

OBJECTIVE: To assess the attitudes and behaviours of North Carolina tobacco farmers around crop diversification. DESIGN: Cross-sectional telephone survey. PARTICIPANTS: Active tobacco farmers in 14 North Carolina counties (n = 1236), interviewed between January and April 1997 (91% response rate). OUTCOME MEASURES: Interest in, experience with, and perceived barriers to diversification. RESULTS: Most farmers (95%) grew/raised a commodity other than tobacco (mean = 2.8). A total of 60% of farmers expressed interest in trying other on-farm activities to supplement their tobacco and 60% reported taking action in the past year around supplementation. Younger age and college education were positively associated with interest. College education, off-farm income, and larger farm size were associated with the number of actions taken. For perceived external barriers to diversification, use of tobacco, percent income from tobacco, lack of college education, and younger age were most strongly associated with the number of barriers. For internal barriers (personal factors), percent income from tobacco, use of tobacco, and lack of college education were most strongly associated with the number of barriers. CONCLUSIONS: Most farmers were involved in diverse operations and expressed interest in continuing to diversify, although the breadth of diversification was narrow. Farmers noted many barriers to diversifying. If conventional production and marketing techniques are employed for non-tobacco alternatives, these alternatives may not provide the sustainable profitability that tobacco has afforded. Competition from foreign tobacco growers is the primary threat to the future of American growers and tobacco dependent communities.

Adult↗
PubMed2005

Pharmacist response to alerts generated from Medicaid pharmacy claims in a long-term care setting: results from the North Carolina polypharmacy initiative.

OBJECTIVE: In response to burgeoning drug costs, North Carolina (NC) Medicaid encouraged pharmacists and prescribers to develop collaborative programs to reduce drug expenditures. One of these programs, the North Carolina Polypharmacy Initiative, was a focused drug therapy management intervention aimed at reducing polypharmacy in nursing homes. This intervention targeted patients with more than 18 prescription fills in 90 days, beginning in November 2002. These patients were believed to have a high likelihood of experiencing potential drug therapy problems (PDTPs). Consultant pharmacists were asked to utilize profiles displaying alerts generated from pharmacy claims to guide interventions in addition to usual-care drug regimen reviews. The pharmacists documented their reviews, recommendations, and resulting changes in drug therapy. Our objectives were to determine (1) the persistence of PDTP alerts following interventions by consultant pharmacists and (2) the impact of these interventions on patient drug costs from a payer perspective. METHODS: A before-after study with comparison group design was used. Medicaid prescription claims data were compared for the 90-day periods prior to the intervention (June-August 2002) and following the intervention (March-June 2003). The 90-day post-intervention period allowed for 2 to 3 follow-up prescriptions and reduced the drop-out rate. The 5 categories of potential problem alerts included potentially inappropriate medications (Beers criteria), substitution opportunity for a lower-cost drug, 16 drugs or drug classes with specific quality improvement opportunities (Clinical Initiatives list), therapeutic duplication, and length of drug therapy evaluation. RESULTS: A total of 253 nursing homes, involving 110 consultant pharmacists and 6,344 patients, were in the intervention arm, with 5,160 patients (81.3%) remaining at the end of the follow-up period. At baseline, study-group patients used an average of 9.7 prescriptions per month, costing the NC Medicaid program 517 US dollars per patient per month (PPPM). There were 6,360 recommendations offered for 3,400 patients, or an average of 1.87 recommendations per patient. Physicians concurred with 59.8% (3,801 of 6,360) of all recommendations to change drug therapy, about half involving a switch to a lower-cost drug. Two of 5 alert categories had significant (P <0.01) reductions in alert persistence: -10.8% for the study group versus -0.7% for the comparison group for the Clinical Initiatives list and -29.7% for the study group versus -14.1% in the comparison group for the drug substitution opportunity. Median drug costs per patient in the study group decreased by 12.14 US dollars (-0.92%), from 1,329.46 US dollars to 1,317.32 US dollars, and increased in the comparison group by 44.98 US dollars (3.35%), from 1,341.25 US dollars to 1,386.23 US dollars, creating a relative cost reduction of 57.12 US dollars per patient in the 3-month follow-up period, or 19.04 US dollars PPPM. CONCLUSION: A supplemental program of medication reviews for nursing home patients targeted by high drug utilization resulted in a reduction in the persistence of PDTP alerts and was cost beneficial based solely on drug cost savings. This intervention may be a model for future medication therapy management services provided by prescription drug plans under Medicare Part D for patients in long-term-care settings and possibly ambulatory patients.

Aged↗
PubMed1975

Dietary survey of low-income, rural families in Iowa and North Carolina. III. Contribution of food groups to nutrients.

Percentage contributions of specific food groups indicated in the Basic 4 to protein, calcium, vitamin A, and ascorbic acid in one day's diets of thirty-five Iowa families and twenty-five North Carolina families are reported. All members of the families ate all meals at home. Their diets met or exceeded two-thirds of the 1968 Recommended Dietary Allowances for seven nutrients. Data were collected by the 24-hr. recall method. While the percentage contribution of the meat group to protein intake of the North Carolina families ranged from zero to 84 per cent, that of the Iowa group was from 35 to 85 per cent. The range for the percentage contribution of the milk group to calcium intake of North Carolina families was similar; however, in the Iowa group the range was from 2 to 97 per cent. The vitamin A-rich fruit and vegetable group contributed from zero to 99 per cent for the North Carolina families of vitamin A intake and from zero to 88 per cent for the Iowa group. Ascorbic acid-rich fruits and vegetables contributed from zero to 100 per cent of the ascorbic acid intake of the Iowa group and from zero to 95 per cent in North Carolina families. The results support the argument that the exclusive use of the "Daily Food Guide" or the "Basic 4" to assess nutritional intake of diets may produce biased in formation.

Ascorbic Acid↗
PubMed2001

Human visual function in the North Carolina clinical study on possible estuary-associated syndrome.

The U.S. Environmental Protection Agency assisted the North Carolina Department of Health and Human Services in conducting a study to investigate the potential for an association between fish kills in the North Carolina estuary system and the risk for persistent health effects. Impetus for the study was recent evidence suggesting that estuarine dinoflagellates, including members of the toxic Pfiesteria complex (TPC), P. piscicida and P. schumwayae, may release a toxin(s) that kills fish and adversely affects human health. This report describes one component of the study in which visual system function was assessed. Participants working primarily in estuaries inhabited by TPC or in off-shore waters thought not to contain TPC were studied. The potentially exposed estuary (n = 22) and unexposed offshore (n = 20) workers were matched for age, gender, and education. Visual acuity did not differ significantly between the cohorts, but visual contrast sensitivity (VCS), an indicator of visual pattern-detection ability for stimuli of various sizes, was significantly reduced by about 30% in the estuary relative to the offshore cohort. A further analysis that excluded participants having a history possibly predictive of neuropsychological impairment showed a similar VCS reduction. Additional analyses indicated that differences between the cohorts in age, education, smoking, alcohol consumption, and total time spent on any water did not account for the difference in VCS. Exploratory analyses suggested a possible association between the magnitude of VCS reduction and hours spent in contact with a fish kill. The profile of VCS deficit across stimulus sizes resembled that seen in organic solvent-exposed workers, but an assessment of occupational solvent, and other neurotoxicant, exposures did not indicate differences between the cohorts. These results suggest that factor(s) associated with the North Carolina estuaries, including the possibility of exposure to TPC toxin(s), may impair visual system function.

Analysis of Variance↗
PubMedDate not supplied

Assessing the public's health: community diagnosis in North Carolina.

The community diagnosis process in North Carolina has evolved over a period of years. It began in 1974 and gained great impetus during and after 1983. It serves to address the "true" health problems of the State's citizenry through the identification and communication of these problems from the local level to the State. In this "bottom-up" planning process, conducted biennially, the State health department prepares 100 county-specific health data books and an accompanying guide that advise local health department personnel on the concepts, methods, and materials of community diagnosis. The data books and guides are presented at a series of workshops to county health department personnel who subsequently analyze the data in the light of their local situations and report back to the State their county's priority health problems and strategies for solving them. This county information is then used by the State health director to determine funding requests to the legislature. In the end, it is hoped that the products of this process serve the ultimate goal of allocating resources according to priorities to meet the documented health needs of North Carolinians. "The Future of Public Health," authored by a committee of the Institute of Medicine, defines a health planning and leadership role for a local health authority that is fundamental to the protection of the community's health. Community diagnosis provides for the kind of needs assessment that is crucial to that role.

Community Health Services↗
PubMed1997

Statewide coverage of very low birth-weight infants and young teenage mothers in North Carolina's Child Service Coordination Program.

North Carolina's statewide, interagency Child Service Coordination Program (CSCP) serves children under five years of age with or at-risk for diverse health and developmental conditions. Preliminary assessment of the CSCP linked existing datasets to examine program coverage for two target populations: mothers < 15 year of age and infants < 1,500 g. The expectation that statewide program coverage would be higher for both risk groups in 1993 than in 1991 was true for mothers less than 15 years of age but not for infants < 1,500 g. This efficient method of evaluation can direct program outreach to the areas where it is most needed and provide a focus for more detailed program evaluation.

Adolescent↗
PubMed1980

Representative hearing levels by race and sex in North Carolina industry.

An extensive sample of North Carolina industrial audiometric test data has been compiled. The sample includes data from several different types of industrial environments, with the size of the industries represented ranging from less than fifty to over eight thousand employees. The total population considered is in excess of 14000 employees. The data are examined using analytical techniques developed over the past six years while investigating the effectiveness of industrial hearing conservation programs. One of the findings is significant differences in the initial hearing threshold levels by race and sex. A second observation is differences by race and sex in the change in haring levels with time It is concluded that the hearing levels of industrial employees differ significantly by race and sex. The differences are of such magnitude that meaningful evaluations of industrial audiometric data bases are not possible unless the race and sex compositions of the population are considered.

Adolescent↗
PubMed1980

Job satisfaction of hospital pharmacy technicians in North Carolina.

Factors related to job satisfaction among pharmacy technicians in North Carolina hospitals were studied. To gather data on job satisfaction, job function, and work attitudes, a questionnaire was designed and sent to pharmacy directors and technicians at 83 North Carolina hospitals. The 389 responses represented response rates of 70.3% for technicians and 91.6% for directors. Pharmacy technicians had significantly lower job satisfaction scores (p = 0.05) for work pay, promotion, and coworkers than those reported elsewhere for other workers. There was no difference between technicians and other workers in satisfaction with supervisors. Pharmacy technicians were most satisfied with their supervisors and coworkers, least satisfied with their pay and promotion outlook, and neutral about their work. Higher satisfaction scores were found for technicians who (1) worked in smaller hospitals, (2) performed a wider variety of tasks, or (3) were over 35 years old. Directors judged technician attitudes toward their work to be slightly higher than the technicians did. The study indicates that, in addition to monetary reward, careful consideration of nonmonetary rewards and job functions could contribute to greater technician job satisfaction.

Administrative Personnel↗
PubMed1980

Breeding practices on selected North Carolina dairy farms.

In 1978, 147 North Carolina dairy farms were surveyed concerning their breeding practices. Average herd size was 121 cows (range 24 to 440). Of 17,773 cows 78.5% and of 4,300 heifers 25.5% were bred by artificial insemination. Approximately 25% of dairymen indicated they had increased artificial insemination in the past 3 yr, whereas 12% reported less. A bull was used on 88% of farms. Herds having the same number of cows but using 100% artificial insemination on the milking herd averaged more days open (13.3), longer calving intervals (.44 mo), and more cows leaving the herd because of reproductive problems (8.3% vs. 5.8%) compared to herds using 80 to 99% artificial insemination. Herds using 0 to 75% artificial insemination were intermediate between the two. Herds using 100% artificial insemination and those using 80 to 99% averaged 7050 kg milk and 1.8 services per conception. Herds using 0 to 75% artificial insemination had lower milk production (480 kg). Larger herds had lower reproductive performance. Herds with higher average milk production had more services per conception. Average estimated transmitting abilities of 88 natural service sires were 371 kg milk, -.05% fat and 10 kg fat.

Animals↗
PubMed1996

The use of feedback signs to increase observed daytime seat belt use in two cities in North Carolina.

Well publicized enforcement programs in North Carolina have raised seat belt use to about 80%. In an effort to find techniques to raise belt use further, signs providing feedback to drivers on belt use rates were introduced in two communities, Asheboro (population 18,000) and Greensboro (population 183,000). Feedback signs remind motorists about belt use and imply a constant and vigorous enforcement presence. The signs were prominently posted by the roadside at high volume locations; belt use information was changed weekly based on observational surveys. Observed daytime driver belt use in Asheboro increased from an average of 75% before the signs to 89% after the signs were established. At urban sites in Greensboro, driver belt use increased from 80% to 86%. Right front passenger belt use increased significantly in Asheboro but not in Greensboro. There were no changes in belt use at two interstate exit sites in Greensboro. Reasons for the differential success rates may relate to differences in initial belt use rates, community size, amount of publicity, and numbers of encounters with the signs. It is clear, however, that feedback signs can be an important supplement to belt use enforcement programs.

Accidents, Traffic↗
PubMed2001

Evaluation of 1-octen-3-ol, carbon dioxide, and light as attractants for mosquitoes associated with two distinct habitats in North Carolina.

Field studies were conducted in North Carolina to determine the responses of mosquitoes found in salt marsh and inland creek flood plain areas to 1-octen-3-ol (octenol), carbon dioxide (CO2), and light in various combinations with Centers for Disease Control (CDC) light traps. Over 56,000 adult mosquito specimens of 12 species in 4 genera were collected in the salt marsh. They exhibited a general response pattern of octenol + CO2 + light > CO2 + light = octenol + CO2 > octenol + light > octenol alone. Significantly, more Aedes sollicitans, Ae. taeniorhynchus, Anopheles bradleyi, and Culex salinarius were attracted to octenol + CO2 + light than to CO2 + light. Over 19,000 specimens of 24 species in 7 genera were collected in the inland creek flood plain. Although the response patterns to the attractants were similar to those in the salt marsh area, there was no significant difference between octenol + CO2 + light and CO2 + light. Aedes vexans, An. crucians, and An. punctipennis were attracted nearly equally to these two attractant combinations. These studies demonstrate that responses to combinations of these attractants are species specific. However, different combinations of attractants can significantly increase the collection of targeted species important in arbovirus transmission. The use of these combinations would be very beneficial in mosquito-borne virus surveillance studies. The use of octenol by itself or in conjunction with light was found the least useful for collecting mosquitoes in both habitats.

Aedes↗
PubMed1989

Epidemiology of tuberculosis in North Carolina, 1966 to 1986: analysis of demographic features, geographic variation, AIDS, migrant workers, and site of infection.

We analyzed all cases of tuberculosis reported in North Carolina between 1966 and 1986, and related the incidence rate of tuberculosis (per 100,000 population) to age (0 to 4 years, 7.59; 5 to 14 years, 3.44; 15 to 24 years, 6.30; 25 to 44 years, 15.92; 45 to 64 years, 33.85; greater than 65 years, 51.54), race (white 9.03, nonwhite 47.40), and gender (male 25.49, female 11.25). Over the 21-year study period the annual number of cases declined from 1,248 to 711 (43%), and the incidence rate from 25.56 to 11.25 (56%). Although the incidence rate of tuberculosis fell for all subgroups, nonwhites continued to have an incidence rate 3.2 to 22.5 times higher than whites, depending on age. The standardized morbidity ratio (SMR) (by age, race, and gender) of tuberculosis in the eastern region of North Carolina was nearly twice that of the western region and unexplainable by its demographics. Between 1983 and 1986 only a small percentage of cases of tuberculosis in North Carolina were accounted for by migrant farm workers (1.7% to 2.7%) and patients with the acquired immunodeficiency syndrome (less than 1%). Tuberculosis is increasingly a disease of the elderly, especially nonwhite men. Tuberculosis is a geographically and demographically focal disease in North Carolina, and preventive strategies should be appropriately targeted.

Acquired Immunodeficiency Syndrome↗