Barri Burrus

Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research.

In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.

Building an Evidence Base to Inform Interventions for Pregnant and Parenting Adolescents: A Call for Rigorous Evaluation

Adolescent parents and their children are at increased risk for adverse short- and long-term health and social outcomes. Effective interventions are needed to support these young families. We studied the evidence base and found a dearth of rigorously evaluated programs. Strategies from successful interventions are needed to inform both intervention design and policies affecting these adolescents. The lack of rigorous evaluations may be attributable to inadequate emphasis on and sufficient funding for evaluation, as well as to challenges encountered by program evaluators working with this population. More rigorous program evaluations are urgently needed to provide scientifically sound guidance for programming and policy decisions. Evaluation lessons learned have implications for other vulnerable populations.

The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties.

CONTEXT Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. PURPOSE To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). METHODS This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings. FINDINGS Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). CONCLUSIONS Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success.

Identifying and responding to technical assistance and training needs in tobacco prevention and control.

The Master Settlement Agreement generated expecta-tions that significant, long-term funding would be avail-able to the 46 participating states in reparation for the health costs incurred by tobacco use. Facing intense pressure to use anticipated funds for effective program-ming, states and national organizations considered how to supply the technical assistance and training at the state and local levels. This article reviews assessments by the American Legacy Foundation, the Tobacco Tech-nical Assistance Consortium, and selected states of the current needs for support, technical assistance, and training in tobacco prevention and control. Key findings indicated the need for information, information exchange, mentoring, and training targeted to new staff, with advanced skill sets for experienced staff. As future funding is uncertain, all these organizations are explor-ing innovative ways to maintain infrastructure and pro-gramming at the state and local levels. Training and technical assistance can be the solution to sustaining impetus in the movement.

Incorporating Trauma-Informed Care into School-Based Programs.

BACKGROUND This article provides an overview of the rationale and process for incorporating trauma-informed approaches into US school-based programs, using school-based adolescent pregnancy prevention programs as an example. METHODS Research literature is reviewed on the prevalence and outcomes of childhood trauma, including the links between trauma and pregnancy. Information is then presented concerning the implementation of trauma-informed approaches in school settings, describing activities undertaken, barriers encountered, and outcomes achieved. Next, we describe the implications of this literature for school-based adolescent pregnancy prevention programs, outlining the reasons for including trauma-informed approaches in these programs, the prerequisites for doing so, and some examples of successful implementation. RESULTS Many children in our country experience trauma, placing them at increased risk of multiple health concerns including adolescent pregnancy. In response to this situation, some schools have successfully incorporated trauma-informed approaches into adolescent pregnancy prevention programs, as well as other programming. CONCLUSIONS Incorporating trauma-informed approaches into school settings, including school-based adolescent pregnancy prevention programs, is a viable and important way to address the multiple needs of traumatized children.