Tamera Coyne-Beasley

Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2014.

In October 2015, the Advisory Committee on Immunization Practices (ACIP)* approved the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2016. This schedule provides a summary of ACIP recommendations for the use of vaccines routinely recommended for adults aged 19 years or older in two figures, footnotes for each vaccine, and a table that describes primary contraindications and precautions for commonly used vaccines for adults. Although the figures in the adult immunization schedule illustrate recommended vaccinations that begin at age 19 years, the footnotes contain information on vaccines that are recommended for adults that may begin at age younger than age 19 years. The footnotes also contain vaccine dosing, intervals between doses, and other important information and should be read with the figures.

Heterosexually Transmitted Hiv Infection Among African Americans in North Carolina

Context: Rates of heterosexually transmitted HIV infection among African Americans in the southeastern United States greatly exceed those for whites. Objective: Determine risk factors for heterosexually transmitted HIV infection among African Americans. Methods: Population-based case-control study of black men and women, aged 18-61 years, reported to the North Carolina state health department with a recent diagnosis of heterosexually transmitted HIV infection and age- and gender-matched controls randomly selected from the state driver s license file. A lower-risk stratum of respondents was created to identify transmission risks among people who denied high-risk behaviors. Results: Most case subjects reported annual household income <

Unintentional injuries in the home in the United States: Part II: Morbidity

16,000, history of sexually transmitted diseases, and high-risk behaviors, including crack cocaine use and sex partners who injected drugs or used crack cocaine. However, 27% of case subjects (and 69% of control subjects) denied high-risk sexual partners or behavior. Risk factors for HIV infection in this subset of participants were less than high school education (adjusted odds ratio [OR] 5.0; 95% CI: 2.2, 11.1), recent concern about having enough food for themselves or their family (OR 3.7; 1.5, 8.9), and having a sexual partner who was not monogamous during the relationship with the respondent (OR 2.9; 1.3, 6.4). Conclusion: Although most heterosexually transmitted HIV infection among African Americans in the South is associated with established high-risk characteristics, poverty may be an underlying determinant of these behaviors and a contributor to infection risk even in people who do not have high-risk behaviors.

Aligning the Goals of Community-Engaged Research: Why and How Academic Health Centers Can Successfully Engage With Communities to Improve Health

BACKGROUND Homes are an important setting for nonfatal unintentional injuries. The purpose of this study was to quantify and describe nonfatal, unintentional injuries in the United States, in which the injury took place at home. METHODS Data derived from the National Health Interview Survey, National Ambulatory Medical Care Survey, and National Hospital Ambulatory Medical Care Surveys for Outpatient and Emergency Departments. The nonfatal unintentional home injury rate and 95% confidence interval were computed for the United States overall (1998-1999), as well as by type of injury, gender, and age group. Weights were applied for each data set as designated by the National Center for Health Statistics. RESULTS In 1998, there were more than 12 million unintentional home injuries requiring some form of medical attention. Falls were the most common injury among all age groups, followed by cutting/piercing injuries, and injuries associated with being struck by or against an object or person. Injury rates were highest among the oldest and youngest age groups. There was inconsistency across data sets with regard to the presence of location information and definitions of the home environment, inclusion criteria, and the presence of external cause of injury and poisoning codes (E-codes). Depending on the data set, information was missing for 8% and 41% of cases on the location of injury, making it impossible to determine whether the injuries occurred in the home environment. CONCLUSIONS Falls are a significant problem, particularly among older adults. Additionally, data collection systems need to be improved so that location of injury data are routinely collected using consistent definitions so as to allow comparisons across data sets and over time.

Designing Messages to Motivate Parents To Get Their Preteenage Sons Vaccinated Against Human Papillomavirus

Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC—including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions but also improve the health of the nation—starting with improving the health of their local communities, one community at a time.

Maltreatment History and Weapon Carrying Among Early Adolescents

CONTEXT Human papillomavirus (HPV) vaccine, licensed for use in 9--26-year-olds, is most effective when given before sexual activity begins. HPV causes genital warts, is associated with several cancers and disproportionately affects racial and ethnic minorities. Parents are typically unaware of male HPV vaccine; messages that might motivate them to get their preteenage sons vaccinated are unexplored. METHODS Messages promoting vaccination of preteenage boys were designed and tested in 2009 and 2010. Five focus groups were conducted with 29 black parents of 11-12-year-old boys, recruited through three churches and a middle school in North Carolina, and a racially diverse sample of 100 parents of 9-13-year-old boys in a university-based adolescent health clinic was interviewed. A constant comparison method was used to code transcripts and interpret themes. Chi-square and t tests or analyses of variance were used to assess differences in quantitative data. RESULTS Focus group parents knew little about HPV in males. Although concerned about safety and cost, parents supported vaccination for their sons. They wanted to see racial diversity and both parents in motivational materials. In interviews, 89% of parents reported never having heard of male HPV vaccine. The largest proportion said that a message stressing the prevalence and possible consequences of HPV infection was the most motivating (32%); the design favored by the largest proportion (43%) showed two parents. CONCLUSIONS Messages that may most motivate parents to get preteenage boys vaccinated against HPV focus on infection risk and include images of parents with their sons.

Review of evaluations of educational approaches to promote safe storage of firearms

This study examines the role of maltreatment in weapon carrying among 12-year-old youth (N = 797) interviewed as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), an ongoing study of the antecedents and consequences of child maltreatment. Participants reported their physical and sexual abuse history and provided responses to items assessing perceived need for a weapon and weapon carrying. There were no gender differences in rates of self-reported physical or sexual abuse. Males were more likely than females to report weapon carrying and perceived need for a weapon. A mediation analysis was conducted to examine the mediating effect of perceived need for a weapon on the association between abuse and weapon carrying. Results indicated that perceived need for a weapon fully mediated the effect of physical abuse and partially mediated the effect of sexual abuse. Results are discussed in the context of self-protection theory.

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.

Objective: To systematically review evaluation studies of educational interventions promoting safe firearm storage. Methods: Medline, ERIC, PsycINFO, Criminal Justice Periodicals Index, Cumulative Index of Nursing and Allied Health Literature, and Sociofile were searched. The references from each potentially eligible study were checked, and experts in the field were contacted for additional reports. In addition, an internet search was performed to identify programs not published in the conventional literature. Sources relevant to safe firearm storage promotion were selected and evaluated. Results: Seven studies met inclusion criteria: adult subjects, program description was included, and firearm storage outcomes were measured. One was a randomized controlled trial and the other six were one group pre-test and/or post-test. The studies were classified into the following categories based on the intervention strategies used: (1) counseling and firearm safety materials (n=3); (2) counseling/educational message (n=3); and (3) firearm safety materials distribution (n=1).The outcomes were safe firearms storage (firearms locked up and unloaded or removal from home) after intervention. Four studies, three using counseling and materials distribution, reported improved storage after the interventions. Conclusions: It is not yet clear what types of interventions, or which specific intervention components, prompt gun owners to securely store their weapons. Increased understanding of gun storage behaviors and stronger evaluation designs will aid further understanding of this important issue.

Reducing firearm violence: a research agenda

OBJECTIVES Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11-12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys. METHODS We targeted parents and providers of 9-13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered. RESULTS The Cox model showed an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11-12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously. CONCLUSIONS Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.

Promoting Education, Mentorship, and Support for Pediatric Research

In the United States, firearms are involved in tens of thousands of deaths and injuries each year. The magnitude of this problem prompted the National Academy of Sciences (NAS) to issue a report in 2004 detailing the strengths and limitations of existing research on the relationship between firearms and violence. In response, a multidisciplinary group of experts in the field of firearms and violence formed the National Research Collaborative on Firearm Violence. The Collaborative met for 2 days in June 2005 to (1) critically review the main findings of the NAS report and (2) define a research agenda that could fill research and data gaps and inform policy that reduces gun-related crime, deaths and injuries. This article summarizes the Collaborative’s conclusions and identifies priorities for research and funding.