Control County Research Articles

Regional Differences in Infant Immunization against Hepatitis B: Did Intervention Work?

Objective.The impact of a community intervention to establish hospital nursery policies for universal newborn immunization against hepatitis B was determined by comparing primary care physician immunization practices in two counties, one intervention and one control.Methods.Surveys were mailed to 855 physicians in 1994; 322 of 533 respondents were eligible, with 155 from San Francisco (SF), the intervention county, and 167 from Sacramento (SAC), the control county. Adoption of universal hepatitis B immunization was defined as immunizing more than 90% of infants seen in 1993.Results.Although similar proportions of physicians agreed, 79% in SF and 72% in SAC, 64% of SF physicians and 40% of SAC physicians adopted universal infant immunization (P< 0.0001). Universal immunization was greater for pediatricians than for family physicians (OR = 2.00, 95% CI 1.66–2.41) but less for physicians who perceived their patient population to be at low risk for hepatitis B compared to those who did not (OR = 0.60, 95% CI 0.45–0.79). While 94% of physicians in both counties indicated their willingness to provide the second and third doses of the hepatitis B vaccine if the first dose had been administered in the newborn nursery, 64% of SF in contrast to 30% of SAC physicians reported routine nursery administration of the vaccine (P< 0.0001).Conclusions.Primary care physician adoption of universal hepatitis B infant immunization and routine nursery administration of the first dose of the vaccine were both greater in San Francisco than in Sacramento, suggesting impact of a community intervention to increase hepatitis B immunization rates.

Provocative appeals in anti-smoking mass media campaigns targeting adolescents--the accumulated effect of multiple exposures.

This paper reports findings from a longitudinal study that evaluated the accumulated effect of three consecutive mass media campaigns using provocative and dissonance arousing appeals to prevent cigarette smoking by adolescents. In the spring of 1992, all eligible adolescents aged 14 and 15 in one intervention county (N = 4898) and one control county (N = 5439) in Norway were included in the study, and were followed until they were 17 and 18 years of age in 1995. Only students who completed questionnaires both in 1992 and 1995 were included in the analyses. Among the non-smokers at baseline, a significantly lower proportion of adolescents of both genders had started to smoke in the intervention county compared to the proportion in the control county. Among those who were smokers at baseline, significantly more girls in the intervention county had stopped smoking than in the control county, while no significant difference between the counties was detected among boys. Our findings suggest that provocative and dissonance arousing appeals that create affective reactions and lead to interpersonal communication should be given more attention in campaigns designed to influence adolescent smoking. However, such appeals may easily produce negative reactions and the normative context should be thoroughly considered when using such appeals in future interventions.

Evaluation of a Model for Improving Emergency Medical and Trauma Services for Children in Rural Areas

Study objective: To evaluate the effectiveness of a rural emergency medical and trauma services project in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. Methods: This prospective, quasi-experimental study used an untreated control group design with pretest and posttest of prehospital and hospital-based emergency care personnel in two rural counties in central Ohio. Project evaluation compared 50 emergency care providers from the intervention county with 43 emergency care providers from the control county. Changes in knowledge and confidence of these personnel in the assessment and management of pediatric emergencies were compared. Results: Providers in the intervention county demonstrated a significantly greater increase in test scores regarding knowledge of pediatric emergencies than did providers in the control county ( P=.001). Significantly greater improvement was also seen when comparisons of test scores were made for field ( P=.02) and hospital ( P=.03) emergency care personnel separately. Self-reports on a visual analog scale indicated that providers in the project intervention county had a significantly greater decrease in anxiety than did control subjects when presented a scenario of a child experiencing a respiratory arrest ( P=.01). On the basis of scores from a five-point Likert scale, emergency personnel in the intervention county had a greater increase in confidence regarding management of the pediatric airway ( P=.0003) and a greater increase in the belief that they had adequate pediatric training ( P=.000001) after participating in the project than emergency personnel in the control county. Conclusion: The rural pediatric emergency medical and trauma services project was effective in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. This project offers a model that can be replicated in other rural areas nationally. [Smith GA, Thompson JD, Shields BJ, Manley LK, Haley KJ: Evaluation of a model for improving emergency medical and trauma services for children in rural areas. Ann Emerg Med April 1997; 29:504-510.]

A Trial of Church-Based Smoking Cessation Interventions for Rural African Americans

Background.The Alliance of Black Churches Health Project was begun in an effort to address the health problems of the African-American residents of two rural Virginia counties. Smoking cessation was chosen as the principal target behavior in one county. Church coalitions were chosen as the principal organizations through which to implement the interventions.Method.A smoking cessation program was designed that combined one-on-one counseling with self-help materials and community-wide activities. To provide these services, up to two smoking cessation counselors were trained from participating churches. To evaluate the impact, population-based cohorts of smokers were assembled in each county using a door-to-door survey. Respondents were recontacted after 18 months. Smoking cessation (1-month continuous abstinence), stages of change, and exposure to the interventions were assessed.Results.The overall smoking prevalence at baseline was 25.8%. At follow-up, the smoking cessation rate in the intervention county was 9.6% and in the control county 5.4% (P= 0.18). Among those attending church once a month or more, the respective quit rates were 10.5% and 5.9% (P= 0.20). There was significantly more progress along the stages of change in the intervention than in the control county. There was also higher awareness of and contact with smoking cessation programs in the former compared with the latter.Conclusion.Smoking cessation interventions for African Americans can be successfully implemented through a church coalition. The interventions were associated with significant progress along the stages of cessation. Although the quit rate was higher in the intervention community, the difference was not significant.

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Bureau of Comunicable Disease Control City and County of San Francisco Department of Public Health San Francisco, CA

Changes in coronary risk factors during comprehensive five-year community programme to control cardiovascular diseases (North Karelia project).

A comprehensive community programme to control cardiovascular diseases (CVD) in North Karelia, Finland, was carried out during 1972-7. The central intermediate objective of the programme was to reduce the prevalence of smoking, the serum cholesterol concentration, and raised blood-pressure values among the population of the area. The effect was evaluated by examining independent representative population samples in 1972 and 1977 in both the county of North Karelia and a matched control county. Over 10 000 subjects were studied each time, the participation rate being around 90%. The decrease that occurred in the risk factors, especially in men, was in general greater in North Karelia compared with the control county. When a multiple logistic function was used for the three risk factors an overall mean net reduction of 17% among men and 12% among women was observed in the estimated risk for coronary heart disease in North Karelia. This community programme effectively reduced the levels of the three main risk factors for CVD in the population, and thus mortality and morbidity from CVD should fall. This is assessed in further studies.