Cook County Research Articles

Sorting by Race/Ethnicity Across HIV Genetic Transmission Networks in Three Major Metropolitan Areas in the United States.

An important component underlying the disparity in HIV risk between race/ethnic groups is the preferential transmission between individuals in the same group. We sought to quantify transmission between different race/ethnicity groups and measure racial assortativity in HIV transmission networks in major metropolitan areas in the United States. We reconstructed HIV molecular transmission networks from viral sequences collected as part of HIV surveillance in New York City, Los Angeles County, and Cook County, Illinois. We calculated assortativity (the tendency for individuals to link to others with similar characteristics) across the network for three candidate characteristics: transmission risk, age at diagnosis, and race/ethnicity. We then compared assortativity between race/ethnicity groups. Finally, for each race/ethnicity pair, we performed network permutations to test whether the number of links observed differed from that expected if individuals were sorting at random. Transmission networks in all three jurisdictions were more assortative by race/ethnicity than by transmission risk or age at diagnosis. Despite the different race/ethnicity proportions in each metropolitan area and lower proportions of clustering among African Americans than other race/ethnicities, African Americans were the group most likely to have transmission partners of the same race/ethnicity. This high level of assortativity should be considered in the design of HIV intervention and prevention strategies.

An Outcome Study on the Naloxone Education/Dispensing Program for Departure Patients at Cermak Health Services of Cook County.

The objective of this study was to evaluate the utilization of the naloxone nasal spray kit provided to patients after discharge from Cermak Health Services of Cook County (CHS). During May and June 2018, the records of currently incarcerated CHS patients were reviewed to identify patients who (1) received the naloxone education and nasal spray kit upon previous discharge from CHS and (2) were then readmitted to the facility. Of the 76 potential participants, 60 interviews were conducted. This study has shown that 38.3% of patients utilized the nasal sprays provided to them upon discharge. Of those who reported using the nasal spray, 95.7% achieved positive outcomes. This study showed the positive impact the Naloxone Education/Dispensing Program had on patients discharged from CHS. In addition to identifying success in the number of lives saved, the study recognizes the long-term effect on patient safety that emerges from the program.

Easy in, tough out: the dam of health-care racism

Until the 1980s, the practice of turning away patients on the basis of their ability to pay, without evaluating or treating them, was legal and frequent in US hospitals. A 1986 study at Cook County Hospital, a public hospital in Chicago, noted that 89% of patients transferred from private hospitals to their facility were Black and Hispanic, and 87% of them were transferred because they did not have adequate insurance. Mortality was disproportionately high among those transferred, likely due to delays in stabilisation and definitive care. This practice was ultimately disrupted—although it continues today—not by institutions recognising its unethical nature and voluntarily halting it, but by the passage of the federal Emergency Medical Treatment and Active Labor Act, which requires hospitals to stabilise and treat patients before transfer, irrespective of insurance status. It took an act of Congress to change this fundamentally racist, inequitable practice. Introducing The PenumbraThere are few topics that cause as much discomfort as inequities, particularly those related to race, gender, and other social identifiers. As a frequent lecturer, I've found the issue of how inequities shape one's experience in the health-care system, whether as a patient or in the workforce, often elicits avoidance, dismissiveness, defensiveness, or even anger. Health-care curricula typically neglect discussion of structural racism or sexism, and relegate race, sex, gender, gender identity, sexual orientation, and disability to the vague and misplaced category of risk factors. Full-Text PDF Parenting in the time of COVID-19Before COVID-19, you could put any two physician parents together and we'd have a shared narrative of all our “fails” as we juggled hospital work with child rearing: missed teacher conferences, late sign-ups for activities, being the only one who didn't attend the field trip. These were all crises in the Before Times. Our lives changed abruptly with COVID-19. The ways we educated, enriched, and entertained our kids were obliterated overnight. For many parents, child care evaporated, as did the endless march of activities that helped to keep our kids happy. Full-Text PDF

Epidemiology of COVID-19 vs. influenza: Differential failure of COVID-19 mitigation among Hispanics, Cook County Health, Illinois.

During the early phases of the COVID-19 pandemic in the U.S., African-American or Hispanic communities were disproportionately impacted. To better understand the epidemiology and relative effects of COVID-19 among hospitalized Hispanic patients, we compared individual and census-tract level characteristics of patients diagnosed with COVID-19 to those diagnosed with influenza, another viral infection with respiratory transmission. We evaluated temporal changes in epidemiology related to a shelter-in-place mandate. We evaluated patients hospitalized at Cook County Health, the safety-net health system for the Chicago metropolitan area. Among self-identified hospitalized Hispanic patients, we compared those with influenza (2019-2020 season) to COVID-19 infection during March 16, 2020-May 11, 2020. We used multivariable analysis to identify differences in individual and census-tract level characteristics between the two groups. Relative to non-Hispanic blacks and whites, COVID-19 rapidly increased among Hispanics during promotion of social-distancing policies. Whereas non-Hispanic blacks were more likely to be hospitalized for influenza, Hispanic patients predominated among COVID-19 infections (40% relative increase compared to influenza). In the comparative analysis of influenza and COVID-19, Hispanic patients with COVID-19 were more likely to reside in census tracts with higher proportions of residents with the following characteristics: Hispanic; no high school diploma; non-US citizen; limited English speaking ability; employed in manufacturing or construction; and overcrowding. By multivariable analysis, Hispanic patients hospitalized with COVID-19 compared to those with influenza were more likely to be male (adjusted OR = 1.8; 95% CI 1.1 to 2.9), obese (aOR = 2.5; 95% CI 1.5 to 4.2), or reside in a census tract with ≥40% of residents without a high-school diploma (aOR = 2.5; 95% CI 1.3 to 4.8). The rapid and disproportionate increase in COVID-19 hospitalizations among Hispanics after the shelter-in-place mandate indicates that public health strategies were inadequate in protecting this population-in particular, for those residing in neighborhoods with lower levels of educational attainment.

Edge Growth Form of European Buckthorn Increases Isoprene Emissions From Urban Forests

Urban trees provide numerous benefits, such as cooling from transpiration, carbon sequestration, and street aesthetics. But volatile organic compound emissions from trees can combine with anthropogenic nitrogen oxide emissions to form ozone, a harmful air pollutant. The most commonly-emitted of these compounds, isoprene, negatively impacts air quality and hence is detrimental to human health. In addition to environmental controls such as light and temperature, the quantity of isoprene emitted from a leaf is a genus-specific trait. Leaf isoprene emission is enzymatically controlled, and species are typically classified as emitters or non-emitters (near-zero emission rates). Therefore, the species composition of urban forests affects whole-system isoprene production. The process of plant invasion alters species composition, and invasive tree species can be either emitters or non-emitters. If an invasive, isoprene-emitting tree species displaces native, non-emitting species, then isoprene emission rates from urban forests will increase, with a concomitant deterioration of air quality. We tested a hypothesis that invasive species have higher isoprene emission rates than native species. Using existing tree species inventory data for the Chicago region, leaf-level isoprene emission rates of the six most common invasive and native tree species were measured and compared. The difference was not statistically significant, but this could be due to the variability associated with making a sufficient number of measurements to quantify species isoprene emission rates. The most common invasive species European buckthorn (Rhamnus cathartica, L.) was an emitter. Because European buckthorn often invades the disturbed edges common in urban forests, we tested a second hypothesis that edge-effect isoprene emissions would significantly increase whole-system modeled isoprene emissions. Using Google Earth satellite imagery to estimate forested area and edge length in the LaBagh Woods Forest Preserve of Cook County (Chicago, IL, USA), edge isoprene emission contributed 8.1% compared to conventionally modeled forest emissions. Our results show that the invasion of European buckthorn has increased isoprene emissions from urban forests. This implies that ecological restoration efforts to remove European buckthorn have the additional benefit of improving air quality.

Genomic Epidemiology of MRSA During Incarceration at a Large Inner-City Jail.

Congregate settings, such as jails, may be a location where colonized detainees transmit methicillin-resistant Staphylococcus aureus (MRSA). We examined MRSA acquisition during incarceration and characterized the genomic epidemiology of MRSA entering the jail and isolated during incarceration. Males incarcerated at the Cook County Jail were enrolled within 72 h of intake and MRSA surveillance cultures collected. Detainees in jail at Day 30 were re-cultured to determine MRSA acquisition. A survey was administered to identify acquisition predictors. Genomic sequencing of surveillance and clinical isolates was integrated with epidemiologic and jail location data to track MRSA transmission pathways. 800 males were enrolled; 19% MRSA colonized at intake. Of 184 who reached Day 30 visit, 12 acquired MRSA. Heroin use before entering (OR 3.67, P = .05) and sharing personal items during incarceration (OR = 4.92, P = .01) were predictors of acquisition. Sequenced clinical USA300 isolates (n = 112) were more genetically similar than diverse intake USA300 strains (P < .001), suggesting jail transmission. Four acquired colonization isolates were within 20 single-nucleotide variant (SNVs) of other isolates; 4 were within 20 SNVs of an intake isolate, 2 for an acquisition isolate, and 1 for a clinical isolate. Individuals with genetically similar isolates were more likely to have had overlapping stays in the same buildings. There was a high MRSA burden entering jail. Genomic analysis of acquisition and clinical isolates suggests potential spread of incoming strains and networks of spread during incarceration, with spread often occurring among detainees housed in similar locations. Sharing personal items during incarceration is associated with MRSA acquisition and could be a focus for intervention.

Opioid overdose deaths before, during, and after an 11-week COVID-19 stay-at-home order - Cook County, Illinois, January 1, 2018-October 6, 2020

This article provides estimates of the opioid-related fatal overdoses in Cook County in Illinois before, during, and after a stay-at-home order was lifted. During the 99-week period from 1 January, 2018, to 6 October, 2020, a total of 3,843 people died in Cook County due to opioid overdoses. The spike in deaths during the last 16 weeks of 2019 followed an increase of almost 10% in the previous 16 weeks. It is possible that the increase in opioid overdose deaths during the stay-at-home period was a continuation of the increases that occurred in the 16 weeks before the order was lifted. Although the mean deaths declined during the period after the order, they still remained elevated above pre-2020 levels. It might indicate a persistent upward trend in the number of overdose deaths reported by the Centers for Disease Control and Prevention (CDC). Since the outbreak of COVID-19, various outreach, treatment, recovery, and education initiatives have been implemented to prevent drug-related deaths.

Journal Digest: Z-Drugs and Dementia; Methotrexate and Schizophrenia; Smartphones and Depression; Brexpiprazole and Sexual Function; E-Cigarettes and Youth; Opioids Deaths and Neighborhoods

Journal Digest: Z-Drugs and Dementia; Methotrexate and Schizophrenia; Smartphones and Depression; Brexpiprazole and Sexual Function; E-Cigarettes and Youth; Opioids Deaths and Neighborhoods

CP01.03 COVID 19’s Pandemic’s Effect on a Community Lung Cancer Screening Program

COVID-19’s pandemic spread in the US in early 2020 led to a drastic change in health care delivery. In April 2020 consensus statement on LC screening advised deferring enrollment in LC screening and modified the evaluation of nodules. This single institution has had an active LC screening program before COVID, which enrolled more than 300 patients per month before COVID and completed more than 11,000 screens over the last six years. Kentucky is the state with the highest LC mortality rate in the US and one of the highest smoking rates in the country. Government directed social distancing was put in place 3/14/2020. LC Screening Registry data 2015-2020 for St Elizabeth Healthcare (SEH) was accessed. The lung cancer screening volumes listed until May 2020 were recorded and graphically illustrated using polynomial trendlines and well as monthly point by point lines. John Hopkin’s COVID Status Report on Kentucky’s and SEH surrounding counties confirmed cases, fatality rate and number of tested patients. By June 2020, Kentucky (pop 4.6m) had 13.630 confirmed COVID cases, 524 deaths and a 3.84% fatality rate with 317,161 tests performed. SEH’s surrounding counties, (pop 370k) had 386 cases per 100k population and a 4.5 % county fatality rate with 71 deaths. The county with the highest rate in the county at the time was Cook county, IL, (pop 5,2m) with 1,711 cases per 100k population and 4,500 deaths due to COVID. 379 LC screens were performed at SEH in February 2020. 212 in March and 13 LC screens in April, 114 in May. The lung cancer rate in the screened population has been 1.81% over the course of six years. The consensus statement on LC screening during COVID advised a delay in LC screening, work up and treatment, even for high probability nodules and stage 1 lung cancers. A delay of LC screens in this community setting by 6 months would delay the diagnosis and treatment of 36 lung cancer cases. The course of the COVID pandemic is presently uncertain. Considering the fact that COVID will affect health care for the foreseeable future, it would be helpful to modify the recommendations based on the area’s prevalence of COVID and prevalence of lung cancer.

Data and Methodology Documentation for a COVID-19 Risk Calculator: Mortality Rates and Loss of Life Expectancy

We develop careful cohort-based estimates of median life expectancy without COVID, COVID population fatality rates (PFRs) for three areas (Cook County, Illinois; Milwaukee County, Wisconsin, and the State of Indiana), and expected life expectancy lost due to COVID. We examine how PFR and lost life expectancy vary with age, gender, race/ethnicity, socio-economic status, and common comorbidities. On average, decedents lose about 12 expected life-years (upward biased estimate). Expected life lost to date for our three areas is around 0.016 years; an estimate for the whole U.S. population is 0.02 years (about one week) (upward biased estimates). Expected life lost rises rapidly with age and can be as high as 3 months for some individuals. Expected life lost for whites and Asians in our three areas is around 0.012, but is roughly double this for Blacks and Hispanics. We also provide data and methodology details underlying the COVID-19 Risk Calculator, available at https://fightcovidmilwaukee.org/risk-assessment-tool.

The COVID-19 Pandemic and Life Expectancy: Decomposition Using Individual-Level Mortality Data

We develop cohort-based estimates of life expectancy without COVID, the fraction of persons who have died of COVID (population fatality rate, or PFR), and life expectancy loss, relying on individual-level data for three areas in the Midwestern U.S. (Cook County, Illinois; Milwaukee County, Wisconsin; and the State of Indiana). We use the individual-level data to assess how estimates of PFR and life-expectancy loss vary with age, gender, race/ethnicity, and socio-economic status. COVID PFR over March 2020-June 2021 for the three Midwest areas is 0.17% and decedents lose about 12 expected life-years. Life expectancy loss (LEL) is 0.17% * 12 years = 0.021 years (8 days); but can be as high as 3 months for some persons. Mean LEL is higher for men (0.025 years) than for women (0.018 years), and substantially higher for Blacks and Hispanic (0.030 years) than for Whites (0.018 years). We also provide national estimates using aggregate data. Life expectancy losses due to COVID exceed the annual gains in life expectancy over 2008-2018 for persons above ages 62-69 (depending on gender and race/ethnicity). Socio-economic status has modest incremental effect on life expectancy loss, relative to age, gender, and race/ethnicity. Our life expectancy loss estimates are much lower than published estimates which use a “period life expectancy” approach.

Covid-19, Race, and Gender

The mounting evidence on the demographics of COVID-19 fatalities points to an overrepresentation of minorities and an underrepresentation of women. Using individual-level, race-disaggregated, and georeferenced death data collected by the Cook County Medical Examiner, we jointly investigate the racial and gendered impact of COVID-19, its timing, and its determinants. Through an event study approach we establish that Blacks individuals are affected earlier and more harshly and that the effect is driven by Black women. Rather than comorbidity or aging, the Black female bias is associated with poverty and channeled by occupational segregation in the health care and transportation sectors and by commuting on public transport. Living arrangements and lack of health insurance are instead found uninfluential. The Black female bias is spatially concentrated in neighborhoods that were subject to historical redlining.

The Incidence of Land Use Regulations

I study the welfare consequences of land use regulations for low- and high-skilled workers within a city. I use detailed geographic data for Cook County and Chicago in 2015-2016, together with a spatial quantitative model with two types of workers and real estate developers who face regulations. For identification, I use the 1923 Zoning Ordinance, which was the first comprehensive ordinance in Chicago. I find that an increase of 10 percentage points in the share of residential zoning in a block group, relative to block groups with more commercial zoning, leads to a 1.7% increase in housing prices, a 2.6% decrease in wages and a higher concentration of high-skilled residents. Welfare changes can be decomposed into changes in housing prices, sorting, wages and land rents. Results suggest that more mixed-use zoning and looser floor-to- area limits lead to welfare improvements, especially for low-skilled residents, and to a reduction in welfare inequality.

LB-6. Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has negatively impacted routine HIV screening in healthcare settings. This has serious implications, especially for patients with acute HIV infection (AHI) presenting with symptoms suggesting COVID-19 infection. This is a high priority population for rapid linkage to care (LTC) and initiation of HAART.MethodsWe reviewed data from our eXpanded HIV Testing and LTC (X-TLC) Program, a collaboration effort between 13 healthcare centers on the South and West Sides of Chicago. Since 2016, most sites had 4th or 5th generation HIV Ag/Ab testing available.ResultsMost sites experienced reductions in HIV screens during the COVID-19 pandemic. Advanced planning by our ED incorporated blood draws for HIV screens as part of COVID-19 evaluations. UCM performed 19,111 HIV screens (11,133 in the ED) between 1/1/20 and 8/17/20, along with 100,635 COVID PCRs (14,754 in ED) between 3/17/20 and 8/17/20. Nine patients were diagnosed with AHI after the first case of COVID-19 in Chicago (1/24/20), and 7 were diagnosed after the first case of community transmission in Cook County (3/8/20). All cases of AHI were diagnosed in the ED. The rate of AHI was significantly higher in 2020 versus the prior 4 years (14.4 vs 6.8 per year, p < 0.05). AHI patients comprised 25.7 % (9/35) of all new diagnoses, the highest percent ever. There were 7 men (6 identified as MSM) and 2 cis-gender women, median age of 25 years (21 to 28 years). The median viral load was 6 million (115,000 to > 6 million) copies/mL. Eight of 9 patients presented with an illness indistinguishable from COVID-19, including 1co-infected patient. All were LTC and started on HAART from time of PCR result within a median of 1 day (0–38), but 3 days (range 1–41) from sample collection as a result of delayed reflex PCR confirmatory testing due to high demands on lab personnel and scarcity of reagents due to COVID-19 PCR volumes (since resolved).HIV Screening and COVID-19 Testing in the ED During COVID-19 ConclusionContinued HIV screening in our ED during the COVID-19 pandemic identified an increased number of patients with AHI. These individuals may be more likely to present for care due to fear of COVID-19 infection. We achieved rapid LTC and initiation of HAART without any incremental increases in resources. All HIV screening programs should incorporate blood-based HIV screening into their COVID-19 testing programs.Disclosures Moira McNulty, MD, MS, Gilead Sciences (Grant/Research Support)

Evaluation of Changes in Beverage Prices and Volume Sold Following the Implementation and Repeal of a Sweetened Beverage Tax in Cook County, Illinois

Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. Implementation and repeal of the Cook County SBT. Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (β = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (β = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.

Is Tax Competition Strategic? Spatial Distributions of Business Property Tax Abatements in the Chicago Suburbs

The authors analyze the locations of property tax abatements awarded to businesses in Cook County, Illinois from 2012 to 2014 to explore their spatial distribution and to examine local government motivations for awarding incentives. The authors’ analysis, which controls for the spatial distribution of businesses, reveals a clustering of abatements at intramunicipal geographic scales. They also find amplified probabilities that abatements are awarded to businesses located near tax increment financing districts or enterprise zones. These patterns suggest that local governments use abatements in a strategic fashion to advance policy goals. The authors use the same data to develop three indices of the degree of abatement clustering at the municipal scale for each of the 64 municipalities in Cook County that awarded five or more abatements. Most of the Chicago suburbs exhibit a pattern consistent with the strategic award of business tax incentives.

A financial benefit-cost analysis of different community solar approaches in the Northeastern US

Community solar farms (CSF) have the potential to expand solar access and improve financial viability compared to traditional residential and commercial solar options. The Cook County Community Solar Project created and made publicly available 26 benefit-cost analysis spreadsheets and associated white papers for 15 case study CSF locations in Illinois with proposed panel leasing financial models. We update these spreadsheets to reflect current federal incentives, fix some key errors, and compare the net present value, annual cash flow, return on investment, and simple payback period for all 26 panel leasing financial models; apply the panel leasing model to a Maine-based location; develop and apply to Maine three additional financial models: lease-to-own, panel purchase with developer, and grassroots “true ownership”; and provide a comparative analysis of the effects of federal and state incentives on CSF panel leasing in Maine and Illinois. Illinois panel lease results for subscribers, owners, and hosts, respectively, include net present values ($2019 thousands) of -$127 to $27, $6 to $450, -$490 to $473; return on investment of −53% to 295%, 8% to 117%, −44% to 474%; and simple payback period (years) of 0 to 20, 3.6 to 20, 0 to 20, (with system owner internal rate of return set at 10%). Respective Maine results include: $5 to $9, $4 to $201, $193 to $209; 84% to 262%, 26% to 207%, 116% to 309%; 0 to 8, 1 to 14, 0 to 3. Holding all else equal, higher electricity prices, a lower labor rate, and a 1:1 net metering bill credit policy yield greater subscriber and host (anchor subscriber) benefits for Maine than Illinois. Although the panel purchase model yields the greatest net present value (NPV) for subscriber and host in the Maine analysis, it yields the lowest developer NPV and requires a large upfront cost to subscribers that may limit participation to those with higher income. Therefore, we recommend the lease-to-own model for the Maine case study site, as it provides positive substantial NPV for all three stakeholder types without large upfront costs for subscribers and with a path to ownership.

Oral Health Behaviors in Very Young Children in Low-Income Urban Areas in Chicago, Illinois, 2018-2019.

IntroductionBecause most data on oral health do not include infants and toddlers, we aimed to describe the oral health behaviors of low-income children younger than 3 years and determine factors associated with child tooth brushing.MethodsWe obtained data from the Coordinated Oral Health Promotion Chicago study, which included 420 families with children aged 6 to 36 months and their caregivers in Cook County, Illinois. We assessed child frequency of brushing from caregiver reports and objectively determined child dental plaque scores. Significant factors associated with tooth brushing frequency and dental plaque score were identified using the Least Absolute Shrinkage and Selection Operator variable selection.ResultsMean child age was 21.5 (SD, 6.9) months, and only 45% of caregivers brushed their children’s teeth twice per day or more. The mean plaque score was 1.9 (SD, 0.6), indicating high levels of plaque. Child brushing frequency was higher when children were older; used the correct toothpaste amount; brushed for a longer duration; and when caregivers brushed their own teeth more frequently, had more help with the overall care of the child’s teeth, and had family to help. Child brushing frequency was lower for caregivers with more interference from activities of daily life. Children whose caregivers had more adult help with child brushing had better plaque scores; worse plaque scores were seen in children with higher sugary beverage and food consumption and lower household incomes.ConclusionThe tooth brushing behaviors of young children are strongly associated with those of their parents and with the level of family support for brushing. Interventions to improve brushing in young children should focus on the entire family.

Identification of Presymptomatic and Asymptomatic Cases Using Cohort-Based Testing Approaches at a Large Correctional Facility-Chicago, Illinois, USA, May 2020.

BackgroundCoronavirus disease 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained persons exposed to laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to identify presymptomatic and asymptomatic cases.MethodsDuring 1–19 May 2020, 2 testing strategies were implemented in 12 tiers or housing units of the Cook County Jail, Chicago, Illinois. Detained persons were approached to participate in serial testing (n = 137) and offered tests at 3 time points over 14 days (day 1, days 3–5, and days 13–14). The second group was offered a single test and interview at the end of a 14-day quarantine period (day 14 group) (n = 87).Results224 detained persons were approached for participation and, of these, 194 (87%) participated in ≥1 interview and 172 (77%) had ≥1 test. Of the 172 tested, 19 were positive for SARS-CoV-2. In the serial testing group, 17 (89%) new cases were detected, 16 (84%) on day 1, 1 (5%) on days 3–5, and none on days 13–14; in the day 14 group, 2 (11%) cases were identified. More than half (12/19; 63%) of the newly identified cases were presymptomatic or asymptomatic.ConclusionsOur findings highlight the utility of cohort-based testing promptly after initiating quarantine within a housing tier. Cohort-based testing efforts identified new SARS-CoV-2 asymptomatic and presymptomatic infections that may have been missed by symptom screening alone.

Jail Guitar Doors: A case study of guitar and songwriting instruction in Cook County Jail

Jail Guitar Doors USA (JGD USA) is an initiative that provides guitars and songwriting instruction in correctional facilities. Founded in 2009, JGD USA is currently in 100 jails, prisons and youth facilities with a waiting list of 50. This study examined the phenomenon of JGD USA in Cook County Jail (Chicago, Illinois) and was guided by the following research question: How do participants describe their experiences in the case of JGD USA in Cook County Jail? Participants consisted of six adult male residents. Other data sources included interviews with the class teacher, the jail administrator who implemented JGD USA, Billy Bragg (founder of the original JGD) and Wayne Kramer (founder of JGD USA). This study employed instrumental case study methodology in order to explore a real-world phenomenon of guitar instruction in jail. Data sources included observation, a focus group interview, four semi-structured phone interviews and examination of lyrics and chord structure. Data were coded for emergent themes. Analysis of data sources revealed themes of group dynamics, expression, flow and intrinsic motivation. Other findings included insights related to the benefits of guitar and songwriting instruction in correctional settings.