County-wide Survey Research Articles

Factors Associated With Caregiver Reporting of Developmental Concerns Among Children in Low-Income Communities

Early detection and access to interventions for developmental delays in young children have been shown to improve health, social, and academic outcomes later in life. The purpose of this study is to examine the factors associated with caregivers' perception of child developmental concerns in low-income communities. A countywide survey was conducted in Los Angeles County (LAC), California, among 4,863 participating Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) families with children ages 1–4 years. Proportional odds ordinal logistic regression was used to evaluate the association between the severity of reported developmental concerns and respondent characteristics. Results indicate that demographic characteristics, support systems, health care visits during COVID-19, and maternal symptoms of depression are associated with higher odds of reporting more severe developmental concerns among the WIC population. Advancing policies, programs, and research that aim to improve early detection and access to childhood professionals for all families will be essential to allow all children in low-income households to optimize their development.

Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border.

As of October 26, 2022, only 9% of children in the United States aged 6 months to 4 years have received at least one dose of COVID-19 vaccine despite FDA approval since June 17, 2022. Rates are better yet still low for children aged 5 to 11 years as nearly 30% were fully vaccinated as of August 23, 2022. Vaccine hesitancy among adults is one of the major factors affecting low vaccine uptake rates in children against COVID-19, yet most studies examining vaccine hesitancy have targeted school-age and adolescent children. With the aim of assessing the willingness to recommend the COVID-19 vaccination to children under 5 years compared to children 5 to 12 years of age, a county-wide survey was conducted between January 11 and March 7, 2022, among adults on the United States-Mexico border. Among the 765 responses, 72.5% were female and 42.3% were Latinx. The most significant factor associated with likelihood to recommend the COVID-19 vaccine to children less than 5 years and 5-12 years of age was adult vaccination status. Ordinal logistic regression also indicated that ethnicity, primary language, being a parent, previous COVID-19 infection, and concern about getting COVID-19 in the future were significantly associated with likelihood of COVID-19 vaccine recommendation to children < 5 years and 5-12 years old. This study found high consistency among respondents in their willingness to vaccinate children aged < 5 years compared with children aged 5-12 years. Our findings support public health strategies that target adult vaccinations as an avenue to improve childhood vaccinations for young children.

Staying in School: Connection, Cohesiveness, and Suspension.

Individual-, school-, and neighborhood-level support and connectedness may help to mitigate against school suspensions, which have profound health and social consequences. Most research on social connectedness and suspension has focused only on school connectedness, and much less is known about the effects of individual social support and neighborhood-level connectedness on suspension. We examined associations between all three levels of connectedness and suspension in a cross-sectional analysis of a population-based youth sample in Allegheny County, Pennsylvania. The Healthy Allegheny Teen Survey, a county-wide survey of 1813 male and female youth ages 14 to 19, assessed health risk/protective behaviors through random-digit-dialing in 2014. This survey included validated items evaluating each type of support as well as items assessing lifetime history of suspension. Logistic regression models examined associations between suspension and social support, school connectedness, and neighborhood-level cohesion. In fully adjusted logistic regression models examining associations between suspension and each type of support, youth with high social support had 0.38 times the odds of school suspension compared to youth with low social support (95% confidence interval [CI] 0.19-0.74). High levels of school connectedness and neighborhood-level cohesion were also associated with significantly lower odds of suspension (odds ratio [OR] 0.31, 95% CI 0.18-0.53; OR 0.28, 95% CI 0.16-0.47, respectively). Examining all 3 types of support jointly, school connectedness and neighborhood-level cohesion were significantly inversely related to suspension (OR 0.41, 95% CI 0.24-0.71; OR 0.41, 95% CI 0.23-0.74, respectively). Programs that foster connectedness at the individual-, school-, and neighborhood-level may help reduce school suspension.

Do the Determinants of Mental Wellbeing Vary by Housing Tenure Status? Secondary Analysis of a 2017 Cross-Sectional Residents Survey in Cornwall, South West England.

Housing is a social determinant of health, comprising multiple interrelated attributes; the current study was developed to examine whether differences in mental wellbeing across housing tenure types might relate to individual, living, or neighbourhood circumstances. To achieve this aim, an exploratory cross-sectional analysis was conducted using secondary data from a county-wide resident survey undertaken by Cornwall Council in 2017. The survey included questions about individual, living, or neighbourhood circumstances, as well as mental wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale). A random sample of 30,152 households in Cornwall were sent the survey, from whom 11,247 valid responses were received (38% response), but only 4085 (13.5%) provided complete data for this study. Stratified stepwise models were estimated to generate hypotheses about inequalities in mental wellbeing related to housing tenure. Health, life satisfaction, and social connectedness were found to be universal determinants of mental wellbeing, whereas issues related to living circumstances (quality of housing, fuel poverty) were only found to be related to wellbeing among residents of privately owned and rented properties. Sense of safety and belonging (neighbourhood circumstances) were also found to be related to wellbeing, which together suggests that whole system place-based home and people/community-centred approaches are needed to reduce inequalities.

Impact of COVID-19 on Older Adults: Changes in Health Access, Health, Socialization and Adaptive Coping Activities

Indirect effects of stay-at-home guidelines may negatively affect mental health by reducing health self-care behaviors and engagement in social participation. This study reports on the impact of the COVID-19 pandemic on community-dwelling older adults’ perceived physical and mental health and everyday health behaviors. 126 older adults participated in a county-wide telephone survey during June-July of 2020, asking about changes in mental and physical health, and adaptations in health behaviors. We investigated the effects of three negative everyday health behavior changes during the pandemic (changes in health services access, perceived changes in health, and increased social isolation) as well as two positive everyday health behaviors (adherence to stay-at-home guidelines to reduce risk, and adaptive coping activities) on mental health and COVID-related distress. Examples of active coping strategies were stockpiling resources, spiritual practices, or outreach to others. Descriptive statistics, bivariate correlations, and multiple regressions characterized the impact of COVID-19 on perceived mental health. Descriptive data included changes in health service access, changes in mental and physical health, reduced social engagement, increased adherence to guidelines, and increased adaptive coping activities. Significant predictors of mental health impact of the pandemic were changes in health service access (β = .18, p < .05), health changes (β = .25, p < .01), and adaptive coping activities (β = .21, p < .05). Findings suggest COVID-19 distress may be alleviated with improved health care access and increased social contact. Mental health challenges may also benefit from increased engagement in adaptive coping activities.

Time trends and disparities in anxiety among adolescents, 2012-2018.

PurposePrior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups.MethodsWeighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012–2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups.ResultsThe prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4–34.9) in 2012 to 44% (95% CI 43.2–44.7) in 2018 (OR for trend = 1.07, P for trend < 0.001). The trend remained significant after adjusting for known confounds (AOR for trend = 1.07, P for trend < 0.001). Anxiety increased significantly for several subgroups and widening disparities were documented among females relative to males (P < 0.001), and sexual minority youth relative to heterosexual youth (P = 0.003). In addition, Black youth did not increase at the same swift rate as White youth over the study period (P < 0.001).ConclusionThis study reports recent data on anxiety time trends and finds that among a geographically representative sample of adolescents, anxiety prevalence is rising. Findings provide new evidence documenting increased anxiety prevalence among sexual minority youth relative to their peers. Results highlight the need to bolster public health interventions focused on adolescent mental health, with tailored interventions for vulnerable groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-021-02122-9.

Abstract PO-253: Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia

Abstract Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profiles, conducting key informant interviews with clinic and community champions, and completing data inventories to assess clinic capacity, ultimately resulting in two primary care clinics being selected for pilot year implementation activities. Results: Key informant interviews revealed barriers to CRC screening at multiple levels: patient (e.g., fear of screening results), provider (e.g., competing priorities), clinic (e.g., lack of reminder or tracking systems), and community (e.g., cultural norms). Clinic champions were provided with menus of evidence-based interventions (EBIs) to address barriers at each level and were encouraged to select locally relevant, implementable EBIs. Clinics chose to implement the following EBIs: improved patient education materials (patient-level), additional provider education (provider-level), improvement of electronic health record (EHR) reporting and creation of clinic-wide screening protocols (clinic-level), and provision of interactive screening education at community events (community- level). Conclusion: Results from pilot year activities were used to refine the project approach for years two through five. Project activities will be expanded to 10 more Appalachian counties in Kentucky and Ohio using a design wherein counties will be paired by participating clinic patient volume. As in pilot year activities, clinic/community champions will be encouraged to select EBIs appropriate to their patients, providers, clinics, and communities. To measure clinical outcomes, self- reported screening will be monitored using data from county-wide telephone surveys with additional data from clinic EHRs. Using an MLI approach may be well- received in underserved rural Appalachian communities and may ultimately be successful at reducing CRC screening disparities. Citation Format: Aaron J. Kruse-Diehr, Jill M. Oliveri, Mira L. Katz, Mark Cromo, Robin C. Vanderpool, Michael L. Pennell, Darrell M. Gray II, Paul L. Reiter, Bin Huang, Gregory S. Young, Darla Fickle, Melinda Rogers, David Gross, Sue Russell, Electra D. Paskett, Mark Dignan. Increasing colorectal cancer screening in rural underserved communities with multilevel interventions: Formative evaluation of accelerating colorectal cancer screening and follow-up through implementation science in Appalachia [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-253.

0359 The Moderating Role of Race in the Association of Adolescent Sleep Duration and Marijuana Use

Abstract Introduction Insufficient sleep and marijuana use during adolescence vary by race and are associated with poor outcomes in various domains. Sleep difficulties predict drug-related problems, but not all adolescents with insufficient sleep go on to use substances. We examined whether race/ethnicity moderates the association of sleep duration and marijuana use among Black/African-American and White adolescents using a countywide probability-based survey of adolescents. Methods Using cross-sectional data (n=1447), logistic regression examined whether race moderated the association of adolescent sleep duration and recent marijuana use alone and after controlling for covariates in both weighted and unweighted models. Results Hours of sleep was significantly negatively associated with recent marijuana use. Black/African-American youth in our sample had up to a 60% increased odds of marijuana use in the past 30 days compared to White youth, and they reported significantly shorter sleep duration than their White peers. In weighted models, Black/African-American youth had an increased probability of marijuana use with fewer hours of sleep as compared to White youth, even after accounting for covariates. Conclusion In our countywide survey of adolescents, we found racial differences in the association of sleep duration and marijuana use. Future work should replicate our analyses with a longitudinal sample of adolescents to better evaluate the direction of these effects. Future efforts should also focus on identifying contextual factors that may explain racial differences in the sleep duration—substance use relationship, as well as developing strategies to reduce disparities in this relationship. Support The Heinz Foundation, the Hillman Foundation, the Grable Foundation, and the FISA Foundation. Dr. Levenson’s effort was supported by NICHD.

Assessing preferences for growth on the rural-urban fringe using a stated choice analysis

Increasing the capacity of communities on the rural-urban fringe to accommodate sustainable growth is a key concern among resource management agencies. Decisions about the future of these landscapes involve difficult tradeoffs that underscore the importance of incorporating diverse stakeholder values and preferences into planning efforts. We assessed residents’ preferences for exurban growth alternatives in two Midwestern U.S. counties – Jasper County, IA and Will County, IL – that have strong agrarian roots and lie at the fringe of rapidly-expanding metropolitan areas. Using a choice model, we identified how six landscape characteristics influenced respondents’ stated choices for growth scenarios. Informed by previous research, focus groups, and pilot testing, our final model evaluated preferences for residential growth, protected grasslands, recreation, agriculture, bison reintroduction, and unemployment. Results from a county-wide survey mailed to 3000 residents (final N = 889) indicated that five of the six landscape-scale attributes significantly influenced residents’ choices. Increased residential growth, more protected grasslands and agricultural lands, and greater access to recreation positively predicted choices for hypothetical growth scenarios while residents preferred future scenarios with low levels of unemployment. Further, the strength of preferences for these land use and economic conditions differed between Jasper and Will County residents. The study findings aid decision makers who face growth and urbanization pressures and provide insight on how to integrate preferences of current residents into planning decisions at a regional scale.

General practitioner perception of prostate-specific antigen testing has improved, but more awareness of prostate cancer risk in younger patients is still awaited.

BackgroundIn 2006, a county-wide survey of general practitioners (GPs) in the United Kingdom (UK) identified a reluctance to refer younger men with abnormal prostate specific antigen (PSA) levels. Younger men have the most to gain from early-detection of prostate cancer (PCa), which remains a national government priority in the UK and around the world. We sought to assess changes in perception of abnormal PSA-values amongst UK GPs over the past 10 years.Materials and methodsA total of 500 self-administered paper questionnaires were distributed to individually named GPs. One hundred and forty two responded (28.4%), representing a patient population of ∼600,000. A series of visual analogue questions assessed referral thresholds and understanding of risk factors related to the development of PCa.ResultsGPs with a median of 23-years experience responded. Although mean PSA threshold for referral to urology did fall between 2006 and 2016 in both the 45-year (5.42 ng/mL vs. 4.61 ng/mL P = 0.0003) and 55-year (5.81 ng/mL vs. 5.30 ng/mL P = 0.0164) age groups, the median referral values were unchanged. Significantly, referral thresholds quoted for younger men (<65 years) were considerably higher than recommended UK maximum PSA-levels. Using case-based scenarios, practitioners appeared more likely to refer older men with abnormal PSA values, with GPs reporting an average 56.2% likelihood of referring an asymptomatic 55-year-old with elevated age-adjusted PSA of 4.6 ng/mL. A total of 95.1% recognised a family history of PCa to be a potential risk factor but other at-risk categories were not so clearly understood.ConclusionAwareness of abnormal PSA values in UK primary care is improving, but continues to lag behind the evidence. Strategies to disseminate knowledge of maximum PSA-values to GPs should focus especially on those for younger patients.

Disparities in Health Information Access: Results of a County-Wide Survey and Implications for Health Communication

ABSTRACTHealth knowledge and behavior can be shaped by the extent to which individuals have access to reliable and understandable health information. Based on data from a population-based telephone survey of 1,503 respondents of ages 18 years and older living in Douglas County, Nebraska, in 2013, this study assesses disparities in health information access and their related covariates. The two most frequently reported sources of health information are the Internet and health professionals, followed by print media, peers, and broadcast media. Relative to non-Hispanic Whites, Blacks are more likely to report health professionals as their primary source of health information (odds ratio [OR] = 2.61, p < .001) and less likely to report peers (OR = 0.39, p < .05). A comparison between Whites and Hispanics suggests that Hispanics are less likely to get their health information through the Internet (OR = 0.51, p < .05) and more likely to get it from broadcast media (OR = 4.27, p < .01). Relative to their counterparts, participants with no health insurance had significantly higher odds of reporting no source of health information (OR = 3.46, p < .05). Having no source of health information was also associated with an annual income below $25,000 (OR = 2.78, p < .05 compared to middle income range) and being born outside of the United States (OR = 5.00, p < .05). Access to health information is lowest among society’s most vulnerable population groups. Knowledge of the specific outlets through which people are likely to obtain health information can help health program planners utilize the communication channels that are most relevant to the people they intend to reach.

Velvet Ants, Past and Present: A County-Wide Checklist of the Distribution and Diversity of Mutillidae (Insecta: Hymenoptera) in Oklahoma Including Two New State Records, and New Behavioral Observations for Dasymutilla foxi (Cockerell)

Oklahoma has some of the highest recorded diversity of velvet ants (Insecta: Hymenoptera: Mutillidae) in North America, as well as having a correspondingly high diversity of ecosystems and potential velvet ant habitats. Velvet ants are relatively large, conspicuous, parasitic wasps that are potential indicators for studies of habitat quality and change over time. However, little is known about in which habitats these insects live within the state other than their sole presence in Oklahoma. Herein we provide a county checklist and maps of known distributions of Mutillidae species in Oklahoma to provide a baseline for future studies comparing habitats and distributions. Two species collected in the summer of 2013 in Cimarron Co., Dasymutilla foxi (Cockerell) and D. snoworum (Cockerell), were found to be new state records. Data were compiled using direct specimen information, confirmed observations, literature records, and specimens collected in the summer of 2013 by the author(s). Efficacy of past Oklahoma insect and Mutillidae surveys across the state before and after 1950 are investigated. Future county-wide survey work of Oklahoma Mutillidae using citizen science surveys is also discussed.

Sexual Risk Taking and Bullying Among Adolescents

Psychological and educational correlates of bullying have been explored extensively. However, little information is available about the link between bullying and sexual risk-taking behaviors among adolescents, though for some youth it may be that sexual risk taking emerges in response to bullying involvement. Associations for both heterosexual youth and those who identify as gay, lesbian, bisexual, transgender, or questioning (GLBTQ) should be considered, as should the influence of victimization exposures in other domains. Accordingly, associations among bullying, other victimization forms, and sexual risk-taking behaviors were examined among adolescents with particular consideration to sexual orientation. A sample of 8687 high school students completed the Dane County Youth Survey, a countywide survey administered high school students from 24 schools. Participants were asked questions about their bullying involvement and sexual risk-taking behaviors (ie, engaging in casual sex and having sex while under the influence of alcohol or drugs). Results indicated that bullies and bully-victims were more likely to engage in casual sex and sex under the influence. In multivariate analyses, these findings held even after controlling for demographic characteristics and victimization exposures in other domains, but primarily for heterosexual youth. Bullies and bully-victims engaged in more sexual risk-taking behaviors, although patterns of association varied by sexual orientation. Bullying prevention programs and programs aimed at reducing unhealthy sexual practices should consider a broader stress and coping perspective and address the possible link between the stress of bullying involvement and maladaptive coping responses.

The intersection of employment and care: evidence from a UK case study

Working carers are a key focus of UK policies on health and social care and employment. Complementing national and European evidence, this paper presents a local case study of working carers. It draws on data from a county-wide survey containing a module on caring. Data were primarily categorical and were analysed using SPSS. Three quarters of all carers who responded to the survey were of working age: two thirds were employed and one third had been employed previously. The majority of working carers were mid-life extra-resident women. Over half of cared for relatives were elderly parents/in law; ‘physical illness’ was the primary cause of dependency. A tenth provided intensive care and half reported that caring adversely affected their health. Both were triggers for leaving employment. Two thirds of households received input from services and/or friends/family; being a co-resident carer appeared to mitigate against service allocation. Four issues were identified as pivotal to facilitating employment: access to advice and information, the availability of a matrix of affordable good-quality social-care services, ‘joined up’ needs assessment of the carer and cared for person, and employers identifying carers in their workforce. Europe's ageing profile underscores the study's timeliness.

Changes in the native flora of Worcester County, Massachusetts1

I analyzed changes in the native flora of Worcester County, Massachusetts, between the mid-1900s and the early 2000s in relation to changes in land use and climate. I also identified genera and families in which declines and apparent losses were particularly high. Current floristic data came from a recent survey of the county and historical data were obtained largely from herbarium collections, especially a county-wide survey from the 1930s to the 1950s. Climate data came from records collected in Worcester beginning in 1950, and land use data came originally from aerial photographs taken in 1951, 1971, 1985, 1999 and 2005. Average daily temperatures increased by 0.15 °C per decade between 1950 and 2011. The most prominent land use changes during this period were an increase in disturbed land and a decrease in fields and pastures. Extent of forests declined slightly, though forest maturity increased. Northern species decreased relative to southern species, presumably reflecting climatic changes. Losses of northern species were most evident in the southernmost towns in their ranges and were more pronounced than gains of southern species. This difference in behavior of northern and southern species presumably reflects the fact that range extensions depend on dispersal mechanisms, which can be slow, whereas range retractions reflect unsuitability of conditions, which occurs more quickly. Species of disturbed sites increased and species of fields declined, consistent with patterns of habitat change. Several families and genera had high rates of species loss or decline, and some of these, including the Orchidaceae, Ophioglossaceae, Orobanchaceae and Violaceae, have shown high rates of loss or decline elsewhere in the Northeast. Some of these changes may be tied to succession or to active eradication efforts. Two declining families (Orchidaceae, Ophioglossaceae) have juvenile stages dependent on fungi. Changes in climate, patterns of land use and other factors are likely to continue and perhaps accelerate, leading to further changes in the flora and posing challenges for conservation of biodiversity.

Individual- and Community-Level Determinants of Public Attitudes Toward Nonprofit Organizations

It is often suggested that nonprofit organizations positively impact our local communities. Studies, however, have consistently shown that the distribution of these organizations varies considerably from one community to the next. These differences have led some scholars to begin raising serious concern about the degree of “charitable equity” across communities. Thus, the purpose of this study was to explore how the makeup of a community’s nonprofit sector affects the views of those who potentially depend on nonprofit services. Specifically, using data from a countywide survey of public attitudes toward nonprofits in southern California ( N = 1,002), we examined whether differences in the distribution of nonprofits affected individuals’ confidence in nonprofit performance as well as their awareness of what nonprofit organizations even are. Findings indicated that nonprofit density was strongly related to awareness of the sector, while awareness was, in turn, strongly related to confidence in nonprofit performance.

An Increase in economic adversity is associated with poorer self-reported physical and mental health

Background Numerous studies document the inverse relationship between socioeconomic status and health. The recent economic recession provides an opportunity to examine the relationship between temporal declines in financial status and health outcomes. Methods We assessed the association of financial decline with health indicators at the individual level with data from 733 adult participants in a countywide survey conducted in Spring 2009. We included general health and mental health items from the Behavioral Risk Factor Surveillance System (BRFSS), Brief Symptom Inventory (BSI-18) depression subscale, and Perceived Stress Scale. Analysis was conducted in 2011. Results The degree to which an individual’s financial situation declined over the past year was associated with worse self-reported general and mental health, increased number of days that poor general and mental health interfered with daily activities in the past month, as well as higher levels of self-reported stress and depressive symptoms. These relationships were independent of education, income, age, gender and minority status. Conclusion Our results indicate that a decline in financial status is associated with a decline in self-reported physical and mental health quality independent of traditional demographic and socioeconomic indicators.

Health Care Workers' Ability and Willingness to Report to Work During Public Health Emergencies

We conducted a county-wide survey to assess the ability and willingness of health care workers to report to work during a pandemic influenza and a severe earthquake and to identify barriers and strategies that would help them report to work. A stratified random sample of 9211 health care workers was selected from the Washington state licensure database and from health care agencies. We assessed correlates between self-reported ability and willingness to report to work and demographic and employer-related variables under two scenarios, influenza pandemic and a severe earthquake. For the influenza pandemic scenario, 95% of respondents reported that they would be able and 89% reported that they would be willing to report to their usual place of work. Seventy-four percent of respondents reported that they would be able and 88% would be willing to report to their usual place of work following a severe earthquake. The most frequently cited strategies that would help respondents report to work during an influenza pandemic were the availability of anti-viral influenza treatment and the ability to work from home. For persons with children at home, the strategy to increase ability to report to work during an earthquake was the availability of child care. The majority of the King County health care workforce is willing and able to respond to an influenza pandemic or a severe earthquake.

The binge drinking culture: Fact or fiction?

Aim: To explore drinking culture in young people and considers the strategies that might be employed to address this public health issue as well as the motives for binge drinking. Method: A mixed-methods research project in southern England employed a countywide survey and qualitative focus groups. Discusion in this article focuses mainly on the qualitative phase of the project, and presents data and ideas from the young people’s perspective. Results were compared with those of a recent national survey, and there was good cross-validation between the two. In this study, survey and focus group data largely complement one another too. Focus group interviews explored young people’s opinions about how interventions would need to change in order to be most effective. Results: The results indicate that most young people have experience of alcohol, typically taking their first full drink around the age of 13 years. Conclusions: Focus groups revealed the type of alcohol consumed by young people, and the sources from which it is obtained. Young people talked about where drinking takes place and some of the untoward consequences. The results show that young people have no difficulty in obtaining alcohol, and that current attempts to dissuade them from drinking are largely ineffective. The implications for health promotion staff, teachers and other stakeholders in the community are explored.

The development of public attitudes towards the Stockholm congestion trial

A full-scale congestion charging trial was carried out in Stockholm the first months of 2006. Almost half of respondents in a county-wide survey stated that they changed their attitudes towards congestion charges during the trial. Most of them became more positive.An analysis of media shows that the attitudinal change in media towards the trial coincides with the attitudinal change of the public. There was no dramatic change in the proportion of articles expressing a negative view. Instead, the result indicates that the increase in positive views was driven by a shift from neutral to positive articles during the trial.In order to ascertain why the public attitudes swung, we have analysed the anticipated and perceived effects of the trial. Generally, the analysis seems to indicate that improved understanding of the type and magnitude of concrete effects was not a main driving force behind the attitudinal change. Instead, it seems that the public attitude changed because personal experience gave a new understanding of the implications of the charges for the personal well-being. This would imply that trials, generally, may be a more useful tool than information in the process of implementing ‘difficult’ policy measures, such as congestion charges.