Public Health Entities Research Articles

Harnessing Data Science Through Healthcare IT Interoperability

Harnessing Data Science Through Healthcare IT Interoperability

Development of Text-Based Algorithm for Opioid Overdose Identification in EMS Data

Development of Text-Based Algorithm for Opioid Overdose Identification in EMS Data

Perceptions of Public Health 3.0: Concordance Between Public Health Agency Leaders and Employees.

Context and Background:The newest era of public health, deemed “Public Health 3.0,” supports cross-sector collaborations to address social determinants of health. These activities often require collaborations with nontraditional public health entities. As this new era begins, it is important to understand perceptions of the public health workforce with regard to Public Health 3.0.Objective:To assess perceptions of support toward Public Health 3.0 activities by the public health workforce, identify characteristics associated with support, and measure concordance in support between agency directors and the general workforce.Design:This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey to understand support and concordance regarding Public Health 3.0 activities by a nationally representative sample of governmental public health employees. Logistic regression models are used to identify characteristics associated with support of each 3.0 activity and concordance.Main Outcome Measures:Governmental public health employees' opinions on how involved their agency should be in the K-12 education system, the economy, the built environment, transportation, housing, social connectedness, and health equity within their jurisdiction and concordance in support of involvement between agency directors and the general workforce.Results:Overall, individual perceptions supporting involvement were highest for health equity and social connectedness and lowest for transportation. Supervisory status, education, and being at a local health department were associated with greater odds of supporting all 3.0 activities. Concordance with agency directors was greatest among other executives relative to nonsupervisors.Conclusions:There is overall generally high support of many 3.0 activities, but there are gaps in agreement by supervisory status, gender, race/ethnicity, education, role type, and jurisdiction. Findings may help support agency leaders in better communicating the role of their agencies in Public Health 3.0 activities, and workforce education regarding such activities may be necessary for the success of Public Health 3.0's success.

European university students of pharmacy: survey on the use of pharmaceutical drugs.

Background and aim: In recent years, self-medication is an increasing public health issue, also among the European young people. Only 48% of people throughout the world use prescribed medications, while the remainder admits that they self-medicate with over the counter drugs or leftover prescribed drugs. Also, the risk of antibiotic resistance, throughout the world, has doubled, due to the recourse to these drugs when they are not called for, or to failure to follow their instructions for use. Methods: A five-part questionnaire, translated into the national languages and validated, was given to Pharmacy students in Italy, Spain, the Czech Republic and Romania obtain anonymous information about their pharmaceutical drugs use. Results: Regarding the use of pharmaceutical drugs, students in Spain and Romania indicated the highest percentages of use. In Italy and Romania, the pharmacist is rarely consulted, while the advice of family members or friends is more frequently requested. In all four countries the problem of taking antibiotics without a medical prescription is significant, and 50% of Romanian students use antibiotics to treat the flu. Another important result is that, in Spain, 38.4% of the respondents admitted to using medicines with alcohol. Conclusions: Considering that the drug information leaflet is not read by 50% of young people interviewed, it would be important for public health entities to instruct the population, especially younger age groups such as secondary school students, about the importance of reading this information carefully. The use of mass media in such a preventive medicine campaign could be effective. (www.actabiomedica.it)

Primary Care and Public Health Collaboration Reports: A Qualitative Review of Integration Aims, Participants, and Success Determinants.

This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability.

IR-MALDESI mass spectrometry imaging of underivatized neurotransmitters in brain tissue of rats exposed to tetrabromobisphenol A.

There is a pressing need to develop tools for assessing possible neurotoxicity, particularly for chemicals where the mode of action is poorly understood. Tetrabromobisphenol A (TBBPA), a highly abundant brominated flame retardant, has lately been targeted for neurotoxicity analysis by concerned public health entities in the EU and USA because it is a suspected thyroid disruptor and neurotoxicant. In this study, infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) coupled to a Q Exactive Plus mass spectrometer was used for the analysis of neurotransmitters in the brains of rats exposed to TBBPA in gestation and lactation through their mothers. Three neurotransmitters of interest were studied in three selected regions of the brain: caudate putamen, substantia nigra (SN), and dorsal raphe. Stable isotope labeled (SIL) standards were used as internal standards and a means to achieve relative quantification. This study serves as a demonstration of a new application of IR-MALDESI, namely that neurotransmitter distributions can be confidently and rapidly imaged without derivatization.

A quantitative risk assessment (QRA) of the risk of introduction of the Japanese encephalitis virus (JEV) in the United States via infected mosquitoes transported in aircraft and cargo ships

Following a qualitative risk assessment, in which we identified and assessed all viable pathways for the introduction of the Japanese encephalitis virus (JEV) into the United States (US), we identified entry through infected vectors via aircraft and cargo ships as the most likely pathway, and thus considered it further in a quantitative risk assessment (QRA) model. The objective of this study was to evaluate the risk of introduction of JEV in the US via infected mosquitoes transported in aircraft and cargo ships arriving from Asia, using a QRA model.We created a stochastic model to quantify the probability of introduction of at least one infected mosquito in the continental US via aircraft and cargo ships, per at-risk period (March to October) or year, respectively. We modeled the following parameters: number of flights (per at-risk period, i.e., March to October) and cargo ships (per year) and per region, number of mosquitoes per flight and ship, number of mosquitoes that were not found and sensitivity of the mosquito collection method in aircraft, mosquito infection rates, and number of mosquitoes coming in aircraft per at-risk period (March to October) and cargo ships per year. Flight and cargo ship data pertained to years 2010-2016. For model building purposes, we only considered port-to-port vessels arriving from Asia to the US, we assumed that mosquitoes survive the trans-Pacific Ocean ship crossing and that the number of mosquitoes in cargo and passenger flights is similar.Our model predicted a very high risk (0.95 median probability; 95% CI = 0.80-0.99) of at least one infected mosquito being introduced in the US during the at-risk period, i.e., March to October, via aircraft transportation from JEV-affected countries in Asia. We also estimated that a median of three infected mosquitoes can enter the US during the at-risk period, i.e., March to October (95% CI = 1–7). The highest probability of introduction via aircraft was attributed to the Mediterranean California ecoregion (0.74; 95% CI = 0.50-0.90). We predicted, however, a negligible risk (0; 95% CI = 0.00-0.01) of at least one infected mosquito being introduced via cargo ships.Although the risk of introduction of JEV-infected mosquitoes by cargo ships was negligible, the risk via aircraft was estimated to be high. Our findings indicate the need to prioritize JEV prevention and control methods for aircraft-based pathways, such as aircraft disinfection. The quantitative estimates provided in this study are of interest to public health entities and other stakeholders, as they may support future interventions for preventing JEV introduction, as well as other vector-borne diseases, in the US and other countries.

Commentary. Fentanyl-related death and the underreporting risk

Novel synthetic opioid overdose deaths have been rising largely worldwide as a result of fentanyl adulteration in the illegal drug supply. Interpretation of post mortem analytical results concerning fentanyl can be challenging in particular due to redistribution phenomena. Lacking of resources, infrastructures and expertise to perform forensic toxicological investigation when an unknown drug or complex mixture of drugs is suspected can affect failure in exactly reporting cause in drug related death. Public safety and public health entities are called working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids.

Hotspots of Transmission Driving the Local Human Immunodeficiency Virus Epidemic in the Cologne-Bonn Region, Germany.

Geographical allocation of interventions focusing on hotspots of human immunodeficiency virus (HIV) transmission has the potential to improve efficiency. We used phylogeographic analyses to identify hotspots of the HIV transmission in Cologne-Bonn, Germany. We included 714 HIV-1 infected individuals, followed up at the University Hospitals Cologne and Bonn. Distance-based molecular network analyses were performed to infer putative relationships. Characteristics of genetically linked individuals and assortativity (shared characteristics) were analyzed. Geospatial diffusion (ie, viral gene flow) was evaluated using a Slatkin-Maddison approach. Geospatial dispersal was determined by calculating the average distance between the residences of linked individuals (centroids of 3-digit zip code). In sum, 217/714 (30.4%) sequences had a putative genetic linkage, forming 77 clusters (size range: 2-8). Linked individuals were more likely to live in areas surrounding the city center (P = .043), <30 years of age (P = .009). and infected with HIV-1 subtype B (P = .002). Clustering individuals were nonassortative by area of residency (-.0026, P = .046). Geospatial analyses revealed a median distance between genetically linked individuals of 23.4 kilometers (km), lower than expected (P < .001). Slatkin-Maddison analyses revealed increased gene flow from central Cologne toward the surrounding areas (P < .001). Phylogeographic analysis suggests that central Cologne may be a significant driver of the regional epidemic. Although clustering individuals lived closer than unlinked individuals, they were less likely to be linked to others from their same zip code. These results could help public health entities better understand transmission dynamics, facilitating allocation of resources to areas of greatest need.

The Opioid Epidemic: Moving Toward an Integrated, Holistic Analytical Response.

In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs. These compounds, which mimic heroin in pharmacologic effect but can be far more potent, are inconsistently present in chemical identification libraries, and are currently largely unavailable as reference materials for analytical comparison. Additionally, federal, state and local governments as well as nongovernmental organizations require potency, toxicity and potential-for-abuse data to evaluate the potential health risks of emerging drug threats. Subsequent scheduling efforts and criminal prosecutions also require these thorough drug characterization studies. Pilot programs have demonstrated that early communication of real-time drug toxicity and analytical data significantly impacts the successful response to emerging opioids. High-quality, real-time, national-level data on chemical composition, toxicological test data, drug toxicity and overdoses, and analysis of seized materials by law enforcement are needed to track drug trends. However, the USA still lacks a national system to coordinate and communicate toxicology, medical and medical examiner and coroner data with the broader medical and law enforcement communities. Opportunities to address these gaps as well as recent advancements collected through interagency efforts and technical workshops in the toxicology and analytical chemistry communities are presented here. Opportunities for partnership, increased communication and expanding best practices to move toward an integrated, holistic analytical response are also explored.

Primary Prevention of Clostridium difficile-Associated Diarrhea: Current Controversies and Future Tools

Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in hospitalized patients and rates in most places have not decreased significantly despite broad efforts by both hospitals and public health entities. This review aims to provide readers with a better understanding of the limitations of current prevention strategies. We also review potential future tools that may be available for the primary prevention of CDI in the next decade. Research over the last decade has expanded our appreciation of the role of asymptomatic shedding in the healthcare setting and in the community. This review demonstrates that poor quality data underlies even well-established guidance from national authorities on basic topics such as contact precautions, avoidance of alcohol-based hand hygiene products, CDI testing, supplemental cleaning modalities, and the use of bleach solutions. Additionally, we review research on novel preventative interventions such as identification of asymptomatic carriers, supplemental environmental cleaning technologies, vaccines, and the manipulation of the intestinal microbiome. While there is preliminary data that supports further research in all of these areas, the research is not yet robust enough on which to base local or national policy recommendations, though late-phase human clinical trials of CDI vaccine trials are ongoing. Over the last decade, researchers have begun to reassess the traditional infection prevention model for CDI. Data suggesting a greater role for asymptomatic shedders has increased our understanding of current vertical prevention techniques and is forcing researchers to look more at new processes and technologies to decrease disease incidence.

Technical Efficiency of Polish Independent Public Health Care Centres: Data Envelopment Analysis Approach

In the face of the growing demand for health services, which can be observed in Poland (as well as in many other countries), it is extremely important to make effective allocation decisions in relation to financial resources (at the disposal of health sector decision-makers). The pace of demographic, technological and market changes forces an increase in financial expenditures on health, while at the same time the resources allocated to these objectives are still lacking. The present paper assesses the technical efficiency of 24 independent public health care centers (IPHCCs) in 2010–2014 with the use of the data envelopment analysis method and evaluates changes in the examined efficiency categories using the Malmquist Index. The research has shown that independent public health care institutions in Poland are facing the problem of debt and inefficiency. It has also been established that the level and method of financing health services in Poland contribute to a large extent to the technical inefficiency of IPHCCs, and that the increase in IPHCCs’ revenues leads to an increase in their technical efficiency. The conclusions of this paper provide, on one hand, the basis for in-depth research into the efficiency of public health entities and, on the other, guidance that can be used in the practical management of public health entities and in the shaping of national health care policy.

Pennsylvania policymakers' knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems.

INTRODUCTIONUse of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators.METHODSWe approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers.RESULTSWe received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information.CONCLUSIONSPolicymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information.

Cancer Community Education in Somali Refugees in Nebraska.

Nebraska has one of the highest numbers of refugees per capita in the U.S. A high number of Somalis have resettled in Nebraska due to job opportunities and the low cost of living. In this paper, we report the process and the results of a cervical and breast cancer education program for Somali women conducted through a collaboration among public health, academia, and community entities. The curriculum was built to be suitable for the literacy level and cultural values of this community. Topics include female reproductive anatomy; breast and cervical cancer knowledge and screening; hepatitis C and liver cancer; and preparing for a health screening visit. Two community members trained as lay health workers conducted a pilot and an actual education session. The 2-day education program was attended by 52 women. Qualitative data showed the intervention to be promising for this and other African refugee populations.

Implementation of Health Information Exchange at the Pima County Adult Detention Complex: Lessons Learned.

Successful transition of patients between health care entities is difficult. Historically, the process of transitioning individuals through the corrections system with regard to health care was made even more challenging by the limitation of paper records. Recently, the advent of electronic medical records has improved health care nationwide. The use of health information exchange (HIE) systems in areas such as emergency medicine has also impacted patient outcomes. To date, this technology has not been used in the corrections system. Semi-structured interviews were conducted with 12 correctional health care professionals, corrections staff, and public health entities to evaluate the novel implementation of HIE at a local correctional facility. This article describes the challenges and successes that occurred during the implementation and their implications for successful implementations in the future.

Development of a Measurement Tool to Assess Students' Knowledge and Perceptions About Cancer (SKPaC).

Cancer literacy is currently one of the most important dimensions of cancer continuum. Objective assessment of cancer knowledge in populations remains a challenging field to public health entities. Different evaluation tools are currently available; still, some groups remain disregarded due to the absence of validated instruments. Cancer literacy in adolescents and young adults has been clearly overlooked being a subject that requires new tools to be properly studied. To address this topic, we developed a new instrument and field tested it in a classroom environment for internal reliability, construct, and face validity. "Students Knowledge and Perceptions about Cancer questionnaire" was designed in Portuguese language and adapted to the Portuguese context by a multidisciplinary team. The final version of the questionnaire includes 35 items organized in three sections, encompassing knowledge and perceptions about cancer and socio-biographic data. Cancer experts ensured content validity, while tailoring of contents was refined with high school teachers. Test and retest of the instrument showed a good reliability of the scale and construct validity. Also, the clarity of the questionnaire and suitability to proper evaluate cancer knowledge was consistent between test and retest. The Students' Knowledge and Perceptions About Cancer Questionnaire (SKPaC) showed to be a valid tool to assess adolescents' knowledge and perceptions about cancer that can be used in the educational context.

Systematic Assessment of Research on Autism Spectrum Disorder (ASD) and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research

Historically, entities with a vested interest in a product that critics have suggested is harmful have consistently used research to back their claims that the product is safe. Prominent examples are: tobacco, lead, bisphenol A, and atrazine. Research literature indicates that about 80–90% of studies with industry affiliation found no harm from the product, while only about 10–20% of studies without industry affiliation found no harm. In parallel to other historical debates, recent studies examining a possible relationship between mercury (Hg) exposure and autism spectrum disorder (ASD) show a similar dichotomy. Studies sponsored and supported by industry or entities with an apparent conflict of interest have most often shown no evidence of harm or no “consistent” evidence of harm, while studies without such affiliations report positive evidence of a Hg/autism association. The potentially causal relationship between Hg exposure and ASD differs from other toxic products since there is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. This review includes a systematic literature search of original studies on the potential relationship between Hg and ASD from 1999 to August 2015, finding that of the studies with public health and/or industry affiliation, 86% reported no relationship between Hg and ASD. However, among studies without public health and/or industry affiliation, only 21% find no relationship between Hg and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest.

Distributed Data Networks That Support Public Health Information Needs.

Data networks, consisting of pooled electronic health data assets from health care providers serving different patient populations, promote data sharing, population and disease monitoring, and methods to assess interventions. Better understanding of data networks, and their capacity to support public health objectives, will help foster partnerships, expand resources, and grow learning health systems. We conducted semistructured interviews with 16 key informants across the United States, identified as network stakeholders based on their respective experience in advancing health information technology and network functionality. Key informants were asked about their experience with and infrastructure used to develop data networks, including each network's utility to identify and characterize populations, usage, and sustainability. Among 11 identified data networks representing hundreds of thousands of patients, key informants described aggregated health care clinical data contributing to population health measures. Key informant interview responses were thematically grouped to illustrate how networks support public health, including (1) infrastructure and information sharing; (2) population health measures; and (3) network sustainability. Collaboration between clinical data networks and public health entities presents an opportunity to leverage infrastructure investments to support public health. Data networks can provide resources to enhance population health information and infrastructure.

Regional Sociodemographic Determinants of Colon Cancer Incidence in the United States

Introduction: Numerous studies have assessed the correlation between Colon cancer incidence and some socio-demographic factors; but little has been done at the population level and has included the following socio-demographics factors body max index (BMI), smoking rate, median income, insurance coverage rate. Here, we investigate the correlation between these socio-demographic factors and Colon cancer incidence at the population level. We planned to use regional variations in these socio-demographic factors to examine correlation patterns with U.S Colon cancer incidence geographical variations. Methods: From 1999 to 2012, the following data per state were obtained to construct the datasetmedian income and insurance coverage rate data from the United States census bureau, BMI data from the Robert Wood Johnson Foundation, smoking rate data from the Institute for Health Metrics and Evaluation, colon cancer incidence data from the Centers for Disease Control and Prevention (United States Cancer Statistics). All 50 states were grouped into 7 regional subdivisions (West, Southern Rockies, Northern Rockies, South Central, North Central, Southeast and Northeast). A regression analysis was performed using IBM SPSS for data analysis and results are reported as Unstandardized Correlation Coefficient. Results: Yearly colon cancer incidence increases in the West, Southern Rockies and Southeast (1.293, 1.215 and 0.860 respectively). The incidence increases as BMI decreases in the West, Southern Rockies and Southeast (1.565, 1.702 and 1.056 respectively). The incidence is not affected by income and it increases as smoking rates increases everywhere except in the North Central (2.241). The incidence increases as the percentage of insured increases in the Northern Rockies and South Central (0.693 and 0.894 respectively) but not in the Southeast (0.624). Conclusion: Regional differences exist in the correlation coefficient between Colon cancer incidence and the selected socio-demographic factors, suggestive of their various level of influence in Colon cancer incidence. Our results suggest that ways to decrease Colon cancer incidence will be to decrease smoking rate. BMI and insurance coverage had various effects depending on the region. Our study shows that we need to look at the population level and address socio-demographic determinants by working with governmental, state and local public health entities to enact strategies to reduce colon cancer incidence even further.

Regional Socio-Demographic Determinants of Lung Cancer Incidence in the United States

SESSION TITLE: Quality Improvement 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Lung cancer is the leading cause of cancer death in the United States (U.S). Several studies done at the individual level, have assessed the correlation between lung cancer incidence and some socio-demographic factors; but little has been done at the population level and has included body max index (BMI), smoking rate, median income, insurance coverage rate. We wanted to investigate the correlation between the following reported socio-demographic factors (BMI, smoking rate, median income, insurance coverage rate) and lung cancer incidence at the population level. Because cancer incidence can vary by socio-demographic characteristics, we planned to use regional variations in these socio-demographic factors to examine correlation patterns with U.S lung cancer incidence geographical variations between 1999-2012. METHODS: From 1999 to 2012, data for median income and for insurance coverage rate per state were obtained from the United States census bureau (Current Population Survey), data for body mass index per state were obtained from the Robert Wood Johnson Foundation, data for smoking rate per state were obtained from the Institute for Health Metrics and Evaluation, data for lung cancer incidence were obtained from the Centers for Disease Control and Prevention (United States Cancer Statistics) to construct the dataset. All 50 states were grouped into 7 regional subdivisions (West, Southern Rockies, Northern Rockies, South Central, North Central, Southeast and Northeast). A regression analysis was performed using IBM SPSS for data analysis. RESULTS: Our study revealed that yearly lung cancer incidence decreased in most regions with the exception of states in the Southern Rockies and the Northeast (Unstandardized Correlation Coefficient (UCC) 3.78 and 1.39 respectively). Additionally, lung cancer incidence increased as BMI increased in most regions with the exception of states in the Southern Rockies (UCC 2.05). Generally, lung cancer incidence decreased as income increased with the exception of the Southern Rockies (UCC 0.002), and lung cancer incidence increased as smoking rates increased in most of the regions (UCC varying from 1.37 to 6.57). Likewise, lung cancer incidence increased as the percentage of insured increased in some of the regions (UCC from 0.69 to 2.00). CONCLUSIONS: Regional differences exist in the correlation coefficient between lung cancer incidence and the selected socio-demographic factors, suggestive of their various level of influence in lung cancer incidence. CLINICAL IMPLICATIONS: Our results suggest that the most efficient way to decrease lung cancer incidence will be to concomitantly decrease smoking rate, decrease average BMI, increase median income and insurance coverage. As healthcare professionals, we tend to focus on the individual level as we care for our patient. Our study shows that we need to be looking at the population level as well and advocate for policies that address some socio-demographic determinants by working in a more concerted effort wih governmental, state and local public health entities to inact strategies to reduce lung cancer incidence even further. DISCLOSURE: The following authors have nothing to disclose: Hermann Simo, Zaid Ammari, Abhinav Tiwari, Sheza Darr, William Barnett, Mohammad Khan, Arjan Flora No Product/Research Disclosure Information