Public Health Partners Research Articles

New law will place important restrictions on tobacco

On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This historic piece of legislation grants the Food and Drug Administration (FDA) regulatory power over the manufacture, sale, and marketing of tobacco products. This victory is a significant step toward reducing the considerable toll that tobacco takes on our country. Passage of this legislation has been a major priority for the American Lung Association for more than a decade; we have worked for more than 20 years to give the federal government authority over manufactured tobacco products. Why do we view this as so important? Tobacco-related diseases are the leading cause of preventable death in the United States, resulting in 443,000 deaths each year. Tobacco also takes a tremendous toll on our healthcare system and economy—productivity losses due to tobacco use are estimated to be $97 billion annually, and tobacco related health care costs at $96 billion. These numbers have continued to grow as tobacco companies have enjoyed special protections not afforded to any other industry in the United States. President Obama significantly stunted Big Tobacco's unrestricted business environment when he signed this bill into law. For the first time, tobacco companies will be required to disclose all of the ingredients in their products. At the same time, the FDA will be able to require the removal of harmful ingredients and be able to reduce nicotine levels. Tobacco companies also will be required to put larger and graphic warning labels on all cigarette packages that more clearly communicate the risks associated with tobacco use. Gone will be the days when tobacco companies added candy and fruit flavors to their cigarettes to hook children. In addition, the use of terms such as “light” and “low tar,” which mislead consumers into believing that they are smoking safer cigarettes, will be prohibited. Tobacco, which has been almost entirely unregulated, will now be under firm governmental oversight, like other consumable products. The Lung Association believes the act will result in a reduction in the number of cases of lung cancer in the United States. Almost 160,000 Americans die each year from lung cancer, 80% to 90% of which can be directly attributed to tobacco use. Tragically, only 44% of people with lung cancer will live more than a year after diagnosis. Granting the FDA authority to regulate tobacco products will help reduce the incidence and prevalence of lung cancer by preventing young people from becoming addicted to tobacco and helping current smokers quit. Even though passage of this legislation was an epic struggle, the Lung Association and our public health partners recognize that the real work is just beginning. The tobacco companies will fight the FDA at every turn and attempt to weaken the agency's work. The American Lung Association stands ready to push back and assist the agency in any way we can as it implements and enforces this law. We have long viewed giving the federal government regulatory authority over tobacco products to be a crucial and missing piece of the puzzle in tobacco control. But it is still only 1 piece. The Lung Association recognizes that, even as the FDA begins to exercise its new authority over tobacco products, we must continue our efforts at state and local levels to pass comprehensive smoke-free air laws, to increase tobacco taxes, and to dramatically increase funding for, and access to, tobacco- use prevention and cessation programs. Only by continuing this fight on all fronts will we see a significant reduction in the burden caused by tobacco use.

Le sel dans l’alimentation : un problème de santé publique

Salt abuse in nutrition may exert harmful effects on health, increasing arterial hypertension and its cardiovascular consequences. It is a risk factor, particularly for older subjects and those having chronic diseases such as arterial hypertension, some renal diseases, and obesity. In subjects more particularly vulnerable, the maintenance of sodium balance, which is mainly aldosterone dependent, is perturbed. Although the use of salt for food preservation has greatly declined, it remains a serious risk factor. Excessive salt intake however results more often from poor dietary habits. The WHO and AFSSA have advised to reduce daily salt intake to 5 g, whereas it is currently about 9-10 g. In spite of repeated warnings, salt abuse remains the causal agent for many disease conditions, mainly arterial hypertension. That is why legislative measures should be taken in order to limit the salt content of food industry products, particularly as a preservative in foods. A large-scale public information campaign would be necessary with participation of public health partners, particularly physicians and pharmacists.

Steps to a Healthier Washington

Steps to a Healthier Washington , in collaboration with other programs in the Washington State Department of Health and external partners, has implemented training to improve public health practice and create greater organizational and staff capacity for promoting effective policy and systems changes, including reducing disparities. The training is grounded in behavior change and adult learning theories. A comprehensive post training evaluation found long-term improvements in self-efficacy, reported changes in work, and attribution of those changes to the training. Organizations working to refocus public health work on policy and systems change should consider providing skills-based policy training to their staff. This study suggests that an integrated training, using adult learning theory, has led to long-term improvements in capacity among public health staff and partners.

Using decision analysis to select alternate modes of dispensing: An example from Los Angeles County Public Health

Objective: To comply with the Center for Disease Control’s mass prophylaxis mandates, many public health jurisdictions must supplement their existing Points of Dispensing (POD)-based system. Because of limited budgets and personnel availability, only one or two alternatives out of the many potential options can be implemented.Design: Multicriteria decision analysis is a powerful tool that allows public health officials to assess the relative effectiveness of alternate modes of dispensing while incorporating the opinions of their multidisciplinary emergency response planning teams.Setting: This process was utilized to analyze the effectiveness of alternate modes of dispensing that could be used to supplement the existing POD system within the Los Angeles County (LAC) Department of Public Health (DPH).Results: The top two options for LAC were prepositioning for civil service and partnership with a major Health Maintenance Organization. These choices were stable under a variety of sensitivity analyses, and the differences in opinion between the agencies and other stakeholders do not change them.Conclusions: The transparency of the model and analysis may allow decision makers and planners in the LAC DPH to garner support for their alternate modes of dispensing plans. By making the decision criteria clear and demonstrating the robustness of the results in the sensitivity analyses, public health partners gain a deeper understanding of the issues and their potential roles. The process can be repeated by any jurisdiction, but definition of “best” will rely on the issues and gaps that are identified with the jurisdiction’s POD plan for mass prophylaxis.

Investigation of Outbreak of Infections Caused by Salmonella Saintpaul

The US Centers for Disease Control and Prevention (CDC) has been working with state, local and tribal health departments, the Indian Health Service, and the Food and Drug Administration (FDA) to investigate a large, multistate outbreak of Salmonella Saintpaul.On May 22, 2008, the New Mexico Department of Health notified CDC of 4 persons who became ill with the outbreak strain of Salmonella Saintpaul and 15 other persons with Salmonella infection whose isolates had not yet been characterized. In the following weeks, cases of illness with the outbreak strain continued to be reported and the outbreak had expanded to include 43 states, the District of Columbia, and Canada. The outbreak now seems to be over. The CDC and its public health partners on the federal, state, local, and tribal levels searched for the source of the outbreak and said it “took steps to stop transmission of the infection.” The investigation involved the cooperation of hundreds of ill and well persons across the country who answered questions about what foods they had recently consumed.According to agency officials, “This allowed investigators to link illness with particular food items. In addition, public health officials in several states, with the assistance of CDC, investigated clusters of ill persons who had eaten at the same restaurants. FDA and state investigators traced the origin of some produce items back through the distribution chain and collected samples to test for the presence of the outbreak strain.“The investigation showed that jalapeño peppers were a major source of contamination and that serrano peppers also were a source. In addition, tomatoes were possibly a source, particularly early in the outbreak. Jalapeño peppers were traced back to distributors in the United States that received produce grown and packed in Mexico. The outbreak strain was isolated from samples of jalapeño peppers collected in a US warehouse and a patient's home and from samples of serrano peppers and water collected on a farm in Mexico.”The CDC and state health departments are continuing to conduct surveillance for cases of infection with the outbreak strain and will continue to analyze data gathered during the investigations (Figure).See “Outbreak of salmonella serotype Saintpaul infections associated with multiple raw produce items—United States, 2008,” MMWR 2008;57;929–934. The US Centers for Disease Control and Prevention (CDC) has been working with state, local and tribal health departments, the Indian Health Service, and the Food and Drug Administration (FDA) to investigate a large, multistate outbreak of Salmonella Saintpaul. On May 22, 2008, the New Mexico Department of Health notified CDC of 4 persons who became ill with the outbreak strain of Salmonella Saintpaul and 15 other persons with Salmonella infection whose isolates had not yet been characterized. In the following weeks, cases of illness with the outbreak strain continued to be reported and the outbreak had expanded to include 43 states, the District of Columbia, and Canada. The outbreak now seems to be over. The CDC and its public health partners on the federal, state, local, and tribal levels searched for the source of the outbreak and said it “took steps to stop transmission of the infection.” The investigation involved the cooperation of hundreds of ill and well persons across the country who answered questions about what foods they had recently consumed. According to agency officials, “This allowed investigators to link illness with particular food items. In addition, public health officials in several states, with the assistance of CDC, investigated clusters of ill persons who had eaten at the same restaurants. FDA and state investigators traced the origin of some produce items back through the distribution chain and collected samples to test for the presence of the outbreak strain. “The investigation showed that jalapeño peppers were a major source of contamination and that serrano peppers also were a source. In addition, tomatoes were possibly a source, particularly early in the outbreak. Jalapeño peppers were traced back to distributors in the United States that received produce grown and packed in Mexico. The outbreak strain was isolated from samples of jalapeño peppers collected in a US warehouse and a patient's home and from samples of serrano peppers and water collected on a farm in Mexico.” The CDC and state health departments are continuing to conduct surveillance for cases of infection with the outbreak strain and will continue to analyze data gathered during the investigations (Figure). See “Outbreak of salmonella serotype Saintpaul infections associated with multiple raw produce items—United States, 2008,” MMWR 2008;57;929–934.

Screening Persons Newly Diagnosed With HIV/AIDS for Risk of Intimate Partner Violence

Interventions to prevent intimate partner violence (IPV), including among those at risk for or living with HIV/AIDS, are needed. In 2001, screening persons who test positive for HIV for risk of IPV was required in New York State, launching the first large-scale program to screen for IPV risk in conjunction with HIV counseling and testing (HCT). Written surveys of counselors, physicians, and agency supervisors explored attitudes, practices, knowledge, and training needs surrounding screening for risk of IPV during HCT. Most HCT providers were aware of screening requirements, but practice varied. Counselors were more likely to screen than were physicians and asked more screening questions. Despite guidelines, screening was generally not standardized and sporadic. IPV screening in conjunction with HCT is possible. Building capacity and commitment of local HCT providers through provision of training and by fostering partnerships with public health partner services staff can help overcome identified barriers to preventing IPV in a high-risk population.

US Civilian Smallpox Preparedness and Response Program, 2003

Variola virus, the cause of smallpox disease, has been deemed a possible bioterrorism agent. Since November 2001, federal, state, and local public health partners implemented activities to prepare for a possible smallpox outbreak. The Centers for Disease Control and Prevention (CDC) produced and delivered training and educational materials for smallpox preparedness in many formats, developed detailed smallpox vaccine information statements about vaccine contraindications and vaccination site care, and established mechanisms to monitor and respond to adverse events after smallpox vaccination. The last included enhancements to the Vaccine Adverse Event Reporting System, a pregnancy registry for inadvertently vaccinated pregnant women, and a Clinician Telephone Information Line to collect reports about adverse events. The civilian responder vaccination program was conducted with rigorous safety procedures, and few historically recognized adverse events were observed. However, myocarditis and/or pericarditis was newly recognized as an adverse event caused by the New York City Board of Health vaccinia vaccine strain. This smallpox preparedness program put into place a number of measures to advance the United States' readiness for a smallpox outbreak that have assisted in preparedness for other threats.

Bioviolence: Preventing Biological Terror and Crime

Even before the anthrax attacks in 2001, public health agencies and partner sectors had begun intensifying efforts to detect and respond to the specter of biologic agents used as instruments of terror. The events in 2001 highlighted the substantial preparedness gaps and needs in multiple dimensions, particularly the requirements for coordinating the work of public health and law enforcement, sectors that operate under different jurisdictional configurations and legal regimes. This book is written by a law professor who begins by positing the thesis that humanity is vulnerable to bioterrorism because current international legal regimes are inadequate to support preventive policies. The author may thus be overly ambitious by attempting to cover this topic on a global scale, rather than through the prism of 1 or a few governance systems. This book may be particularly helpful to persons who want to learn more about basic concepts regarding the methods of bioterrorism. For example, the second chapter provides an overview and description of biologic agents identified as candidates for use by terrorists, and the third chapter presents a synopsis of historical milestones in the use of bioweapons. The second part of the book offers a conceptual treatment of the author’s beliefs about factors accounting for the global failure to effectively confront the threat of biologic agents by multiple actors, and combines this with a focused discussion of 4 categories of measures to reduce bioterrorism. These categories are interdiction (a practically framed summary), denial of access to methods of bioterrorism, preparedness (i.e., detection and response), and nonproliferation regimens. The author concludes with a call for the establishment of “a global governance architecture for preventing bioviolence.” The book’s utility for practical applications seems constrained, in part, by a limitation common to single-authored books on topics with myriad and complex technical dimensions. In particular, examining bioterrorism must take into account the convergence of numerous and complex fields, including forensic and laboratory sciences, public health, law enforcement, and behavioral sciences, to name only a few. In addition, although some chapters provide information helpful for shaping readers’ understanding of particular issues, in many instances the text falls short of being practically relevant. For example, within the chapter on public health preparedness, the author devotes only 3 paragraphs to the critically important issue of “law enforcement–public health cooperation,” which, since the 2001 anthrax attacks, has been the focus of several major initiatives within the United States. An additional point is that the author appears to be coining a new term, bioviolence (“...the infliction of harm by the intentional manipulation of living micro-organisms or their natural products for hostile purposes”), for which he also provides a rationale. Yet to be determined is whether this term truly is helpful or possibly confusing because of the already well-established lexicon and conceptions surrounding bioterrorism. On balance, however, this book can be recommended because it helps to address a void in the literature, particularly in relation to concepts of preventing bioterrorism, and because it represents another step toward establishing the multidimensional knowledge base necessary to enhance preparedness.

Epidemiology Competency Development and Application to Training for Local and Regional Public Health Practitioners

In 2002, the Northwest Center for Public Health Practice (NWCPHP) at the University of Washington initiated the Epidemiology Competencies Project, with the goal of developing competency-based epidemiology training for non-epidemiologist public health practitioners in the northwestern United States. An advisory committee consisting of epidemiology faculty and experienced public health practitioners developed the epidemiology competencies. NWCPHP used the competencies to guide the development of in-person trainings, a series of online epidemiology modules, and a Web-based repository of epidemiology teaching materials. The epidemiology competencies provided a framework for collaborative work between NWCPHP and local and regional public health partners to develop trainings that best met the needs of a particular public health organization. Evaluation surveys indicated a high level of satisfaction with the online epidemiology modules developed from the epidemiology competencies. However, measuring the effectiveness of competency-based epidemiology training for expanding epidemiology knowledge and skills of the public health workforce remains a challenge.

Conspiracy Beliefs and Trust in Information About HIV/AIDS Among Minority Men Who Have Sex With Men

Conspiracy Beliefs and Trust in Information About HIV/AIDS Among Minority Men Who Have Sex With Men

Design and Development of Standards (HL7 V3) Based Enterprise Architecture for Public Health Programs Integration at the County of Los Angeles

Public Health (PH) applications in County of Los Angeles (LAC), Department of PH have been developed to meet individual PH program’s goals. This resulted in lack of county-wide PH data integration, efficiency, and usefulness. LAC encouraged the development of web-based applications utilizing standards-based PH Information Network interoperable service-oriented architecture (SOA). The goal was to stop the evolution of fragmented health data systems which place limitations on the PH mission of safeguarding and improving the health of the community as well as responding to large-scale threats to PH. PH Nursing case management is one example of LAC’s initiative for promotion of web-based tools which will be utilized within this SOA. This PH architecture is capable of supporting electronic data exchange from PH partners using a HL7 integration hub. It promotes the development of management tools and applications to assist PH response and recovery activities while providing resources to support departmental integration.

A Vision for More Effective Public Health Information Technology

Recently there has been a surge in dialogue both among public health partners and within the Centers for Disease Control and Prevention (CDC) regarding efforts to identify a consolidated set of best of software application development, specifically to fit the mold of public health information technology (IT). While the intentions behind these motivations are to be applauded -- such talk recognizes the truth that public health IT is a complicated and difficult field which attempts to provide workable, viable technology solutions for additional public health capacity -- intentions toward a single set of consolidated IT approaches risk surrendering the strength of public health to adapt and respond to unforeseen challenges, such as outbreaks or emergency scenarios. Not all areas of public health have the same set of requirements. Epidemiological response to a sudden disease outbreak, for example, will be quite different in its approaches and investigative methods from a response to an increase in chronic disease in a specific population group. Unique disease outbreaks each unfold differently. Similarly, laboratory methods for clinical specimens vs. environmental samples are not expected to follow precisely similar practices either, for each is a unique entity.

Turning Point: implications for collaborative governance

PurposeThe purpose of this paper is to show how the Turning Point Initiative to improve the health of populations by improving the USA public health system has many lessons on collaboration for governance systems.Design/methodology/approachThe article synthesizes published literature outlining the results of a Robert Wood Johnson Foundation/W.K. Kellogg Foundation grant program to 21 USA states and 43 communities and relationships to administrative practice.FindingsTurning Point's creation of a formalized network of public health partners across the USA has led to innovations in collaboration, increased system capacity, and alternative structures for improving health.Originality/valueTurning Point's efficacy in community health system improvement can be mirrored in clinical governance. A major potential for improvement in clinical delivery systems is available by re‐thinking key partners, organizational structures, and system administrative capacity.

Can Public Health And Medicine Partner In The Public Interest?

The dominant issues for health and health care today can be effectively engaged only if public health and medicine work together as better partners. Yet historical, professional, organizational, operational, and financial barriers exist to closer relationships. Fostering the necessary collaboration will require changes for both public health and medicine in leadership styles, professional education, practice incentives, accountability measures, and financing structures.

Surveillance for human Salmonella infections in the United States.

Surveillance for human Salmonella infections plays a critical role in understanding and controlling foodborne illness due to Salmonella. Along with its public health partners, the Centers for Disease Control and Prevention (CDC) has several surveillance systems that collect information on Salmonella infections in the United States. The National Salmonella Surveillance System, begun in 1962, receives reports of laboratory-confirmed Salmonella infections through state public health laboratories. Salmonella outbreaks are reported by state and local health departments through the Foodborne Disease Outbreak Reporting System, which became a Web-based, electronic system (eFORS) in 2001. PulseNet facilitates the detection of clusters of Salmonella infections through standardized molecular subtyping (DNA "fingerprinting") of isolates and maintenance of "fingerprint" databases. The National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) monitors antimicrobial resistance in Salmonella by susceptibility testing of every 20th Salmonella isolate received by state and local public health laboratories. FootNet is an active surveillance system that monitors Salmonella infections in sentinel areas, providing population-based estimates of infection rates. Efforts are underway to electronically link all of the Salmonella surveillance systems at CDC to facilitate optimum use of available data and minimize duplication.

CDC International HIV Prevention Research Activities Among Injection Drug Users in Thailand and Russia

The Centers for Disease Control and Prevention (CDC) has participated in collaborative HIV prevention research activities in injection drug users (IDUs) with the Bangkok Metropolitan Administration (BMA) in Bangkok, Thailand, from 1995 to the present and with the Orel AIDS Center in Orel Oblast, Russia, from 2001 to 2003. Studies in Bangkok have included an HIV prevention trial preparatory cohort from 1995 to 1998, a seroconverter cohort from 1998 to the present, a phase III trial of the AIDSVAX B/E gp120 HIV vaccine from 1999 to 2003, and a phase II/III HIV prophylaxis trial with tenofovir scheduled to begin in 2005. Activities in Orel included a review of HIV surveillance data in 2001, focus group discussions and a case-control study with HIV-infected and -uninfected IDUs in 2001, a cross-sectional study with the female sex partners of male IDUs in 2002, and a community outreach intervention in 2002-2003. In Bangkok, 1,209 IDUs were enrolled in the preparatory cohort which revealed an HIV incidence of 5.8% per 100 person-years; 133 HIV-infected IDUs have been followed in the seroconverter cohort with >85% follow-up and HIV and tuberculosis care provided; 2,546 IDUs were enrolled in the HIV vaccine efficacy trial which was successfully completed with a follow-up rate of >95%, although the vaccine was not shown to be effective at reducing HIV incidence; and 1,600 IDUs will be enrolled in the daily tenofovir HIV prophylaxis trial in 2005. In Orel, initial focus group discussions and epidemiologic studies revealed low HIV knowledge and high rates of unsafe injecting and sexual practices among IDUs and their female sex partners; and educational campaigns and the community outreach intervention were developed and implemented. A steady decline in new HIV infections in IDUs was then observed in Orel in 2002-2003. CDC has participated in the conduct of successful collaborative HIV prevention research activities in Thailand and Russia over the past decade. The establishment of long-term relationships with in-country public health and community partners has been instrumental in the success of these efforts.

The Use of an Emergency Response Tabletop Exercise to Foster Collaboration among Regional Public Health Partners and Academia

The Use of an Emergency Response Tabletop Exercise to Foster Collaboration among Regional Public Health Partners and Academia

Maintaining High Vitamin A Supplementation Coverage in Children: Lessons from Niger

In 1997, the reduction of child mortality became a policy priority for the Government of Niger because Niger's child mortality rate was the highest in the world. The Ministry of Public Health, Helen Keller International (HKI), and UNICEF spearheaded a coalition-building process linking vitamin A deficiency (VAD) control to national child survival goals. An evidence-based advocacy strategy was developed around the child survival benefits of adequate and sustained VAD control with one unambiguous message: "VAD control can avert over 25,000 child deaths per year." As a result, in 1997 Niger became one of the first countries in Africa to effectively integrate vitamin A supplementation into National Immunization Days (NIDs) for polio eradication. The challenge was then to provide children with a second annual dose of vitamin A. This led in 1999 to the first ever National Micronutrient Days (NMDs) in Africa. NMDs are mobilization campaigns in which caregivers are actively encouraged to take their children for the delivery of vitamin A supplements. Since 1999, the combination of NIDs and NMDs has ensured that over 80% of children 6 to 59 months of age receive two vitamin A doses annually. The success of NIDs/NMDs has relied on five pillars: leadership and ownership by the Ministry of Public Health; district-level planning and implementation; effective training and flexible delivery mechanisms; effective social information, communication, and mobilization; and responsiveness and flexibility of Ministry of Public Health and development partners. This successful approach has been widely disseminated, notably through the West African Nutrition Focal Points Network.

Adult Education and Public Health Partner to Address Health Literacy Needs

The 1993 publication of findings from first National Adult Literacy Survey (NALS) drew attention of nation. Among health researchers, realization that almost half of U.S. adults have difficulty using common texts to complete everyday tasks spurred interest in health-related consequences. Subsequently, improving health literacy was listed among objectives of Healthy People 2010, Department of Health and Human Services' (HHS) document, which articulates health goals and objectives of nation. The action plan for this objective, contained in Communicating Health: Priorities and Strategies for Progress, notes that partnerships will be required to marshal necessary resources to make progress (HHS, 2003). A partnership between health sectors and adult education sectors is a highlighted goal, and adult educators are called on to augment students' abilities to access and navigate difficult pathways of health information for themselves, their families and their communities (HHS, 2003). Similarly, National Academies' Institute of Medicine report, Health Literacy: A Prescription to End Confusion (2004) recommends that adult educators augment their students' abilities to access and navigate health information and health services. Many health researchers and practitioners awaited 2005 analyses, in part, because research studies established a link between reading skills and a variety of health-related outcomes (Berkman et al., 2004; Rudd, Soricone, & Santos, 2000) and hope of documented improvements in literacy skills. Unfortunately, initial findings from 2003 National Assessment of Adult Literacy (NAAL), announced at end of 2005, indicated little or no improvement over 1993 survey findings (Rutner, Greenberg, & Baer, 2005). The need for collaborative work articulated at beginning of century becomes even more essential in face of a growing body of literature that documents health consequences of limited literacy, Since publication of NALS, many partnership programs engaged health educators and adult educators in a variety of funded programs focused on health information. Although a focus on health topics is not really business of ABE, ESOL, or GED programs, health subjects can be incorporated in lessons to enrich discussion and engage students, as long as focus remains on improving reading, writing, math, and oral language skills. This article reports on collaborative efforts to focus attention, not on health content, but instead on critical literacy skills needed for everyday life, and most especially for a wide variety of health-related activities and tasks. Background Health literacy is often defined as the degree to which individuals have capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (HHS, 2003, [paragraph] 15). However, definition has evolved beyond a focus on individuals and is considered to be interaction of demands of health systems and skills of individuals (HHS, 2003; Institute of Medicine, 2004). Assessments indicate that demands of health systems are high, and that many materials and tools are prepared at reading levels that exceed average reading skills of U.S. adults. In addition, findings indicate that individuals entering health services are not able to access information, act on information, or understand and follow directions as presented. Studies have firmly linked limited reading skills with higher rates of hospitalization, less understanding of one's disease or regimen, and less control over chronic disease (Berkmann et al., 2004; Institute of Medicine Committee on Health Literacy, 2004; Rudd, Moeykens, & Colton, 2000). Focus on Critical Health Issues In light of these suggestions and findings from policy makers and health literacy research studies, colleagues from public health and adult education fields developed a conceptual model and a professional development approach to address issues of health literacy in adult education instruction. …

Support among persons infected with HIV for routine health department contact for HIV partner notification.

Public health partner notification (PN) services are provided inconsistently to persons diagnosed with HIV/AIDS in the United States, and some community groups representing persons with HIV/AIDS have opposed widespread application of PN. We surveyed persons with HIV recently reported to our health department and a random sample of HIV-infected persons attending an HIV/AIDS clinic. A total of 95 persons, of whom 76 (80%) were men who have sex with men, completed an anonymous self-administered questionnaire. Eighty-four percent of participants believed the health department should routinely offer everyone diagnosed with HIV help in notifying their partners; 79% indicated they would be somewhat or very likely to provide information to a doctor, case worker, or health department employee for purposes of PN; and 20% indicated they wanted help in notifying a recent sex partner. Seventy-eight percent of participants believed the health department should contact all HIV-infected persons after diagnosis to help them access medical care and social services, and 68% wanted the health department to contact them about the availability of medical or social services. In contrast to common public perceptions, these results suggest that most persons with HIV support health departments routinely contacting people after HIV diagnosis and that many want assistance with PN.