Preventing Halloween arson in an urban setting: a model for multisectoral planning and community participation.

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a city wide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.

Who washes hands after using the bathroom?

Handwashing is one of the most important control measures for preventing the spread of bacteria. Although young children are taught the procedure through different types of behavior modification, its effect has not been measured in older children. We have documentation that adults and health care workers have a compliance rate of only 50% with this basic control measure. This article reports on the compliance rate, duration, and handwashing techniques used by middle and high school students after using the bathroom.

Preventing perinatal transmission of HIV--costs and effectiveness of a recommended intervention.

OBJECTIVE: To calculate the national costs of reducing perinatal transmission of human immunodeficiency virus through counseling and voluntary testing of pregnant women and zidovudine treatment of infected women and their infants, as recommended by the Public Health Service, and to compare these costs with the savings from reducing the number of pediatric infections. METHOD: The authors analyzed the estimated costs of the intervention and the estimated cost savings from reducing the number of pediatric infections. The outcome measures are the number of infections prevented by the intervention and the net cost (cost of intervention minus the savings from a reduced number of pediatric HIV infections). The base model assumed that intervention participation and outcomes would resemble those found in the AIDS Clinical Trials Group Protocol 076. Assumptions were varied regarding maternal seroprevalence, participation by HIV-infected women, the proportion of infected women who accepted and completed the treatment, and the efficacy of zidovudine to illustrate the effect of these assumptions on infections prevented and net cost. RESULTS: Without the intervention, a perinatal HIV transmission rate of 25% would result in 1750 HIV-infected infants born annually in the United States, with lifetime medical-care costs estimated at $282 million. The cost of the intervention (counseling, testing, and zidovudine treatment) was estimated to be $ 67.6 million. In the base model, the intervention would prevent 656 pediatric HIV infections with a medical care cost saving of $105.6 million. The net cost saving of the intervention was $38.1 million. CONCLUSION: Voluntary HIV screening of pregnant women and ziovudine treatment for infected women and their infants resulted in cost savings under most of the assumptions used in this analysis. These results strongly support implementation of the Public Health Service recommendations for this intervention.

Counseling and testing for HIV prevention: costs, effects, and cost-effectiveness of more rapid screening tests.

New rapid human immunodeficiency virus (HIV) antibody tests permit many individuals to receive test results and appropriate counseling at one clinic visit. Because currently used tests require significant time for processing, all individuals must return for a second visit for test results and counseling. Since return rates for the second visit are low, the more rapid tests present an opportunity to improve the efficiency of HIV counseling and testing. The authors compared the costs and effectiveness of the currently used counseling and testing procedure and a streamlined procedure made possible by the new, more rapid screening tests. When test-positive clients are given preliminary screening test results, the rapid procedure is more cost-effective than the current procedure. Since over 90% of the clients in most clinics will test negative, the rapid counseling and testing procedure allows the vast majority of clients to be counseled and tested and to receive their results and posttest counseling in one visit. However, in the case where the goal of HIV counseling and testing is to focus only on infected individuals, if information regarding a positive result from the rapid screening test is not given to clients at the initial visit before a confirmatory test is performed, then the rapid counseling and testing procedure is not more cost-effective than the current procedure.

Sexual behavior, sexually transmitted diseases, and risk of cervical cancer.

To explore sexually transmitted diseases and sexual behavior as risk factors for cervical cancer, we analyzed data from a population-based case-control study of breast and cervical cancer in Costa Rica. Data from 415 cases of cervical carcinoma in situ, 149 cases of invasive cervical cancer, and 764 controls were included in the analysis. Multivariate analysis showed that lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, herpes simplex virus type 2 seropositivity, and serologic evidence of previous chlamydial infection were predictors of carcinoma in situ. Serologic evidence of previous syphilis was not associated with carcinoma in situ. Predictors for invasive cervical cancer included lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, serologic evidence of previous syphilis, herpes simplex type 2 infection, and chlamydial infection. Cigarette smoking, socioeconomic status, self-reported history of sexually transmitted diseases, and douching were not associated with either carcinoma in situ or invasive cervical cancer.

Prevention of HIV infection in women: overcoming barriers.

The proportion of total reported cases of acquired immune deficiency syndrome (AIDS) in US women increased annually between 1988 and 1994 from 10% to 18%, indicating an urgent need for prevention measures. Interventions designed to reduce unsafe sex and drug-using behaviors in women have been limited. Barriers to human immunodeficiency virus (HIV) prevention for women include a disproportionately low investment of resources, inadequacy and inaccessibility of substance abuse treatment programs, the crack/cocaine epidemic and resulting unsafe sex behaviors, lack of a woman-controlled method to prevent sexual transmission of HIV, and unique social and cultural factors that limit women's power in sexual decision making. Some interventions have been successful in reducing women's risk behaviors. Expanding prevention efforts targeted to women is necessary in order to stem the rising rate of HIV infection.

An overview of the effectiveness and efficiency of HIV prevention programs.

Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly when they are delivered with sufficient resources, intensity, and cultural competency and are based on a firm foundation of behavioral and social science theory and past research. Economic evaluations have found that some of these behaviorally based programs yield net economic benefits to society, and others are likely cost-effective (even if not cost-saving) relative to other health programs. Still, specific improvements should be made in certain HIV prevention programs.

Estimating the value of preventing a human immunodeficiency virus infection.

We estimated the medical cost savings for a case of human immunodeficiency virus (HIV) infection prevented. Using medical care cost estimates, assumptions concerning knowledge of serostatus, time spent in various stages of HIV disease, and a discount factor, we estimated the present value of future cost savings for a case of HIV prevented, which ranged from $56,000 to $80,000. Since this method excludes both indirect costs and direct costs other than medical care, these figures underestimate the true cost savings for a case of HIV prevented. However, the method may prove useful in assigning a systematic economic value to an HIV infection averted that can be used in cost-benefit analyses of HIV prevention interventions.

Black communities' belief in "AIDS as genocide". A barrier to overcome for HIV prevention.

The belief that acquired immunodeficiency syndrome (AIDS) is a form of genocide targeted at the black population is prevalent in black communities in the United States. Public health authorities are distrusted, in part because of the legacy of the Tuskegee Study of untreated syphilis, a perceived racist experiment. For effective interventions to prevent the transmission of human immunodeficiency virus in black communities, genocidal fears and beliefs must be addressed and black community leaders should be involved in planning and implementation.