A School-Level Proxy Measure for Individual-Level Poverty Using School-Level Eligibility for Free and Reduced-Price Meals.

BACKGROUND: Socioeconomic status (SES) impacts health outcomes. The Youth Risk Behavior Survey (YRBS), like many school-based data sources, lacks individual-level poverty information. We propose using school-level percentages of student eligibility for free/reduced-price meals (%FRPM) as a proxy for individual-level poverty. METHODS: Using the New York City (NYC) 2009 YRBS, we created school-level poverty quartiles to append to individual YRBS records by ranking schools by %FRPM. We compared this with 2 other school-level poverty measures using students' home and school neighborhood-level poverty and measured the association of these 3 school-level proxies with individual's household income. Last, we evaluated health outcomes by race/ethnicity and poverty to demonstrate the importance of accounting for poverty. RESULTS: The school-level measure that used %FRPM had the strongest association with household income. When the school-level individual poverty proxy was included in illustrative analyses using YRBS data, patterns by poverty within race/ethnicity emerged that were not seen when looking at race/ethnicity alone. CONCLUSIONS: Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.

Medication injection safety knowledge and practices among anesthesiologists: New York State, 2011.

STUDY OBJECTIVE: To survey anesthesiologists to assess medication injection safety knowledge and practices, and to improve infection control programs of the New York City Department of Health and Mental Hygiene and the New York State Society of Anesthesiologists (NYSSA). DESIGN: Survey instrument. SETTING: Scientific Educational and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA. MEASUREMENTS: A confidential, 23-question survey was emailed to a total of 2,310 NYSSA members. Data from the survey were culled from the responses of NYSSA members who practiced in New York State only. MAIN RESULTS: Of the 607 survey respondents, 595 met inclusion criteria (response rate 26%). Of these, 94% to 99% correctly answered 4 categories of questions about injection-contamination mechanisms. Respondents reported unacceptable practices (eg, not using a new needle and syringe for each new patient [3%]; not using a new needle and syringe to access medication vials [28%]; and combining vial content leftovers [11%]). Resident physicians reported these unacceptable practices more often than attending physicians. Use of medication vials for multiple patients (permitted for multi-dose vials but a potentially high-risk practice) was reported by 49% of respondents and was more common among those who worked in outpatient settings. Reported barriers to using a new medication vial for each new patient were medication shortages (44%), reduction of waste (44%), and cost (27%). Unacceptable or potentially high-risk practices were more common among respondents who reported ≥ one barrier. CONCLUSIONS: Although they were not necessarily representative of all anesthesiologists in New York State, unacceptable or high-risk injection practices were common among respondents despite widespread knowledge regarding injection-contamination mechanisms. System barriers contribute to the use of medication vials for multiple patients.

"I hope I can make it out there": perceptions of women with severe mental illness on the transition from hospital to community.

This study explores the experience of women with severe mental illness in transition from psychiatric hospital care to the community. Three focus groups were conducted among women with severe mental illness from transitional residences at two state psychiatric hospitals. Focus group transcripts and notes were coded according to women's perceived challenges and facilitators of transition. Participants described several challenges including fear of insufficient treatment support, safety concerns, social isolation, stigma, and lack of resources to meet daily needs. The supports that women described as important were an orientation to the neighborhood and residence, access to treatment support with flexibility, and connection to social supports.

Randomized trial of critical time intervention to prevent homelessness after hospital discharge.

OBJECTIVE: This study assessed the effectiveness of a previously tested model, critical time intervention (CTI), in producing an enduring reduction in the risk of homelessness for persons with severe mental illness who were discharged from inpatient psychiatric treatment facilities. METHODS: A total of 150 previously homeless men and women with severe mental illness and who were discharged from inpatient psychiatric hospitalization to transitional residences on the hospital grounds were randomly assigned to receive usual care or usual care plus CTI at the point of discharge to the community. The nine-month intervention aims to gradually pass responsibility to community sources for providing ongoing support after the intervention ends, thereby leading to a durable reduction in risk of future homelessness. After participants were discharged from the transitional residence (length of stay six to 937 days), their housing status was assessed every six weeks for 18 months via participant self-report collected by interviewers blind to study condition. RESULTS: In an intent-to-treat analysis, participants assigned to the CTI group had significantly less homelessness at the end of the follow-up period (the final three six-week intervals) than those assigned to the control group (odds ratio=.22, 95% confidence interval=.06-.88). CONCLUSIONS: A relatively brief, focused intervention for persons with severe mental illness led to a reduction in the risk of homelessness that was evident nine months after the intervention ended. This work suggests that targeted, relatively short interventions applied at critical transition points may enhance the efficacy of long-term supports for persons with severe mental illness who are living in the community.