A study of incentives to support and promote public health accreditation.

CONTEXT: Accreditation of public health agencies through the Public Health Accreditation Board is voluntary. Incentives that encourage agencies to apply for accreditation have been suggested as important factors in facilitating participation by state and local agencies. OBJECTIVE: The project describes both current and potential incentives that are available at the federal, state, and local levels. DESIGN: Thirty-nine key informants from local, state, tribal, federal, and academic settings were interviewed from March through May 2012. Through open-ended interviews, respondents were asked about incentives that were currently in use in their settings and incentives they thought would help encourage participation in Public Health Accreditation Board accreditation. RESULTS: Incentives currently in use by public health agencies based on interviews include (1) financial support, (2) legal mandates, (3) technical assistance, (4) peer support workgroups, and (5) state agencies serving as role models by seeking accreditation themselves. Key informants noted that state agencies are playing valuable and diverse roles in providing incentives for accreditation within their own states. Key informants also identified the Centers for Disease Control and Prevention and other players, such as private foundations, public health institutes, national and state associations, and academia as providing both technical and financial assistance to support accreditation efforts. CONCLUSIONS: State, tribal, local, and federal agencies, as well as related organizations can play an important role by providing incentives to move agencies toward accreditation.

Disability, environmental factors and non-fatal injury.

BACKGROUND: People with disabilities have high rates of non-fatal injury; they are also likely to experience environmental factors as barriers to functioning and participation in society. The reasons for the higher injury rates among those with disabilities have not been explained. OBJECTIVE: To determine if problems with environmental factors influence the higher rates of injury among disabled compared with non-disabled. DESIGN: Data from a population-based, random-digit dial cross-sectional telephone survey were analysed to evaluate whether environmental factors as measured by the Craig Hospital Inventory of Environmental Factors explained higher injury rates among those with disabilities compared with those without. A total of 2511 Colorado adults (1997 with no disability, 386 with moderate disability, and 128 with severe disability) were included in the sample. All rated their experience of environmental factors and reported injuries within the previous 12 months. Logistic regression analyses were conducted to evaluate whether environmental factors could be confounding factors in the association between disability and non-fatal injury. RESULTS: Disability and environmental barriers were independently associated with higher rates of injury. Environmental factors did attenuate the increased odds of experiencing an injury among those with severe disabilities, but these people continued to have significantly higher rates of injury after adjustment for environmental factors. The natural environment, social attitudes and policies were ranked highly as problems by all injured persons. CONCLUSION: Injury prevention efforts need to focus on reducing disability-related injuries and reducing environmental barriers for all.

Suicidal ideation among low-income women on family assistance programs.

Low-income women face significant adversities. Many of the adversities they contend with have been associated with suicidal ideation in other groups. However little is known about low-income women's suicidal ideation and its correlates. The purpose of this study was to evaluate prevalence of and risk factors associated with suicidal ideation in a randomly drawn sample of 2,112 women ranging in age from 18 to 59 years and enrolled in family assistance programs. As in other studies of low-income women, this group had high rates of mental and physical health problems. Yet, the overall prevalence rate of suicidal ideation was not substantially higher than those found in other populations. Emotional difficulties, substance abuse/dependence, physical limitations, having been arrested, and injuries were associated with suicidal ideation. Increasing numbers of adversities were associated with increasing prevalence of suicidal ideation. Employment and pregnancy were inversely associated with suicidal ideation when controlling for adverse events. This study provided important information on prevalence and risk factors associated with suicidal ideation among low income women on family assistance programs as well as suggested areas for future work to improve the health of these women.

Validity of women's self-reports of cancer screening test utilization in a managed care population.

This study was undertaken to examine the validity of self-reported data on breast and cervical cancer screening behavior. An abbreviated version of the Behavioral Risk Factor Surveillance System telephone survey, including questions on mammography, clinical breast examination (CBE), and Papanicolaou test utilization, was administered to a sample of 480 women aged 40-74 years, enrolled in Kaiser Permanente Colorado for at least 5 years. Screening information reported in the telephone interview was compared with that abstracted from respondents' medical records. The vast majority of women had a mammogram, CBE, and Pap test according to both self-report and medical record. Sensitivity for determining whether her last test was within 2 years (3 years for Pap test) exceeded 95% for all, whereas specificities were <55%. The percentage of overall agreement between self-reported and recorded information was 88.4% (kappa = 0.62) for mammography, 87.9% (kappa = 0.45) for CBE, and 87.2% (kappa = 0.54) for Pap test. Pearson correlations between self-reported and recorded information for specific time interval since most recent mammogram, CBE, and Pap test were 0.72, 0.58, and 0.65, respectively. Correlation increased greatly when time interval was allowed to vary by +/-1 year. In most cases of disagreement, the self-report underestimated the time since last screening. These results suggest that self-reporting of breast and cervical cancer screening is fairly accurate in this managed care population, although women tend to underestimate the time since their last screening.