Objectives We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services' 12-lead electrocardiogram capability, continuous percutaneous coronary intervention [PCI] and cardiothoracic surgical services), after accounting for individual and environmental factors. Methods Data on 14,663 deaths (in-hospital and out of hospital) and live hospital discharges as a result of AMI for 2012 and 2013 among Arkansas residents were obtained from the Arkansas Department of Health. A mixed-effects logistic regression model was used to account for nesting, in which an individual was nested within either a county or a hospital to evaluate the association of system factors with death from AMI. Results Deaths from AMI were significantly associated with two system factors: a 9.2% increase in the odds of deaths from AMI for every 10-mi increase in distance to the nearest hospital (odds ratio 1.092, 95% confidence interval 1.009-1.181) and a 64% increase in the odds of death from AMI among hospitals without continuous PCI capability (odds ratio 1.64, 95% confidence interval 1.15-2.34), after adjusting for individual and environmental factors. Conclusions A higher risk of AMI deaths was associated with healthcare system factors, especially distance to nearest hospital, and hospitals' continuous PCI capability, even after adjusting for individual and environmental factors. A coordinated system of care approaches that mitigates gaps in these system factors may prevent death from AMI.

A variety of health conditions such as asthma, elevated blood lead levels (BLLs) in children, pesticide poisonings, and falls and trips injuries have been associated with substandard housing conditions, implying that improvement in housing can lead to improved health. This group of researchers previously developed and reported on a Habitability Element Rating Scores (HERS) to compare and rank the strength of habitability laws of US states. HERS considers a State's adoption of elements of Uniform Landlord and Tenant Act (URLTA) for upkeep of property (i.e., raw scores), and the potential of elements to influence tenant health (i.e., weighted scores). Here we examine the relationship of HERS raw scores with various state political and demographic features to investigate potential driving forces for the development/existence of comprehensive and equitable housing standards. Statistically significant associations reveal states tend to emphasise low or high HERS raw scores depending on factors such as rurality and the proportion of a state's legislative body, which indicates its political party affiliation. The group of states with moderately strong laws (n = 11) also tended to be Southern states, with concomitantly higher proportions of minorities in the state, female renters heading the household, and renters living in poverty.

There is a strong relationship between experiencing violence and participating in behaviors that increase the risk of contracting sexually transmitted infections. Sexual health education (SHE) tailored to the unique needs of female survivors of violence is needed. This paper presents findings from 40 surveys and 33 accompanying interviews with stakeholders representing 31 agencies in the violence advocacy community in Arkansas to investigate the feasibility, acceptability, and perceived need of a SHE program for female survivors of violence. Data also explore the role and preferences of community agencies in the design and implementation of such a program. Interviews with stakeholders revealed three themes: intervention concerns, content, and structure.

Creation and maintenance of habitable housing conditions can be a challenge, particularly when occupants do not have ownership or control of the housing unit or sufficient resources to address deficiencies. A systematic review of the literature was conducted and a descriptive analysis was performed on habitability laws enacted by the 50 states and the District of Columbia to determine variability in the strength of habitability laws and their potential to affect resident health. The systematic review stratified states according to first dates of adoption and last dates of annotations to habitability laws. The descriptive analysis referred to as the Habitability Element Rating Scale, scored and ranked states according to their basic level of consistency with the Uniform Residential Landlord Tenant Act (URLTA); weights were applied to reflect each element's potential to influence health and party responsibility. The review and analysis found substantial variation in habitability laws across states and indicate that the Western region of the United States typically have landlord and tenant laws that are more consistent with the URLTA. Results also suggest states that adopted URLTA (in whole or in part) soon after its initial development and dissemination in 1972 may prioritise habitability of housing and health policy.

Volunteer leaders are increasingly being utilized to deliver community strength training classes, but the factors affecting adoption of volunteer delivery approaches by educators or program managers have not been well explored. This study sought to identify these factors by comparing perspectives of adopting and nonadopting county Extension educators for a group strength training program delivered through county Cooperative Extension offices. Semistructured interviews were conducted with a purposive sample of adopting (n=6) and nonadopting (n=13) educators. Interviews were recorded, transcribed verbatim, and coded using thematic content analysis. Review of codes related to adoption or nonadoption of volunteer delivery approaches produced common themes. Both groups acknowledged role differences between educators and volunteers and expressed concerns about maintaining program quality. Adopters expressed greater comfort with volunteer-led program approaches and understanding of the educator-volunteer role. Nonadopters were hesitant to request program participants serve as leaders but felt participants were capable. Both groups were motivated to offer the program for dual personal and community benefit, but nonadopters expressed reliance on the program to maintain physical activity habits and for social support. Findings can inform others seeking to adapt community programs for volunteer delivery or engage volunteers in existing program delivery.

Our aim is to determine if propoxyphene withdrawal from the US market was associated with opioid continuation, continued chronic opioid use, and secondary propoxyphene‐related adverse events (emergency department visits, opioid‐related events, and acetaminophen toxicity).

This article describes findings from a qualitative study of volunteer leaders in the StrongWomen strength training program in Arkansas. The study explored reasons volunteers initially agreed to serve, perceptions of volunteer role, and motivations for continuing to lead strength training groups long-term. Findings suggest a combination of factors supporting volunteer engagement: personal benefit of program, desire to continue program combined with a personal invitation to volunteer extended by the agent, desire to support a co-leader, and exercise and social support needs met through volunteer service. Motivations of Extension health program volunteers are important to address to maximize program impact.

BACKGROUND:The effect of volunteer lay leaders on availability and sustainability of strength-training programs for older adults has not been well explored. We describe implementation of the StrongWomen strength training program by the Arkansas Cooperative Extension Service, and report on the relationship between delivery approach (agent-led, lay-led, or combination of agent- and lay-led) and program access and sustainability.METHODS:All state Extension agents (n = 66) were surveyed on program implementation, continuance, and use of lay leaders. Program records were used to identify the number of trained lay leaders. Regression models were used to examine the relationship between delivery approach and group availability.RESULTS:Counties using lay leaders had twice as many groups as counties using only agents. There was a significant, positive relationship between the number of lay leaders and the number of groups. Counties using lay leaders were 8.3 times more likely to have continuing groups compared with counties not using lay leaders.CONCLUSIONS:Program continuance was significantly and positively associated with lay leader use. Lay delivery expanded access to strength training programs and increased the likelihood that programs would continue. This approach can be used to increase access to and sustainability of strength training programs, particularly in resource-constrained areas.

The Gail and CARE models estimate breast cancer risk for white and African-American (AA) women, respectively. The aims of this study were to compare metropolitan and nonmetropolitan women with respect to predicted breast cancer risks based on known risk factors, and to determine if population density was an independent risk factor for breast cancer risk. A cross-sectional survey was completed by 15,582 women between 35 and 85 years of age with no history of breast cancer. Metropolitan and nonmetropolitan women were compared with respect to risk factors, and breast cancer risk estimates, using general linear models adjusted for age. For both white and AA women, tisk factors used to estimate breast cancer risk included age at menarche, history of breast biopsies, and family history. For white women, age at first childbirth was an additional risk factor. In comparison to their nonmetropolitan counterparts, metropolitan white women were more likely to report having a breast biopsy, have family history of breast cancer, and delay childbirth. Among white metropolitan and nonmetropolitan women, mean estimated 5-year risks were 1.44% and 1.32% (p < 0.001), and lifetime risks of breast cancer were 10.81% and 10.01% (p < 0.001), respectively. AA metropolitan residents were more likely than those from nonmetropolitan areas to have had a breast biopsy. Among AA metropolitan and nonmetropolitan women, mean estimated 5-year risks were 1.16% and 1.12% (p = 0.039) and lifetime risks were 8.94%, and 8.85% (p = 0.344). Metropolitan residence was associated with higher predicted breast cancer risks for white women. Among AA women, metropolitan residence was associated with a higher predicted breast cancer risk at 5 years, but not over a lifetime. Population density was not an independent risk factor for breast cancer.

E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6–12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1–1.5), hookah (AOR: 1.4, 95% CI: 1.2–1.7), cigars (AOR: 1.5, 95% CI: 1.4–1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5–1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1–1.6), hookah (AOR: 1.3, 95% CI: 1.03–1.7), cigars (AOR: 1.3, 95% CI: 1.1–1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5–2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements.

This article describes the evaluation of the Arkansas Act 1220 of 2003, a comprehensive legislative proposal to address the growing epidemic of childhood obesity through changes in the school environment. In addition, the article discusses specific components of the evaluation that may be applicable to other childhood obesity policy evaluation efforts. The conceptual framework for the evaluation, research questions, and evaluation design are described, along with data collection methods and analysis strategies. A mixed methods approach, including both quantitative (surveys, telephone interviews) and qualitative (key informant interviews, records reviews) approaches, was utilized to collect data from a range of informant groups including parents, adolescents, school principals, school district superintendents, and other stakeholders. Challenges encountered with the evaluation are discussed, as are strategies to overcome those challenges. Now in its 9th year, this evaluation has documented substantial changes to school policies and environments but fewer changes to student and family behaviors. The evaluation may inform the methods of other evaluations of childhood obesity prevention policies, as well as inform policymakers about how quickly they might expect implementation of such policies in their own states and localities and anticipate both positive and adverse outcomes.

This article describes the evaluation of the Arkansas Act 1220 of 2003 , a comprehensive legislative proposal to address the growing epidemic of childhood obesity through changes in the school environment. In addition, the article discusses specific components of the evaluation that may be applicable to other childhood obesity policy evaluation efforts. The conceptual framework for the evaluation, research questions, and evaluation design are described, along with data collection methods and analysis strategies. A mixed methods approach, including both quantitative (surveys, telephone interviews) and qualitative (key informant interviews, records reviews) approaches, was utilized to collect data from a range of informant groups including parents, adolescents, school principals, school district superintendents, and other stakeholders. Challenges encountered with the evaluation are discussed, as are strategies to overcome those challenges. Now in its 9th year, this evaluation has documented substantial changes to school policies and environments but fewer changes to student and family behaviors. The evaluation may inform the methods of other evaluations of childhood obesity prevention policies, as well as inform policymakers about how quickly they might expect implementation of such policies in their own states and localities and anticipate both positive and adverse outcomes.

BACKGROUND: Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies. METHODS: Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level. RESULTS: Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs. CONCLUSIONS: The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change.

BACKGROUND: Foods provided in schools represent a substantial portion of US children's dietary intake; however, the school food environment has proven difficult to describe due to the lack of comprehensive, standardized, and validated measures. METHODS: As part of the Arkansas Act 1220 evaluation project, we developed the School Cafeteria Nutrition Assessment (SCNA) measures to assess food availability in public school cafeterias (n = 113). The SCNA provides a measure to evaluate monthly school lunch menus and to observe foods offered in school cafeterias during the lunch period. These measures provide information on the availability of fruit, vegetables, grains (whole or white), chips (reduced fat or regular), side dishes, main dishes, beverages, à la carte selections, and desserts, as well as information on healthier preparation of these items. Using independent raters, the inter-rater reliability of the measure was determined among a subsample of these schools (n = 32). RESULTS: All food categories assessed, with the exception of the side dish and chip categories, had inter-rater reliability rates of 0.79 or greater, regardless of school type. The SCNA scores encompassed the majority of the possible scores, indicating the ability for the measures to differentiate between school cafeterias in the availability of healthier options. CONCLUSION: These measures allow comprehensive, rapid measurement of school cafeteria food availability with high inter-rater reliability for public health and school health professionals, communities, and school personnel. These measures have the potential to contribute to school health efforts to evaluate cafeteria offerings and/or the impact of policy changes regarding school foods.

HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV (PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV and those receiving medical care suggest that use of social services can enhance quality of life and some medical outcomes, but little is known about patterns of social service utilization and need among rural southern PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and 26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social services, and used regression models to determine demographic predictors of those most likely to need each service. We then conducted an exploratory factor analysis to determine whether certain services clustered together for the sample. Case management, assistance obtaining medical care, and financial assistance were most commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs; respondents without spousal or partner relationships had higher SUN scores for substance use treatment. Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical needs. These data provide important information about rural southern PLWHIV and their needs for ancillary services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case managers and other service providers work proactively to identify important gaps in care.

Childhood obesity is a major public health problem. Experts recommend that prevention and control strategies include population-based policies. Arkansas Act 1220 of 2003 is one such initiative and provides examples of the tensions between individual rights and public policy. We discuss concerns raised during the implementation of Act 1220 related to the 2 primary areas in which they emerged: body mass index measurement and reporting to parents and issues related to vending machine access. We present data from the evaluation of Act 1220 that have been used to address concerns and other research findings and conclude with a short discussion of the tension between personal rights and public policy. States considering similar policy approaches should address these concerns during policy development, involve multiple stakeholder groups, establish the legal basis for public policies, and develop consensus on key elements.

Abstract The purpose of our study is to increase recruitment of rural and disparate populations within the Spit for the Cure Breast Cancer Cohort. The Spit for the Cure Breast Cancer Cohort being established at the University of Arkansas for Medical Sciences provides a repository of information and DNA samples to study breast cancer in Southern women. Currently, over 19,000 women from Arkansas and surrounding states have been recruited into the cohort. Demographics of the cohort closely match the demographics of the state of Arkansas, though our cohort is better educated and younger on average than the state's overall female population. One of our goals is to over-sample disparate populations in rural areas, which presents many challenges; these areas tend to have sparse populations which are located in largely agricultural areas of Arkansas. Furthermore, it has been reported in literature that a lower percentage of minority populations and rural populations participate in biorepositories and cancer research. These are the same populations that suffer from limited access to health services. The assumption is that these populations are not willing to participate in cancer research; however, we hypothesize that disparate populations would enroll in research studies if given access to research opportunities. As a novel method for reaching underrepresented populations, Spit for the Cure recruiters collaborated with a mobile mammography unit, the Mammovan, based out of the Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences. We compared the demographics of participants recruited through community events in Southeast Arkansas, whose residents live in the rural Delta region, to recruitment from the Mammovan in that same region. Mammovan participants from Southeast Arkansas had a lower education level compared to women in that same area recruited through community events; 53.7% of Mammovan participants had no education beyond high school, compared to 25% of community participants (p-value <0.0001). Also, a greater proportion of African American women were recruited through the Mammovan (40.3%) compared to community events (31.1%) within the southeast region (p-value 0.01). Overall, the recruitment of Mammovan participants more closely reflects the actual demographics of the population of Southeast Arkansas. Interestingly, a high proportion of the Mammovan participants (81.8%) reported having had a mammogram prior to their Mammovan experience; indicating that these marginalized groups with limited access to health care facilities, are still able to leverage available resources in order to address their health needs. In conclusion, traveling with the mobile mammography unit is a valuable resource for the Spit for the Cure Breast Cancer Cohort to recruit disparate populations, who are in fact willing to participate, in order to more accurately mirror the demographics of Arkansas women. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3715. doi:10.1158/1538-7445.AM2011-3715