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Abstract: The total number of outpatient visits to 10 hospital emergency rooms declined 64 per cent and emergency admissions 35 per cent immediately after the February 1978 blizzard in Rhode Island: both quickly returned to normal levels. Three days after the storm, admissions for myocardial infarction increased markedly. Total mortality and ischemic heart disease deaths showed a considerable increase for the five-day period following the blizzard. The physical and psychological stress of the blizzard probably precipitated cardiac deaths in susceptible individuals. (Am J Public Health 69: 1050-1052, 1979.) [ABSTRACT FROM AUTHOR]

Objectives. We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign. Methods. We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program. Results. Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114). Conclusions. Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses. [ABSTRACT FROM AUTHOR]

Objectives. Although differential exposure by socioeconomic position (SEP) to hazardous waste and lead is well demonstrated, there is less evidence for particulate air pollution (PM), which is associated with risk of death and illness. This study determined the relationship of ambient PM and SEP across several spatial scales. Methods. Geographic information system-based, spatio-temporal models were used to predict PM in the Northeastern United States. Predicted concentrations were related to census tract SEP and racial composition using generalized additive models. Results. Lower SEP was associated with small, significant increases in PM. Annual PM10 decreased between 0.09 and 0.93 micrograms per cubic meter and PM2.5 between 0.02 and 0.94 micrograms per cubic meter for interquartile range increases in income. Decrements in PM with SEP increased with spatial scale, indicating that between-city spatial gradients were greater than within-city differences. The PM-SEP relation in urban tracts was not substantially modified by racial composition. Conclusions. Lower compared with higher SEP populations were exposed to higher ambient PM in the Northeastern United States. Given the small percentage change in annual PM2.5 and PM10, SEP was not likely a major source of confounding in epidemiological studies of PM, especially those conducted within a single urban/metropolitan area. [ABSTRACT FROM AUTHOR]

Having identified gaps in implementation of Rhode Island's syringe access law and police occupational safety education, public health and police professionals developed police training to boost legal knowledge, improve syringe access attitudes, and address needlestick injuries. Baseline data (94 officers) confirmed anxiety about needlestick injuries, poor legal knowledge, and occupational risk overestimation. Before training, respondents believed that syringe access promotes drug use (51%), increases likelihood of police needlestick injuries (58%), and fails to reduce epidemics (38%). Pretraining to posttraining evaluation suggested significant shifts in legal and occupational safety knowledge; changes in attitudes toward syringe access were promising. Training that combines occupational safety with syringe access content can help align law enforcement with public health goals. Additional research is needed to assess street-level effect and to inform intervention tailoring. INSET: TRAINING CONTEST. [ABSTRACT FROM AUTHOR]

Objectives. The effect of a community-based physical activity program in Pawtucket, RI, was evaluated relative to one in a comparison community. Methods. Cross-sectional surveys of 7529 residents of Pawtucket, RI, and 7732 residents of the comparison city were conducted at 2-year intervals during 7 years of intervention. Results. There were no differences in self-reported knowledge of the benefits of physical activity, attempts to increase exercise, or prevalence of physical inactivity between Pawtucket and the comparison community. Conclusions. Future community-based physical activity interventions should attempt to involve a wider range of individuals. (Am J Public Health. 1999;89:1741-1744) [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to determine whether adequacy of prenatal care. utilization improved after the implementation of a Medicaid managed care program in Rhode Island. Methods. Rhode Island birth certificate data (1993-1995; n=37021) were used to analyze pre- and post- program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal dare adequacy as a function of both time and the various covariates. Results. Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1%. to 62.1 % (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program .was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). Conclusions. Unlike many other Medicaid expansions for pregnant woman, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care. [ABSTRACT FROM AUTHOR]

Objectives. Incomplete external cause of injury (E) coding limits the usefulness of hospital discharge data sets for injury surveillance and research. Hospital medical records were examined to determine whether they contained adequate cause of injury documentation to allow for more complete E coding of injury discharges. Methods. Medical records for a sample of discharges involving a principal diagnosis of injury from the Uniform Hospital Discharge Data Set for Rhode Island were selected. We assigned E codes to these discharges and compared our E codes with those of the discharge data set. Results. Documentation of cause of injury in the medical records was sufficient to allow assignment of a specific E code to 70% of the injuries for which no E codes or vague E codes were submitted on the Uniform Hospital Discharge Data Set. It was estimated that specific cause of injury documentation is available in the medical records of 80% of all injury discharges in Rhode Island; for approximately 90%, an E code describing at least the broad cause of injury could be assigned. Conclusions. Rates of E coding can be substantially increased by making better use of existing documentation in medical records. [ABSTRACT FROM AUTHOR]

Objectives. Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. Methods, Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. Results. The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. Conclusions. The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs. [ABSTRACT FROM AUTHOR]

Background. Rhode Island's Division of Substance Abuse asked us to assess the State's drug treatment needs and make recommendations regarding its treatment system for the next three years. Methods. We used a statewide telephone drug use survey of 5,176 households supplemented by drug-related hospital discharges, Division of Drug Control statistics, and interviews with providers, state officials, and out-of-state experts. Drug abuse was measured with items from the Diagnostic Interview Schedule. Abusers were asked if they were receiving or wanted to receive treatment. Results. Survey responses, used to estimate the unmet need for drug treatment, indicated a need to triple drug treatment services. Regression models using survey data indicated that the treatment network was overly centralized in the Providence area. Interviews with state officials, clinicians, and out-of-state experts provided material for recommendations on reimbursement policy, treatment mix, quality assurance, and cost containment. Conclusions. The RI Department of Health's certificate-of-need program adopted our overall recommendation for tripling the drug treatment system as its guideline in evaluating proposals for new treatment facilities. With State funding of a new adolescent center and expansion of outpatient slots in the private sector, this recommendation has now been fully implemented. [ABSTRACT FROM AUTHOR]

Abstract: Hospital discharge summary data were used to identify and study all 2,870 Rhode Island residents hospitalized in-state with head injuries during 1979 and 1980. The overall hospitalized incidence rate was 152 per 100,000 of population per year with age and sex variations similar to those found in other studies. This is consistent with the observation that fatal injury rates in Rhode Island are only 75 per ¢ of the United States average. Hospitalized incidence rates of head injury for the census tracts in the lowest decile of median income were twice those for census tracts in the highest decile. Smaller increases were also observed with increasing population density. Length of hospital stay increased with age. Discharge to chronic care facilities plus in-hospital deaths increased 20-fold with increasing age. In each age group, in-hospital deaths and discharge to chronic care facilities were associated with long hospital stays. [ABSTRACT FROM AUTHOR]

The article presents a study that analyzes the attitudes of the public toward abortion in Rhode Island, with regard to socioeconomic correlates. The study makes use of the information collected in the 1971 follow-up survey of the cumulative sample of the Rhode Island Health Study, to ascertain attitudes on abortion. The study shows that education and religion were the most important variables in causing differentials in attitudes toward abortion, indicating a greater extent of approval from the better educated and the Protestants to the less educated and the Catholics.

Conclusions. Rhode Island's legislation seems to have promoted safer child passenger seating behavior. (Am J Public Health. 2001;91:311-313) [ABSTRACT FROM AUTHOR]

Breast biopsy is a common procedure for which few age-specific, population-based data are available. We identified all women who underwent breast biopsy in Rhode Island in 1989 by reviewing the specimen logs at each of 13 pathology laboratories. Among 425 000 women aged 15-97 years, 2685 underwent breast biopsy, for an overall rate of 6/1000. The rate increased with age, peaking among 45- to 54-year-olds and then declining in women over 75. Among those biopsied. 726 were diagnosed with breast cancer, for an overall biopsy positivity of 27%. In contrast to rate, positivity increased steadily with age. These results are within the range of estimates produced by smaller group studies. [ABSTRACT FROM AUTHOR]

Population-based hospital emergency department data on motor vehicle traffic trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status. Annualized rates of overall and severe trauma were 1,195 cases (95% confidence interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000 population, respectively. Overall and severe rates peaked at ages 15-24 years. Male rate excesses were most pronounced for motorcycle and pedal cycle trauma. [ABSTRACT FROM AUTHOR]

Abstract: Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7,17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5,41). (Am J Public Health 1990; 80:730-731.) [ABSTRACT FROM AUTHOR]

Abstract: Four years of participant tracking data (N = 24,995) for community-based programs targeting cardiovascular disease risk factors are presented. Over two-thirds of contacts were female; age segment representation in these programs was comparable to the city's demography. However, the data show that programs of varying formats which target specific risk factors attract different types of participants. Implications for marketing strategy are discussed. (Am J Public Health 1987: 77: 1342-1344.) [ABSTRACT FROM AUTHOR]

Abstract: A statewide Survey to identity and abate spray-on asbestos hazards in schools has been conducted in Rhode Island. Of 326 target schools. 24 (8 per cent) contained material confirmed in the laboratory to be spray-on asbestos. Overt hazards requiring major corrective measures were found in 4 (1 per cent) of the target schools. Simplified identification and reporting procedures allowed for the efficient conduct of the survey. [ABSTRACT FROM AUTHOR]

This article presents a study which examines the impact of medicare and medicaid programs to the traditional positive relationship of income and the use of ambulatory care services. It analyzes the data obtain in Rhode Island, about the source of care and the type of regular care source that people have. Evaluation of income, race, and source of payment for medical care are highlighted. The study emphasizes use of clinic type facilities by the disadvantaged groups. Discussion on the characteristics of the country as a metropolitan area, with a population of around 910,000 are presented.

The smoking habits of physicians have been a popular subject for study in this country and abroad for the last couple of decades largely because of the presumed potential influence of the doctor's precept and example on patient behavior. Nearly all studies have shown a tendency for the physician to smoke less than the general population and, despite a frequent lack of comparability of method, the rate of cigarette use among doctors is found to be falling and the fall is sustained. This communication reports the cigarette smoking status of the physicians of Rhode Island, exploring the changes since 1963 and 1968. using questions designed for comparability with these two earlier reports. Surveys have tended to show strong relationships of socioeconomic status and education to cigarette smoking. Professionals, persons with post-graduate university education, and members of high-income families have all tended to show rates of smoking substantially below those for the population as a whole, at least among males.

Abstract: A survey of practicing physicians in Rhode Island revealed a cigarette smoking rate of only 8.3 per ¢ in 1983. This represents a continuation of the consistent decrease seen in the percentage of physician smokers in each such survey since 1963. Under age 30, the rate was only 4.5 per ¢. An exponential model suggests that the overall rate for Rhode Island physicians will be below 3 per ¢ by the year 2000. (Am J Public Health 1986; 76:285-286.) [ABSTRACT FROM AUTHOR]

Abstract: In Rhode Island a law went into force July 1, 1980, requiring drivers to transport children who are in the front seats of vehicles in properly used child restraints. In the fourth month of the law restraint use and travel in rear seats had increased moderately; the net result was an increase in proper restraint use in rear seats (11 to 23 percent) and a decrease in unrestrained front seat travel (41 to 26 per ¢). [ABSTRACT FROM AUTHOR]