Pulse and Innovations are regular publications of Public Health Solutions. Pulse is a capsule report of our most recent public health research. This research focuses on developing and evaluating interventions that address new and long-standing public health problems. Innovations is a brief summary of recent peer-reviewed publications that feature our public health programs. Precisely because Public Health Solutions operates large public health programs--such as WIC and MIC Women's Health Services--it can link its research with its service delivery activities.

The following Pulse and Innovations reports are available for download:

A "Real Chicken" Revolution In The Schools
School Food FOCUS (FOCUS), a program of Public Health Solutions, is a national collaborative working on this crucial issue by leveraging the knowledge and buying power of 36 of the largest school districts in the nation. FOCUS´ ultimate goal is to make school meals everywhere more healthful, regionally sourced,and sustainably produced. Chicken, which is the principal protein in the National School Lunch Program, has become a key ingredient in FOCUS´ work reforming school food.

Public Health Solutions: Using Digital Technology to Merge Research and Action
Health literacy, the extent to which an individual can obtain, process, and understand the basic health information and services needed to make appropriate health decisions, is a key factor in improving public health. The latest national assessment of adult literacy estimated that approximately 75 million adults – more than one-third of the adult population – in the United States have limited literacy skills. Lower levels of health literacy are consistently associated with increased hospitalization, more use of emergency care, less use of preventive health services, and lower ability to use medication properly.

Changing WIC Changes What Children Eat
WIC, the Special Supplemental Nutrition Program for Women, Ifants and Children, protects the health of low-income pregnant and postpartum women, infants and children up to age five who are at nutritional risk.

Testing a Self-Administered Computerized Counseling Module to Improve Contraceptive Method Choice
Half of all pregnancies in the United States are unplanned, and millions of women are at risk of unintended pregnancy because neither they nor their partners use contraception. Interventions are needed to help women choose acceptable and effective contraceptive methods. A randomized controlled trial was conducted to test the efficacy of a self–administered computerized contraceptive method counseling module in increasing the proportion of family planning patients choosing a more effective birth control method.

Smoking, Mental Health, and Continuity of Care
A project integrating routine, standardized mental health and behavioral risk factor (BRF) screening of patients at MIC Women's Health Services, a network of six reproductive health centers, includes efforts to identify links among behavioral, mental and reproductive health.

Knowledge and Use of Non-Occupational Post-Exposure Prophylaxis (nPEP) to Prevent HIV Infection after Sexual Exposure in a Cohort of High-Risk Men Who Have Sex with Men Recruited Online
The most effective way to prevent HIV infection is to avoid exposure to the virus. If a non-occupational blood-to-blood or sexual exposure to an HIV-infected person does occur, post-exposure prophylaxis (nPEP) with a 28-day course of antiretroviral medications initiated within 72 hours of the exposure may prevent HIV transmission.† To assess the likelihood that this method of prevention would be used, a national sample of gay, bisexual and other men who have sex with men (MSM) was asked if they knew about and whether they had used nPEP.

Novel Interventions to Prevent Early Childhood Obesity: Conference Summary
On March 17, 2009, nearly 200 pediatricians, nutritionists, other providers, policy makers and funders attended the conference. Childhood obesity has become one of the defining public health challenges of our time and the severity of the epidemic is underscored by the ever younger ages at which obesity is touching the lives of children. While most obesity prevention programs have focused on school-age children, evidence is mounting that programs must target children well before age five. This conference provided an opportunity for attendees to learn about findings from new obesity prevention programs and interventions that begin in infancy or early childhood, ranging from simple video-based interventions to multi-session intensive family counseling programs. The following is a synopsis of each of the presentations.

Testing An Innovative Video Intervention To Prevent Early Childhood Obesity
Obesity, the major health problem of America's children, is now occurring among the youngest children. Public Health Solutions is currently engaged in an innovative effort to prevent childhood obesity among children under two years of age. While most childhood obesity prevention programs focus on school-age children, our study of children 2-4 years old in our WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children)* indicates that 40% of these children are already obese or at risk for obesity. Furthermore, our prior research showed that WIC clients would prefer receiving an educational video rather than written material, and that nearly all had access to a DVD player. Based on this information, Public Health Solutions began producing and distributing educational DVDs on infant feeding in a number of languages.

Comparison of Sexual Risk Behaviors in Non-Hispanic Black and White Men
As HIV behavioral risk surveys and prevention activities for men who have sex with men (MSM) move online, more information is needed about racial/ethnic differences in behavior among men responding to online surveys in order to target prevention messages. This analysis compared sexual behavior between Non-Hispanic white and Non-Hispanic black MSM participating in online surveys.

Spread the Word
Spread the Word, based at Public Health Solutions' MIC-Women's Health Services Center in Astoria, Queens, was designed specifically to address and overcome a variety of barriers that South Asian immigrant women face in receiving breast health information and care. Since its inception, the project has actively collaborated with more than 59 organizations serving South Asian communities to provide linguistically and culturally appropriate health education and services to promote early detection of breast cancer.

Infant Bedsharing among Low-Income Mothers in New York City: Prevalence, Correlates and Added Risks
Evidence of the risks and benefits of infant bedsharing is mixed and complicated. While there is some evidence that bedsharing may facilitate breastfeeding and mother-infant attachment, several studies have shown bedsharing to be hazardous to an infant due to the potential risks of wedging, overlay, suffocation, and death. Other research has shown that there are added risks of bedsharing among mothers who are overweight/obese or use alcohol or drugs. In 2005 the American Academy of Pediatrics recommended that infants not bedshare with adults or other children.

Mexicans in New York City: Addressing the Health Concerns of One of the City's Fastest Growing Hispanic Groups.
In keeping with its mission, MHRA is dedicated to improving the health status and well-being of New Yorkers, with a special emphasis on high-risk, underserved populations, including immigrants to New York City. MHRA has become one of the city's largest providers of services to immigrants, with a staff that has the language and cultural capacity to reach both longtime residents and new arrivals. This study of a specific population subgroup, Mexicans in New York City, was undertaken as an important step in serving our target populations by gaining a better understanding of their health needs.

Low Literacy Prenatal Care Education Program: Evaluation of the Pilot Phase of Baby Basics at MIC-Women's Health Services
Baby Basics* is a low literacy prenatal care education program that seeks to integrate health literacy concepts into the provision of prenatal care. In 2005-2006, a pilot Baby Basics program was introduced at the MICWomen's Health Services center in Jamaica, Queens. The goals of the evaluation were to measure: how the program was implemented at the site, how many women were reached by the program, and the impact of the Baby Basics program on patient satisfaction with and adherence to prenatal care.

Functional Health Literacy and Breast Cancer Screening among Low-Income Hispanic Women
Researchers at MHRA have collaborated with the Columbia University Breast Cancer Screening Partnership to examine the links between health literacy and breast cancer and cervical cancer screening and follow-up. The Breast Cancer Screening Partnership is a participant in the National Breast and Cervical Cancer Early Detection Program, funded by the Centers for Disease Control and Prevention (CDC), which provides no-cost mammograms for uninsured and underinsured women across the country. Many programs have emphasized the importance of encouraging women to initially seek breast and cervical cancer screening. Recognizing that mammography must be repeated on an annual basis to be an effective method of early detection, MHRA's research is examining whether functional health literacy is a key predictor of whether women receive appropriate follow-up for breast cancer screening, including returning for annual mammography.

Online Video Changes Behavior Among At-Risk Men Who Have Sex With Men (MSM)
The abundance of sexually-oriented gay websites and the absence of political, geographic and demographic boundaries online make the Internet an ideal medium for delivering an new generation of behavioral interventions with the potential to change both national norms and individual behavior at minimal cost.

Evaluating the Integration of Mental and Behavioral Risk Factor Screening In Reproductive Health Care
In response to a needs assessment of clients at our health centers, MHRA initiated routine mental and behavioral risk screening of patients seeking reproductive health care services through MIC-Women's Health Services (MIC). Before the new screening program was implemented, patients were screened for behavioral and mental health risks according to standard clinical practice defined by the American College of Obstetrics & Gynecology.

Highlights From Recent MHRA Research Publications
(1) Diet, Activity, and Overweight Among Preschool-Age Children Enrolled in MHRA's New York City Neighborhood WIC Program
(2) Conducting HIV Behavioral Research Online
(3) Using Pedometers to Promote Walking in Working Urban Women: Results of a Feasibility Study

Misuse of Erectile Dysfunction Drugs Among Men Who Have Sex With Men
HIV transmission among men who have sex with men (MSM) is increasing. Erectile dysfunction (ED) drugs (Viagra, Levitra, or Cialis) are prescribed by physicians for the treatment of ED. However, increasing reports of misuse of ED drugs among MSM indicate that it is associated with other drug use (i.e., crystal methamphetamine) and risky sexual behavior. No study to date has examined the role of ED drug use in a recent sexual encounter.

Sexual Behavior and Sexual Risk Among Persons Living with HIV/AIDS in NYC
HIV are living longer, healthier lives, Prevention for Positives, initiated by the Centers for Disease Control and Prevention (CDC), has been informing HIV prevention programs in recent years. In response, increasing attention has been paid to the importance of understanding sexual behaviors among persons living with HIV that put others at risk for HIV infection and themselves at risk for infection with other sexually transmitted diseases. This analysis includes a representative sample of 968 adults who were interviewed every 6-12 months between 1994 and 2002 and describes patterns over time of sexual behavior among persons living with HIV/AIDS in New York City.

The HealthConnect Evaluation: Measuring the Impact of an Enhanced Insurance Enrollment Project
The goal of HealthConnect -- a pilot project conducted by MHRA -- was to help women enrolled in public health insurance programs optimize their own and their children's use of preventive health care. This time-limited, low-intensity intervention included periodic dissemination of tailored educational materials through the mail (e.g., about diabetes prevention) and supportive phone calls (e.g., answering questions about insurance coverage for preventive care) over a period of 30 weeks. A rigorous evaluation compared a Control Group receiving standard facilitated enrollment services to an Intervention Group receiving the enhanced services.

Characteristics of Obstetrical Services in New York City Hospitals
Racial disparities in perinatal outcomes persist in New York City; infant mortality rates, for example, are highest in neighborhoods with large black populations. While previous research has examined associations between race and biologic and social factors related to poor maternal and infant outcomes, the relationship between race and systems factors has not been scrutinized. This study sought to describe the structure of obstetrical (OB) services at the 44 New York City hospitals with OB departments and the relationship of those services to the racial composition of the hospital's neighborhood and of the women delivering at the hospital.

Home Environmental Factors Associated with Overweight in Very Young Children: Non-Juice Fruit Drinks and Television
Childhood obesity is fast becoming a defining public health problem in the United States. Nationally, more than 20% of preschool-aged children are overweight or at risk of overweight, putting them at risk for a lifetime of health problems such as type 2 diabetes and cardiovascular disease. Research has pointed to numerous factors that may contribute to the epidemic; however, prevention efforts have met with limited success to date.

Crystal Methamphetamine Use Among Men Who Have Sex With
Crystal methamphetamine (crystal) use among men who have sex with men (MSM) has been on the rise, and its relationship to high-risk sexual behavior, and consequently HIV risk, has received recent research and media attention. With an increase since 1999 in the number of newly diagnosed HIV infections among MSM, a better understanding of crystal and other drug use in connection with high-risk behavior is needed. MHRA, in collaboration with Columbia University and the Centers for Disease Control and Prevention, conducted two national Internet-based surveys of high-risk sexual behavior among MSM. Data from these surveys were analyzed to better understand the relationship between substance use and unprotected anal intercourse (UAI).

Family Planning Decision Making in Immigrant Populations in New York City
New York City has always been a city of immigrants and, in recent years, the immigrant population has been increasing in number and diversity. Over 50% of 2001 births in New York City were to foreign-born mothers and 2000 census data show that 36% of the city's residents were foreign-born, up from 28% in 1990. These new residents are arriving from points all over the globe, and they are bringing with them a vast array of languages and cultures. These trends are evident at MIC-Women's Health Services (MIC), a division of MHRA that operates eight reproductive health centers around the city. MIC provides family planning, prenatal, and medical abortion services to over 25,000 women each year, 70% of whom are foreign-born.

Regional Variation in the Use of Highly Active Anitretroviral Therapy
In many states, public formularies provide access to antiretroviral medications for HIV-positive patients, regardless of their ability to pay or social circum-stances. Analyzing geographic and demographic variation in highly active antiretroviral therapy (HAART) usage is therefore vitally important in monitoring access and estimating population-level use rates, as well as identifying disparities among subgroups or populations. Data are presented on patterns of HAART use for New York City and the surrounding suburban Tri-County region of Westchester, Rockland and Putnam counties.

Health Literacy, Cervical Cancer Screening, and Access to Care among Immigrant Latina Women in New York City
Health literacy is a critical barrier to effective cervical cancer screening for immigrant Latina populations. Women with low health literacy have difficulty under-standing and interpreting medical materials, including guidelines for screening, appointment notifications, and referrals for follow-up.

Prepregnancy Obesity, Prenatal Weight Gain, and Adverse Perinatal Outcomes in New York City
In women of childbearing age, overweight and obesity have particular adverse effects, including greater risk of infertility, maternal morbidity, complications of labor and delivery, neural tube defects and perinatal mortality. Among pregnant women, increases in weight have been associated with gestational diabetes, preeclampsia, eclampsia, cesarean delivery, and macrosomia. This study examined the effect of prepregnancy obesity and the added effect of excessive prenatal weight gain on adverse outcomes among obese women.

The Internet and High-risk Sex Among Men Who Have Sex With Men
As HIV transmission resurges among men who have sex with men (MSM), efficient methods of reaching large numbers of high-risk men must be identified and new prevention messages developed. The Internet may be an important venue for these activities.

Mental Health Status of Low-Income Women in Childbearing Years
Prevalence of Depression and Anxiety Symptoms Cause Concern

Recent Breast Cancer Screening Research At MHRA

Childhood Obesity in a New York City WIC Population

The "Epidemiologic Paradox": Birth Outcomes Among Latinas in New York City

Pathways To Uninsurance: Where You Start Out Is Where You End Up

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