Baltimore City Health Department

Asthma is the most common pediatric chronic disease, affecting about 5 million U.S. children. Controlling asthma requires intervention at the individual, household, and community levels. State asthma programs offer activities to support asthma control. We profiled U.S. state asthma programs through a website survey (24 CDC-funded, 10 non-CDC-funded) and then interviewed program managers about their information needs to identify ways to support their work. While CDC-funded and non-CDC-funded programs report similar goals and activities, their levels of engagement differed. Most programs rely on federal agencies or national associations for education materials. Concerns about materials were the lack of accessibility due to readability (reading level above sixth grade) and the lack of translations for culturally and linguistically diverse populations. In addition to priority needs around accessibility of materials, programs requested research to enhance their work and to support asthma management for young adults and incarcerated individuals.

ABSTRACT Introduction Tobacco and nicotine use are prevalent in residential substance use disorder (SUD) treatment programs that serve pregnant and parenting women. This study evaluated a group intervention that integrates knitting instruction, psychoeducation, and social support to improve readiness to quit and reduce tobacco and nicotine use among this population. Methods Clients and staff in four residential SUD treatment programs were assigned to a six-week group intervention or a wait-list control group. Intervention implementation and preliminary effectiveness were assessed using surveys, interviews, and observational measures. Results From pre- to post-test, knowledge related to tobacco and nicotine use increased and number of cigarettes smoked per day and nicotine dependence decreased, on average. Additionally, the intervention group reported lower levels of nicotine dependence relative to the control group. Participants described knitting as an enjoyable replacement for smoking and a strategy to regulate stress and emotions. Conclusions Smoking cessation interventions that include knitting are promising and warrant further testing.

Background: Suboptimal sleep is a risk factor for hypertension (HTN) and is one of the eight risk factors for cardiovascular disease (CVD). However, the association between sleep disturbances and HTN is unclear. Objective: To examine the relationship between sleep disturbances and HTN among adults in the U.S. We hypothesized that higher sleep disturbance scores are associated with HTN. Methods: We used a cross-sectional design to examine the 2013-2018 National Health Interview Survey. We computed a sleep disturbance score, composite of five components of suboptimal sleep; sleep duration, trouble falling asleep, staying asleep, sleep medication use, and restful. The sleep disturbance score ranges from 0-10 high scores reflect worse sleep disturbance and were categorized into quartiles. Survey-weighted multinomial logistic regression models were fitted, adjusting for covariates. Results: A total of 190,217 participants were included; 31% had HTN, mean age was 47.2 (±0.09 SE) years, and 49% were male. Mean sleep disturbance score was 2.7; mild sleep disturbance was observed in 21%, moderate in 33%, severe in 13%, and very severe in 33%. In the fully adjusted model, the odds of moderate (adjusted odds ratio (aOR): 1.30; 95% Confidence Intervals, 95%CI: [1.15,1.47]) and severe sleep disturbances (aOR: 1.42; [1.30,1.56]) were 30% and 42%, respectively, higher in persons with HTN compared to those without HTN (Table). Conclusion: Adults with self-reported HTN are more likely to have higher sleep disturbances, hence, HTN may play a larger role in sleep outcomes. When screening for HTN, it is also important to screen for sleep patterns that may have an adverse effect on health outcomes.

From 2015 to 2020, the THRIVE project supported 7 US health departments to improve HIV prevention services for Black or African American (Black) and Hispanic or Latino gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). We described services provided in the THRIVE PrEP continuum. Using Poisson regression models, we estimated associations between race or ethnicity and age and PrEP screening, linkage, and prescription. We examined associations between colocation of services and PrEP linkage and prescription for 2 sites. THRIVE served 12,972 GBM without HIV; 37% of PrEP-eligible GBM were prescribed PrEP. THRIVE served 1185 TGW without HIV; 45% of PrEP-eligible TGW were prescribed PrEP. Black and Hispanic or Latino GBM were 29% (RR = 0.71, 95% CI: 0.66-0.77) and 19% (RR = 0.81, 95% CI: 0.75-0.87) less likely, respectively, to be prescribed PrEP than White GBM. GBM aged 18-24 years and 55 years or older were 19% (RR = 0.81, 95% CI: 0.75-0.87) and 22% (RR = 0.78, 95% CI: 0.67-0.9) less likely, respectively, to be prescribed PrEP compared with those aged 35-44 years. Colocated services were associated with a 54% (RR = 1.54, 95% CI: 1.44-1.64) and a 31% (RR = 1.31, 95% CI: 1.19-1.43) greater likelihood of PrEP linkage and prescription, respectively, compared with services at different locations. THRIVE provided PrEP to higher proportions of PrEP-eligible persons than current national estimates; however, PrEP use disparities persist. Colocation of services may be a useful component of jurisdictional strategies to increase PrEP coverage.

Background Centers for Disease Control and Prevention recommendation for treatment of uncomplicated gonorrhea (NG) were revised in December 2020 and include ceftriaxone monotherapy when chlamydial infection was excluded. We evaluated the impact of these revised treatment recommendations using data from a network of sexually transmitted disease (STD) clinics before the change in guidelines. Methods We performed a cross-sectional analysis from 8 STD clinics participating in the STD Surveillance Network from January 2015 to June 2018 assessing NG/chlamydia (CT) testing episodes, nucleic acid amplification test results, CT only and NG/CT treatment records, and timing of treatment. We describe the frequency of NG and CT treatment practices and what proportion of patients treated would not have had to receive an antichlamydial agent. Results Of 190,589 episodes that occurred during the study period, 67,895 (35.6%) episodes were associated with a treatment record consistent with NG or chlamydia (CT only [n = 37,530] or NG/CT [n = 30,365]), most (~86%) were prescribed on the same-day as initial testing. Of the 67,895 episodes with corresponding treatment record(s), 42.1% were positive for either NG or CT compared with 3.7% were positive for NG or CT for those not associated with treatment records (n = 122,694 episodes). Among 30,365 episodes associated with NG/CT treatment records, monotherapy would only have been indicated for 10.1% (3081/30,365) of the episodes as they were treated on follow-up and were NG positive and CT negative. Conclusions Treatment was prescribed in one-third of NG/CT testing episodes, with the majority provided same day. Despite changes in NG treatment guidelines to ceftriaxone monotherapy, majority of patients would continue to receive an antichlamydia agent when treated for NG in these settings.

The City of Baltimore owns and operates the 108-in. Susquehanna Raw Water Main, which runs parallel to Interstate I-95 for much of its length. With construction of four new express toll lanes on the interstate beginning in 2019, Baltimore City Department of Public Works (DPW) needed to find a way to protect the prestressed concrete cylinder pipe (PCCP) water main and ensure that construction activities would not result in wire breaks. After developing new specifications for the transportation authority to ensure that their contractors would be engaged with the monitoring of the buried asset, the city partnered with Xylem Assessment Services to develop a custom-built solution that utilizes acoustic monitoring technology at five construction sites, with no wire breaks from construction activity yet detected. This paper reviews PCCP and its failure modes, the City of Baltimore and Xylem Assessment Services' approach to managing the city's PCCP, the specific concerns arising from the heavy construction conducted by others, and the development of the monitoring solution.