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Concept: Confederate States of America


Confirmed local transmission of Zika Virus (ZIKV) in Texas and Florida have heightened the need for early and accurate indicators of self-sustaining transmission in high risk areas across the southern United States. Given ZIKV’s low reporting rates and the geographic variability in suitable conditions, a cluster of reported cases may reflect diverse scenarios, ranging from independent introductions to a self-sustaining local epidemic.

Concepts: United States, U.S. state, Florida, Native Americans in the United States, Southern United States, Texas, American Civil War, Confederate States of America


Smoke-free air laws in restaurants and bars protect patrons and workers from involuntary exposure to secondhand smoke, but owners often express concern that such laws will harm their businesses. The primary objective of this study was to estimate the association between local smoke-free air laws and economic outcomes in restaurants and bars in 8 states without statewide smoke-free air laws: Alabama, Indiana, Kentucky, Mississippi, Missouri, South Carolina, Texas, and West Virginia. A secondary objective was to examine the economic impact of a 2010 statewide smoke-free restaurant and bar law in North Carolina.

Concepts: U.S. state, Native Americans in the United States, Southern United States, American Civil War, Confederate States of America, Tennessee, Oak Ridge Associated Universities, States of the United States


Aim: To address high rates of inactivity and related chronic diseases among African-American women. Materials & methods: Eleven focus groups on physical activity barriers for African-American women in the deep south (USA) were conducted (n = 56). Feedback guided an intervention development process. The resulting Home-Based Individually Tailored Physical Activity Print intervention was vetted with the target population in a 1-month, single arm, pre-post test demonstration trial (n = 10). Results: Retention was high (90%). Intent-to-treat analyses indicated increases in motivational readiness for physical activity (70% of sample) and physical activity (7-day Physical Activity Recall) from baseline (mean: 89.5 min/week, standard deviation: 61.17) to 1 month (mean: 155 min/week, standard deviation: 100.86). Small improvements in fitness (6-Min Walk Test), weight and psychosocial process measures were also found. Conclusion: Preliminary findings show promise and call for future randomized controlled trials with larger samples to determine efficacy. Such low-cost, high-reach approaches to promoting physical activity have great potential for addressing health disparities and benefiting public health.

Concepts: Health care, Epidemiology, Statistics, Randomized controlled trial, Standard deviation, Southern United States, American Civil War, Confederate States of America


There is a concerted push for adopting a minimalist strategy with emphasis on early hospital discharge for patients undergoing Transcatheter aortic valve implantation (TAVI). However, studies on discharge patterns and predictors of early discharge (≤3 days post-TAVI) are sparse, in the United States.

Concepts: Hospital, United States, Poverty in the United States, U.S. state, Republic, Aortic valve, American Civil War, Confederate States of America


North Carolina’s Smart Start and More at Four (MAF) early childhood programs were evaluated through the end of elementary school (age 11) by estimating the impact of state funding allocations to programs in each of 100 counties across 13 consecutive years on outcomes for all children in each county-year group (n = 1,004,571; 49% female; 61% non-Latinx White, 30% African American, 4% Latinx, 5% other). Student-level regression models with county and year fixed effects indicated significant positive impacts of each program on reading and math test scores and reductions in special education and grade retention in each grade. Effect sizes grew or held steady across years. Positive effects held for both high- and low-poverty families, suggesting spillover of effects to nonparticipating peers.

Concepts: Mathematics, Education, Southern United States, American Civil War, English American, Democratic Party, Confederate States of America, South Carolina


Approximately 8,500 vape shops in the United States sell a variety of electronic nicotine delivery systems (ENDS). This study examined vape shop operators' perceptions of benefits and risk of ENDS use, what they perceive to be the reasons for ENDS use, their source of product information, what information they shared with customers, and the impact of existing and future regulation of ENDS on its use and on their business.

Concepts: United States, U.S. state, North Carolina, Southern United States, American Civil War, Georgia, Confederate States of America, Tennessee


The prevalence of nephrolithiasis in the United States has increased substantially, but recent changes in incidence with respect to age, sex, and race are not well characterized. This study examined temporal trends in the annual incidence and cumulative risk of nephrolithiasis among children and adults living in South Carolina over a 16-year period.

Concepts: United States, U.S. state, North Carolina, Maryland, Southern United States, American Civil War, Confederate States of America, Tennessee


Unregulated commercial harvest remains a major threat for turtles across the globe. Due to continuing demand from Asian markets, a significant number of turtles are exported from the United States of America (US). Beginning in 2007, several southeastern states in the US implemented restrictions on the commercial harvest of turtles, in order to address the unsustainable take. We have summarized freshwater turtle exports from the US between 2002 and 2012 and demonstrated that the magnitude of turtle exports from the US remained high although the exports decreased throughout the decade. Louisiana and California were the major exporters. The majority of exports were captive bred, and from two genera, Pseudemys and Trachemys. We review the changes over the decade and speculate that the increase in export of wild turtles out of Louisiana after 2007 could be a consequence of strict regulations in surrounding states (e.g., Alabama, Florida). We suggest that if wild turtle protection is a goal for conservation efforts, then these states should work together to develop comprehensive regulation reforms pertaining to the harvest of wild turtles.

Concepts: United States, U.S. state, Southern United States, Asian American, Humid subtropical climate, Los Angeles, Plurality voting system, Confederate States of America


The United States has never experienced a sea change in national health policy like that which occurred in early 2017.

Concepts: Universal health care, United States, U.S. state, Republic, Massachusetts, American Civil War, Great Lakes, Confederate States of America


Until the 1930s, malaria was endemic throughout large swaths of the American South. We used a Poisson mixture model to analyze the decline of malaria at the county level in Alabama (an archetypical Deep South cotton state) during the 1930s. Employing a novel data set, we argue that, contrary to a leading theory, the decline of malaria in the American South was not caused by population movement away from malarial areas or the decline of Southern tenant farming. We elaborate and provide evidence for an alternate explanation that emphasizes the role of targeted New Deal-era public health interventions and the development of local-level public health infrastructure. We show that, rather than disappearing as a consequence of social change or economic improvements, malaria was eliminated in the Southern United States in the face of economic dislocation and widespread and deep-seated poverty. (Am J Public Health. Published online ahead of print June 13, 2013: e1-e13. doi:10.2105/AJPH.2012.301065).

Concepts: Malaria, United States, Florida, Southern United States, Texas, American Civil War, Confederate States of America, Tennessee