Health Benefits from Upgrading Public Buses for Cleaner Air: A Case Study of Clark County, Nevada and the United States

Public transit buses, which move more than 5 billion passengers annually in the United States (U.S.), can contribute substantially to the environmental health burden through emitted air pollutants. As a leader in transforming to cleaner bus fleets, the Regional Transport Commission of Southern Nevada (RTC) has been transitioning from diesel to compressed natural gas (CNG) transit buses since 1999. By 2017, ~75% of RTC’s buses operating in Clark County, Nevada were CNG-powered. This study assesses the health benefits of the venture using the US Environmental Protection Agency’s (EPA) Co-Benefits Risk Assessment (COBRA) model, considering the emission and exposure changes from the 2017 baseline for two hypothetical scenarios: (1) no transition (CC_D) and (2) complete transition (CC_N). The CC_D scenario shows realized health benefits, mostly due to avoided mortality, of 0.79⁻8.21 million per year for 2017 alone, while CC_N suggests an additional 0.88⁻2.24 million annually that could be achieved by completing the transition. The wide range of estimates partly reflects uncertainties in determining diesel bus emissions under business-as-usual. These health benefits were not limited locally, with ~70% going to other counties. Two national-scale scenarios, US_D and US_N, were also constructed to explore the health impact of transitioning from diesel to CNG buses across the U.S. As of 2017, with CNG powering only ~20% of transit bus mileages nationwide, there could be massive unrealized health benefits of $0.98⁻2.48 billion per year including 114⁻258 avoided premature deaths and >5000 avoided respiratory and cardiovascular illnesses. Taking into account the health benefits, economic costs, and the inter-state nature of air pollution, expanding federal assistances to accelerate a nationwide transition to cleaner bus fleets is highly recommended

The Use of Social Marketing Campaigns to Increase HIV Testing Uptake: A Systematic Review

Social marketing campaigns have been increasingly used in HIV prevention efforts to address barriers to HIV testing. The purpose of this review is to evaluate the social marketing campaigns in the past ten years (2008–2017) that have targeted HIV testing or intent to test as an outcome, and synthesize the results to determine which campaigns work or do not work. The search was conducted using PubMed, Scopus, PsycINFO, EMBASE, and ABI/Inform. The quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project was used to assess study quality. The search generated 373 articles, of which 13 articles met the inclusion criteria. These articles were from 13 distinct campaigns carried out in 9 countries, twelve of which were in high income countries. Sixty-nine percent (n = 9) of the campaigns targeted MSM, gay men, or MSMW, 23% (n = 3) targeted the general population, while 8% (n = 1) focused on African-American women. The study designs for evaluating the campaigns were predominantly cross-sectional, with 4 of the articles combining two or three study designs to evaluate their campaign. Overall, 38% (n = 5) of the campaigns had an increase in HIV testing outcomes, 23% (n = 3) reported no change in HIV testing outcomes, and the remaining 38% (n = 5) of the studies reported mixed outcomes. The results of the quality rating showed that 69% (n = 9) of the papers had weak global ratings, while 31% (n = 4) had moderate rating. None of the articles had a strong rating. This review displayed that social marketing campaigns intended to increase HIV testing uptake were effective in some context. Social marketing practitioners will need to come up with a standardized way of communicating the results of campaign exposure and impact so as to enhance comparison among the multitude of campaigns

Health Benefits from Upgrading Public Buses for Cleaner Air: A Case Study of Clark County, Nevada and the United States

Public transit buses, which move more than 5 billion passengers annually in the United States (U.S.), can contribute substantially to the environmental health burden through emitted air pollutants. As a leader in transforming to cleaner bus fleets, the Regional Transport Commission of Southern Nevada (RTC) has been transitioning from diesel to compressed natural gas (CNG) transit buses since 1999. By 2017, ~75% of RTC’s buses operating in Clark County, Nevada were CNG-powered. This study assesses the health benefits of the venture using the US Environmental Protection Agency’s (EPA) Co-Benefits Risk Assessment (COBRA) model, considering the emission and exposure changes from the 2017 baseline for two hypothetical scenarios: (1) no transition (CC_D) and (2) complete transition (CC_N). The CC_D scenario shows realized health benefits, mostly due to avoided mortality, of $0.79–8.21 million per year for 2017 alone, while CC_N suggests an additional$0.88–2.24 million annually that could be achieved by completing the transition. The wide range of estimates partly reflects uncertainties in determining diesel bus emissions under business-as-usual. These health benefits were not limited locally, with ~70% going to other counties. Two national-scale scenarios, US_D and US_N, were also constructed to explore the health impact of transitioning from diesel to CNG buses across the U.S. As of 2017, with CNG powering only ~20% of transit bus mileages nationwide, there could be massive unrealized health benefits of $0.98–2.48 billion per year including 114–258 avoided premature deaths and \u3e5000 avoided respiratory and cardiovascular illnesses. Taking into account the health benefits, economic costs, and the inter-state nature of air pollution, expanding federal assistances to accelerate a nationwide transition to cleaner bus fleets is highly recommended

Changes in Body Mass Index Among People Living with HIV Who are New on Highly Active Antiretroviral Therapy: A Systematic Review and Meta-Analysis

In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I2 = 85%; p \u3c .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and \u3e1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6–12 months on treatment, with minor gains in the second and subsequent years of treatment

Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa's most populous country

Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa\u27s most populous country