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CHAIN
The CHAIN Study

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The Community Health Advisory & Information Network (CHAIN) is an ongoing prospective study of representative samples of persons living with HIV/AIDS in New York City and the Tri-County region of Westchester, Rockland and Putnam Counties. CHAIN is conducted by researchers from Mailman School of Public Health at Columbia University in collaboration with the New York City Department of Health and Mental Hygiene, Public Health Solutions, Inc. and the Westchester County Department of Health as part of evaluation activities of the New York Health and Human Services Planning Council. Its mission is to supply systematic data from the perspective of persons living with HIV about their needs for health and human services, their encounters with the full continuum of HIV services, and their physical, mental and social wellbeing.

Since its initiation in 1994, CHAIN has fielded three separate cohorts of persons living with HIV/AIDS. The first cohort was recruited between1994 and 1995 and remained active through 2001. A second NYC cohort was initiated in 2002 and remains active. Starting in 2001, CHAIN was extended to the Tri-County region. For all three cohorts, a two-stage sampling method was followed to recruit cohorts that would be representative of HIV positive adults (age 20+ years) who were aware of their HIV positive status. For the first stage, a large number of medical and social services known to have HIV case loads of 20 or more were invited to participate as recruitment sites. HIV positive clients were then recruited either through random selection from a client list prepared by agency staff or through onsite, sequential enrollment. For the 1994 NYC cohort, 648 HIV positive individuals were initially recruited from 43 of 52 sampled agencies. An additional 52 HIV positive individuals unconnected to medical care and case management services at the time of the interview were also recruited to supplement the agency-based sampling strategy. These "unconnected" individuals were contacted at outreach sites and through acquaintance sampling from among enrolled CHAIN participants. During 1998 an additional 286 HIV positive individuals were recruited from 22 of the 1994 recruitment sites. Baseline and up to seven follow-up interviews were completed with the members of this cohorts.

Following the same methodology used for the original CHAIN cohort, a new NYC CHAIN cohort was recruited between July 2002 and December 2003. A total of 684 HIV positive individuals were recruited from 36 agencies, along with nine persons living with HIV unconnected to care. During 2008 and 2009 we recruited an additional 319 HIV positive individuals. A baseline and six follow-up rounds of interviews have been completed with the 2002 NYC cohort. A seventh round of follow-up interviews was initiated in May 2013 and is scheduled for completing by the end of 2014.

A similar methodology was followed to recruit a Tri-County CHAIN cohort of 398 adults from 22 agencies during 2001 and 84 additional members between 2004 and 2006. Four rounds of interviews were completed by 2007. Starting in 2008 a repeated cross sectional design was instituted, in which unduplicated study participants are recruited over successive two-year cycles. Eighteen Tri-County agencies participate as recruitment sites. In this new procedure 125 to 150 HIV positive Tri-County residents are interviewed each year. Two two-year interview cycles have been completed. A third cycle was initiated during the winter of 2012 and is scheduled for completion during the winter of 2014. Although the current Tri-County sample is not longitudinal, a small number of individuals interviewed in one cycle are by chance re-interviewed in subsequent cycles.

Aside from death, sample attrition in the CHAIN cohorts has remained at low levels. Among CHAIN participants alive and still living in NYC, survey completion rates have remained in excess of 80 % and exceeded 90 percent for some rounds of individuals. Individuals lost to follow-up over the course of study showed few differences when compared with those who continued to participate.

CHAIN interviews, take approximately two hours to complete, and are conducted in person by trained community interviewers who were matched to respondents as much as possible with regard to gender and race/ethnicity. Approximately 10% of interviews are conducted in Spanish. Major interview topic areas include: (1) need for health and social services, (2) access, utilization and satisfaction with health and social services; (3) socio-demographic characteristics; (4) housing and other aspects of living situation; (5) sex and drug risk behaviors; (6) informal caregiving from friends, family and volunteers; and (7) their quality of life with respect to health status and psychological and social functioning. A number of items have been added over the years related to antiretroviral therapies, specific medical care services, care coordination, use of internet and social media and other topics of interest to policymakers, planners, providers, and members of the HIV Planning Council and its committees.

Each year CHAIN researchers produce a series of reports for the HIV Planning Council responding to the questions, interests, and priorities of the Council and its committees, the NYC Department of Health and Mental Hygiene (DOHMH), the Tri County Ryan White Part A Steering Committee and consumer communities. To date, close to 200 reports have been written examining a range of topics with focus on unmet health and social service needs, trends in service utilization and various outcomes among the CHAIN cohort. All CHAIN reports are available at no cost and widely distributed.

A Technical Review Team (TRT) provides oversight for the CHAIN Project in New York City and in the Tri-County. In addition to the research team from Columbia University's Mailman School of Public Health, TRT consists of representatives of NYC DOHMH, Public Health Solutions, and Westchester County Department of Health.

Since its inception the CHAIN project has been supported by the HIV Health and Human Services Planning Council of New York under a Part A (formerly Title I) grant from the Ryan White HIV Treatment Extension (formerly CARE) Act to the New York City Department of Health and Mental Hygiene. In addition to the work done on behalf of the Planning Council, CHAIN researchers have conducted special studies funded by the Ryan White SPNS program of the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, the Centers for Disease Control and Prevention, and most recently the MAC AIDS Foundation.

Below is a complete list of CHAIN documents since the study's inception in 1994. Reports that are electronically available are underlined with link to a pdf version of the document. Senior CHAIN investigators are available to present results from CHAIN studies to interested professional and community groups. For more information about Columbia University's Center for Applied Public Health, which produces the CHAIN reports, click here.

TECHNICAL REPORTS
Tech #1 8/31/94 SAMPLE DESIGN FOR STAFFING NEEDS AND CLIENT SURVEY STUDIES
Tech #2 7/5/94 SURVEY OF PERSONNEL NEEDS OF HIV/AIDS AGENCIES: RECRUITMENT & RETENTION DIFFICULTIES AND PERSONNEL INCENTIVE PROGRAMS
Tech #3 9/27/95 TRAINING FOR HIV/AIDS SERVICE AGENCIES
Tech #4 3/1/95 SUMMARY TABLES FOR CLIENT SURVEY - THE FIRST 100 CASES
Tech #5 8/2/95 A TRI-COUNTY SURVEY OF THE PERSONNEL NEEDS OF HIV/AIDS SERVICE AGENCIES
Tech #6 8/2/95 THE PERSONNEL NEEDS STUDY PART II: DELIVERY
Tech #7R 12/14/95 SUMMARY TABLES FOR BASELINE CLIENT SURVEY
Tech #8 10/20/95 THE ADOLESCENT HIV STUDY: NEEDS, UTILIZATION AND BARRIERS FOR MEDICAL CARE, SOCIAL SERVICES AND PREVENTION EDUCATION
Tech #9 11/17/95 THE "UNCONNECTED" - SERVICE NEEDS OF HIV POSITIVE PERSONS WHO ARE OUTSIDE OR MARGINAL TO THE SERVICE DELIVERY SYSTEM
Tech #10 5/10/96 HOUSING & HIV/AIDS IN NEW YORK CITY
Tech #11 5/12/96 HIV CASE MANAGEMENT SERVICES IN NYC: QUALITY AND OUTCOMES
Tech #12 5/22/96 SUBSTANCE USE & HIV AIDS IN NEW YORK CITY
Tech #13 6/3/96 THE INFRASTRUCTURE WORK GROUP REPORT
Tech #14 6/10/96 HIV HEALTH CARE SERVICES IN NEW YORK CITY: UTILIZATION AND QUALITY
Tech #15 (136Kb) 6/16/96 ACCESSING MEDICAL AND SOCIAL SERVICES: BARRIERS AND STRATEGIES FOR IMPROVING HIV CARE INFRASTRUCTURE
Tech #16 6/18/96 NEED FOR MENTAL HEALTH SERVICES AND SERVICE UTILIZATION IN NEW YORK CITY
Tech #17 10/4/96 SUMMARY TABLES TIME 2 CLIENT SURVEY
Tech #18 04/24/00 CLIENT OUTCOMES RAPID RESPONSE REPORTS
 
RAPID RESPONSE REPORTS
Rap Resp#2 4/21/97 ECONOMIC SECURITY & INCOME CHARACTERISTICS OF THE BASELINE SAMPLE
Rap Resp#3 4/14/00 HIGH RISK BEHAVIORS: UNPROTECTED SEX & NEEDLE
 
BRIEFING PAPER
Briefing Paper#1 04/29/99 THE UNCONNECTED REVISITED: A CHAIN BRIEFING PAPER UPDATE REPORTS
 
UPDATE REPORTS
Update Rep#1 04/21/97 THE INTRODUCTION OF COMBINATION THERAPIES
Update Rep#2 04/21/97 MIGRATION TO SERVICES
Update Rep#3 04/28/97 FAMILY CONSTELLATIONS AND NEED FOR SOCIAL SERVICES
Update Rep#4 04/24/97 MANAGED CARE AND HEALTH SERVICES FOR PEOPLE LIVING WITH HIV
Update Rep#5 05/30/97 CONTINUITY AND CHANGE IN HOUSING PROBLEMS & NEED FOR HOUSING SERVICES
Update Rep#6 05/09/97 ACCESS TO PRIMARY AND CHANGE IN HEALTH PROBLEMS & NEED FOR HOUSING SERVICES
Update Rep#7 05/30/97 MATCHING CLIENT NEEDS AND INTENSITY OF CASE MANAGEMENT: A METHODOLOGY FOR PLANNING AND EVALUATION
Update Rep#8 06/17/97 SUBSTANCE USE AND NEED FOR ALCOHOL & DRUG SERVICES
Update Rep#9 12/97 NEED FOR MENTAL HEALTH SERVICES AND SERVICE UTILIZATION
Update Rep#11 03/4/98 UNDERSTANDING MIGRATION TO SERVICES
Update Rep#12 04/15/98 TRENDS IN USE OF HIV ANTIRETROVIRAL THERAPY
Update Rep#13 04/24/98 SATISFACTION AND DISSATISFACTION WITH MEDICAL AND SOCIAL SERVICES
Update Rep#14 04/27/98 INDIVIDUAL INITIATION AND CESSATION OF ANTIRETOVIRAL THERAPY
Update Rep#15 02/18/98 TRENDS IN MANAGED CARE PLANS AND PEOPLE LIVING WITH HIV
Update Rep#16 05/1/98 TOP CLIENT IDENTIFIED UNMET NEEDS FOR MEDICAL AN SOCIAL SERVICES
Update Rep#18 04/12/99 COHORT COMPARISON: ASSESSING CHANGES & TRENDS BETWEEN THE 1994 AND1998 CHAIN COHORTS
Update Rep#19 05/03/99 TRENDS IN CURRENT USE OF HIV ANTIRETROVIRAL THERAPY-1998
Update Rep#20 05/19/99 PATTERNS OF ADHERENCE TO ANTIRETROVIRAL MEDICATION
Update Rep#21 05/12/99 TRENDS IN HEALTH STATUS
Update Rep#22 05/18/99 NEEDS ASSESSMENT FOR WORK-RELATED SERVICES AMONG PERSONS LIVING WITH HIV/AIDS
Update Rep#23 05/1/00 PATTERNS OF ADHERENCE TO ANTIRETROVIRAL MEDICATIONS, 1995-1999
Update Rep#24 (239Kb) 04/27/00 COMORBID CONDITIONS: INTERSECTING NEEDS AMONG THE CHAIN COHORT
Update Rep#25 04/27/00 FACTORS INFLUENCING INTEREST IN EMPLOYMENT AMONG PERSONS LIVING WITH HIV
Update Rep#26 04/28/00 DECLINING MORTALITY RATES AND SERVICE INTERVENTIONS
Update Rep#27 04/27/00 COMPLEMENTARY AND ALTERNATIVE MEDICINE: RATES OF UTILIZATION AMONG THE CHAIN COHORT
Update Rep#28 04/21/00 WOMEN'S NEED FOR AND UTILIZATION OF SERVICES BY FAMILY TYPES
Update Rep#29 06/2000 MENTAL HEALTH SERVICES & TREATMENT NEEDS
Update Rep#30 (258Kb) 04/12/00 THE IMPACT OF ANCILLARY SERVICES ON ENTRY & RETENTION TO HIV MEDICAL CARE IN NEW YORK CITY
Update Rep#32 (386Kb) 04/17/00 HOUSING ASSISTANCE AND HOUSING STABILITY AMONG PERSONS LIVING WITH HIV/ AIDS
Update Rep#33 03/28/01 DENTAL SERVICES FOR HIV+INDIVIDUALS IN NYC'S CHAIN COHORT
Update Rep#34 (184Kb) 08/16/01 MEDICATION ADHERENCE AND PATIENT OUTCOMES
Update Rep#35 (194Kb) 05/23/01 ASSESSING THE IMPACT OF RYAN WHITE CARE ACTON ON HEALTH OUTCOMES N NYC: EXECUTIVE SUMMARY
Update Rep#35a (228Kb) 05/23/01 RYAN WHITE IMPACT TECHNICAL TABLES
Update Rep#36 (171Kb) 07/25/01 PATHWAYS TO MEDICAL CARE
Update Rep#37 (206Kb) 07/25/01 HOUSING AND MEDICAL CARE AMONG PERSONS LIVING WITH AIDS
Update Rep#38 (175Kb) 07/31/01 ANCILLARY SERVICES AND ADHERENCE
Update Rep#39 (507Kb) 07/24/01 TRENDS IN HEALTH STATUS, UPDATED
Update Rep#40 (397Kb) 12/01 PATHWAYS TO MENTAL HEALTH SERVICES
Update Rep#41 (253Kb) 11/13/01 HOUSING STATUS AND HEALTH OUTCOMES AMONG PERSONS LIVING WITH HIV/AIDS
Update Rep#42 (2.11Mb) 12/12/01 GEOGRAPHIC DISPLAY OF THE CHAIN COHORT AND SERVICE UTILIZATION
Update Rep#43 (258Kb) 12/19/02 LOW THRESHOLD AOD PROGRAMS
Update Rep#44 (416Kb) 12/19/02 LATINOS IN THE CHAIN COHORT
Update Rep#45 (323Kb) 02/19/03 PATTERNS OF SEXUAL BEHAVIORS AND SEXUAL RISK AMONG HIV POSITIVE PEOPLE IN NEW YORK CITY
Update Rep#46 (146Kb) 07/25/02 CHRONIC DISEASES AND CLINICAL COMORBIDITIES
Update Rep#47 (400Kb) 01/15/03 CHAIN RETROSPECTIVE: 1994-2002

Retrospective: Unmet Need (50.6Kb)

 
BRIEF COMMUNICATIONS
2002-1 (345Kb) 07/24/02 TRAUMA & VIOLENCE
2002-3 (292Kb) 08/10/02 FOOD & NUTRITION
 
MEMOS
2002-1 (345Kb) 07/25/02 PATTERNS OF MEDICAL CARE AND SUBSTANCE USE PROVIDERS
2002-2 (84.8Kb) 07/25/02 PARTNER NOTIFICATION
2002-3 (191Kb) 07/25/02 MEDICAL CARE VISITS
2002-4 (118Kb) 11/20/02 PEOPLE OVER 50 YEARS OLD WITH HIV/AIDS
2005-1 (58.4Kb) 02/18/05 Briefing Memo on HIV Treatment Using CHAIN Data
 
TRI-COUNTY REPORTS
2002-1 11/13/02 COHORT CHARACTERISTICS
2002-2 11/13/02 HEALTH STATUS & HEALTH SERVICE UTILIZATION
2002-3 11/13/02 STIGMA & SOCIAL ISOLATION
2002-4 11/13/02 FIELD NOTES
2002-5 11/13/02 SUPPORT GROUPS
2002-6 11/13/02 BASELINE NEEDS ASSESSMENT
11/12/03 (1.70Mb) 11/12/03 Analyzing Needs & Service Gaps Using the Tri-County CHAIN Study
01/09/04 (26.0Kb) 01/09/04 Proposed Tri-County CHAIN Reports: 2003-2004
03/24/05 (155Kb) 03/24/05 Tri-County CHAIN Presentation - Service Gaps & Key Health Measures
11/01/07 (77Kb) 11/01/07 Tri-County CHAIN Report 2007 - 1 Housing, Transportation, and HIV Medical Care and Outcomes
11/20/07 (82Kb) 11/20/07 Tri-County CHAIN Report 2007 - 2 Components of Medical Care
11/10/07 (77Kb) 11/07/07 Tri-County CHAIN Report 2007 - 3 Service Needs & Gaps
 
REPORTS
1999 (223Kb)   The Unconnected Revisited: A CHAIN Briefing Paper
2001-10 (84Kb)   Housing Status and Health Outcomes among Persons Living with HIV-AIDS
2001-11 (2.1Mb)   Geographic Display of The CHAIN Cohort and Service Utilization
2002-1 (348kb)   Exposure to Trauma and Violence among Persons Living with HIV
2002-1a (288kb)   Drug Use and Service Utilization Among People with HIV in New York City- Barriers to Care and Low Threshold Services
2002-1b (172kb)   TC_The Tri-County Cohort- Demographics & Other Characteristics
2002-2 (132kb)   HIV Drug Holidays Among the CHAIN Cohort
2002-2a (440kb)   Latino Populations in The CHAIN Cohort
2002-2b (164kb)   TC_Health Status and Health Service Utilization
2002-3 (296kb)   Utilization of Food and Nutrition Services among People With HIV in NYC
2002-3a (140kb)   Patterns of Sexual Behaviors and Sexual Risk among HIV Positive People in New York City
2002-3b (156kb)   TC_Stigma & Social Isolation
2002-4 (256kb)   Religion And Spirituality Among Persons Living with HIV
2002-4a (64kb)   Chronic Diseases and Clinical Comorbidities
2002-4b (136kb)   TC_ Field Notes; Recruiting a Longitudinal Cohort
2002-5 (348kb)   Patterns of Medical Providers and Substance Use Providers
2002-5a (148kb)   The CHAIN Retrospective 1994-2002
2002-5b (144kb)   TC_Support Groups
2002-6 (88kb)   Partner Notification
2002-6 (136kb)   TC_Baseline Needs Assessment of the Tri-County Cohort
2002-7 (192kb)   Trends in Medical Care Visits
2002-7 (104kb)   TC_Key Findings from Final 2002 TC CHAIN Data Reports
2002-8 (120kb)   People Over 50 Years Old with HIV-AIDS
2003-1 (275Kb)   2003-1 Strategic Plan Progress Indicators: Baseline Report
2003-1a (404kb)   Strategic Plan Progress Indicators; Baseline Project
2003-1b (328kb)   TC_Service Gaps and Utilization in the Continuum of Care
2003-2a (748Kb)   Geographical Distribution of Service Gaps Among the NYC CHAIN Cohort; A Geomapping Analysis
2003-2b (92Kb)   TC_Do Treatment Adherence Programs Lead to Better Client Outcomes.pdf
2003-3a (60Kb)   Validation of Self-Reported Viral Load Levels
2003-3b (1.4Mb)   Tri-County Report 2003_3 A Geographic Display of Health & Social Service Agencies in the Tri-County Region
2003-4a (120Kb)   Client Attributes and Service Intervention Correlates of Self Reported Viral Load Levels
2003-4b (104Kb)   Partner Notification
2003-5a (204Kb)   Delayed Entry to HIV Care
2003-5b (124Kb)   Estimating the Number of HIV-AIDS Infected Individuals in the Tri-County Region, in Care and Not in Care
2003-6 (176Kb)   Housing Assessment Summary
2003-7 (444Kb)   Strategic Plan Progress Indicators; New Cohort Update
2004-1 (948Kb)   Factors Associated with Delayed Care Seeking Among HIV-Infected Individuals in New York City
2004-1 (268Kb)   Services Gaps and Utilization in the Continuum of Care in New York City
2004-1a (28Kb)   Haitian Respondents in TC CHAIN Cohort
2004-2 (632Kb)   Permanency Planning & Case Mgmnt Memo
2004-2 (80Kb)   STRATEGIC PLAN PROGRESS INDICATORS: NEW COHORT UPDDATE
2004-3 (264Kb)   Baseline Summary of NYC II Cohort
2004-3 (160Kb)   Service Gaps & Strategic Plan Progress Indicators Summary Findings
2004-4 (204Kb)   Field Notes: Recruiting CHAIN's 2002 Longitudinal NYC Cohort
2004-5 (232Kb)   Comprehensive Care Models
2004-6 (356Kb)   The Validity of Self-Reported Clinical Markers and Medication Regimens: A Pilot Study
2004-7 (52Kb)   Regional Variation in the Use of Highly Active Antiretroviral Therapy
2005-1 (60Kb)   Briefing Memo on HIV Treatment
2005-1a (92Kb)   Prevention for Positives
2005-1b (276Kb)   HIV Medication Regimens & Treatment Success- PI-based vs PI-sparing, in 3 Cohorts
2005-2 (110Kb)   Delayers, Drop-outs, the Unconnected, and "Unmet need"
2005-2 (116Kb)   Utilization of Case Management
2005-2a (168Kb)   Delayers, Drop-Outs, The Unconnected and Unmet Needs.
2005-2b (228Kb)   Trends in HAART & Treatment Adherence
2005-3 (82Kb)   Service Gaps and Service Utilization in NYC
2005-3a (80Kb)   Service Gaps and Service Utilization in New York City; Wave 2 Update
2005-3b (228Kb)   Prevention for Positives
2005-4 (51.4Kb)   HIV Medication Regimens and Treatment Success
2005-4a (48Kb)   HIV Medication Regimens & Treatment Success- PI-Based Vs. PI-Sparing in 3 Cohorts
2005-4b (216Kb)   TC_Population Profile- Socioeconomic and Health Characteristics of Men who have Sex with Men (MSM), Non-MSM Men, and Women
2005-5 (208Kb)   Service Gaps Update- A 3 Wave Analysis
2005-6 (36Kb)   Key Findings From 2003-2005 TC CHAIN Data Reports
2006-1 (156Kb)   Service Gaps Among Special Populations of HIV+ Adults in New York City
2006-1a (144Kb)   Gender Differences in Neighborhood Service Use
2006-1b (44Kb)   Prevalence of Interpersonal Violence within the Tri-County CHAIN Cohort
2006-2 (80Kb) 07/13/06 Medical Services Utilization
2006-3 (124Kb)   HIV/AIDS And Aging
2006-4 (88Kb)   Housing and Entry Into Medical Care
2006-5 (529Kb)   Housing Need, Housing Assistance and Connection to Medical Care
2006-6 (84Kb)   Employment & Economic Wellbeing
2006-7 (60Kb) 12/20/06 Interpersonal Violence and Negative Health Behaviors
2007-1 (352Kb)   Changes in the CHAIN Study Questionnaire W3 vs W4
2007-1a (100Kb)   Need for Mental Health Srvs, Srvc Use, and Pathways
2007-1b (80Kb)   Housing, Transportation, and HIV Medical Care and Outcomes
2007-2a (112Kb)   Satisfaction and Dissatisfaction with Medical Services and Primary Medical Provider
2007-2b (548Kb)   Satisfaction and Dissatisfaction with Case Management and Social Services
2007-2c (84Kb)   Components of Medical Care
2007-3 (139Kb)   Pathways to Systems of HIV Medical Care final
2007-3a (88Kb)   Pathways to Systems of HIV Medical Care
2007-3b (80Kb)   Service Needs Gaps Wave 4 Update in Tri-County
2007-4 (144Kb)   Prevalence of Chronic Diseases Comorbid Conditions PLWHA
2008-1 (92Kb)   Need For Mental Health Services, Service Use, and Pathways to Care
2008-1a (236Kb)   Service Needs and Utilization New York City Round 5 Interviews: 2008-2009
2008-2 (180Kb)   Predictors of Antiretroviral Treatment Effectiveness
2009-1 (188Kb)   Demographics of Food Program Users
2009-1 (916Kb)   Mortality in the HAART Final 5 09 12
2009-2 (128Kb)   First 100 Cases for TC 2008 2009 Cohort
2009-3 (288Kb)   Changes in Survey W5 vs W6
2009 (220Kb) 12-14-09 INDEX of CHAIN Reports
2011 (281Kb)   CHAIN Brief Report 2011 Insurance Coverage
2011-1a (439Kb)   Service Needs and Utilization Report NYC
2011-1b (399Kb)   Service Needs and Utilization Report TC
2011-2 (601Kb)   Standard of HIV Medical Care Index Final
2011-4 (123Kb)   CHAIN Brief Report 2011-4 determinants of HAART adherence(2)_DOHMH final
2011-5 (143Kb)   Food and Nutrition Service Needs
2012-8 (342Kb)   CHAIN 2012-8 Validation Study
2012-9 (1.15MB)   Tobacco Use
2012-10 (342Kb)   Utilization of Oral Health Care
2013-02 (217Kb)   Food Service Fact Sheet
2014-01 (204Kb)   CHAIN 2014-01 Brief Report Trends over time from published reports

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