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Information–Seeking Among Chronic Disease Prevention Staff in State Health Departments: Use of Academic Journals

August 21, 2014 Comments off

Information–Seeking Among Chronic Disease Prevention Staff in State Health Departments: Use of Academic Journals
Source: Preventing Chronic Disease (CDC)

Use of scientific evidence aids in ensuring that public health interventions have the best possible health and economic return on investment. We describe use of academic journals by state health department chronic disease prevention staff to find public health evidence. We surveyed more than 900 state health department staff from all states and the District of Columbia. Participants identified top journals or barriers to journal use. We used descriptive statistics to examine individual and aggregate state health department responses. On average, 45.7% of staff per state health department use journals. Common barriers to use included lack of time, lack of access, and expense. Strategies for increasing journal use are provided.

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Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012

July 21, 2014 Comments off

Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012
Source: Preventing Chronic Disease (CDC)

Introduction
In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children’s meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children’s menus), and the energy and nutrient content of all orders and children’s-meal–only orders purchased for children aged 0 through 12 years.

Methods
Restaurant responses were examined from January 2010 through March 2012. Parent–caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.

Results
Both restaurant chains responded to the ordinance by selling toys separately from children’s meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children’s meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children’s side dishes and beverages at Chain A.

Conclusion
Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

Geographical Variation in Health-Related Quality of Life Among Older US Adults, 1997–2010

July 17, 2014 Comments off

Geographical Variation in Health-Related Quality of Life Among Older US Adults, 1997–2010
Source: Preventing Chronic Disease

Introduction
Health-related quality of life (HRQOL) is an important predictor of morbidity and mortality; however, its geographical variation in older adults in the United States has not been characterized. We compared HRQOL among older adults in the 50 US states and the District of Columbia using the Health and Activities Limitation Index (HALex). We also compared the HRQOL of 4 regions: South, West, Midwest, and Northeast.

Methods
We analyzed pooled data from 1997 through 2010 from the National Health Interview Survey for participants aged 65 or older. HALex scores (which range from 0 to 1.00, with higher values indicating better health) were calculated by combining data on participants’ perceived health and activity limitations. We ranked states by mean HALex score and performed multivariable logistic regression analyses to compare low scores (defined as scores in the lowest quintile) among US regions after adjustment for sociodemographics, health behaviors, and survey design.

Results
Older residents of Alaska, Alabama, Arkansas, Mississippi, and West Virginia had the lowest mean HALex scores (range, 0.62–0.68); residents of Arizona, Delaware, Nevada, New Hampshire, and Vermont had the highest mean scores (range, 0.78–0.79). Residents in the Northeast (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.57–0.76) and the Midwest (OR, 64; 95% CI, 0.56–0.73) were less likely than residents in the South to have scores in the lowest quintile after adjustment for sociodemographics, health behaviors, and survey design.

Conclusion
Significant regional differences exist in HRQOL of older Americans. Future research could provide policy makers with information on improving HRQOL of older Americans.

Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States

June 30, 2014 Comments off

Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States
Source: Preventing Chronic Disease (CDC)

Introduction
Excessive alcohol consumption is a leading cause of premature mortality in the United States. The objectives of this study were to update national estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL among those younger than 21 years.

Methods
We used the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application for 2006–2010 to estimate total AAD and YPLL across 54 conditions for the United States, by sex and age. AAD and YPLL rates and the proportion of total deaths that were attributable to excessive alcohol consumption among working-age adults (20-64 y) were calculated for the United States and for individual states.

Results
From 2006 through 2010, an annual average of 87,798 (27.9/100,000 population) AAD and 2.5 million (831.6/100,000) YPLL occurred in the United States. Age-adjusted state AAD rates ranged from 51.2/100,000 in New Mexico to 19.1/100,000 in New Jersey. Among working-age adults, 9.8% of all deaths in the United States during this period were attributable to excessive drinking, and 69% of all AAD involved working-age adults.

Conclusions
Excessive drinking accounted for 1 in 10 deaths among working-age adults in the United States. AAD rates vary across states, but excessive drinking remains a leading cause of premature mortality nationwide. Strategies recommended by the Community Preventive Services Task Force can help reduce excessive drinking and harms related to it.

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits

June 28, 2014 Comments off

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits
Source: Preventing Chronic Disease (CDC)

Introduction
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.

Methods
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.

Results
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.

Conclusions
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.

Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach

June 11, 2014 Comments off

Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach
Source: Preventing Chronic Disease (CDC)

Abstract
National nutrition guidelines emphasize consumption of powerhouse fruits and vegetables (PFV), foods most strongly associated with reduced chronic disease risk; yet efforts to define PFV are lacking. This study developed and validated a classification scheme defining PFV as foods providing, on average, 10% or more daily value per 100 kcal of 17 qualifying nutrients. Of 47 foods studied, 41 satisfied the powerhouse criterion and were more nutrient-dense than were non-PFV, providing preliminary evidence of the validity of the classification scheme. The proposed classification scheme is offered as a tool for nutrition education and dietary guidance.

Objective
Powerhouse fruits and vegetables (PFV), foods most strongly associated with reduced chronic disease risk, are described as green leafy, yellow/orange, citrus, and cruciferous items, but a clear definition of PFV is lacking (1). Defining PFV on the basis of nutrient and phytochemical constituents is suggested (1). However, uniform data on food phytochemicals and corresponding intake recommendations are lacking (2). This article describes a classification scheme defining PFV on the basis of 17 nutrients of public health importance per the Food and Agriculture Organization of the United Nations and Institute of Medicine (ie, potassium, fiber, protein, calcium, iron, thiamin, riboflavin, niacin, folate, zinc, and vitamins A, B6, B12, C, D, E, and K) (3).

Methods
This cross-sectional study identified PFV in a 3-step process. First, a tentative list of PFV consisting of green leafy, yellow/orange, citrus, and cruciferous items was generated on the basis of scientific literature (4,5) and consumer guidelines (6,7). Berry fruits and allium vegetables were added in light of their associations with reduced risks for cardiovascular and neurodegenerative diseases and some cancers (8). For each, and for 4 items (apples, bananas, corn, and potatoes) described elsewhere as low-nutrient-dense (1), information was collected in February 2014 on amounts of the 17 nutrients and kilocalories per 100 g of food (9). Because preparation methods can alter the nutrient content of foods (2), nutrient data were for the items in raw form.

Second, a nutrient density score was calculated for each food using the method of Darmon et al (10). The numerator is a nutrient adequacy score calculated as the mean of percent daily values (DVs) for the qualifying nutrients (based on a 2,000 kcal/d diet [11]) per 100 g of food. The scores were weighted using available data (Table 1) based on the bioavailability of the nutrients (12): nutrient adequacy score = (Σ [nutrienti × bioavailabilityi)/DVi] × 100)/17. As some foods are excellent sources of a particular nutrient but contain few other nutrients, percent DVs were capped at 100 so that any one nutrient would not contribute unduly to the total score (3). The denominator is the energy density of the food (kilocalories per 100 g): nutrient density score (expressed per 100 kcal) = (nutrient adequacy score/energy density) x 100. The score represents the mean of percent DVs per 100 kcal of food.

Third, nutrient-dense foods (defined as those with scores ≥10) were classified as PFV. The Food and Drug Administration defines foods providing 10% or more DV of a nutrient as good sources of the nutrient (3). Because there are no standards defining good sources of a combination of nutrients-per-kilocalories, the FDA threshold was used for this purpose. The 4 low-nutrient-dense items were classified as non-PFV.

To validate the classification scheme, the Spearman correlation between nutrient density scores and powerhouse group was examined. The robustness of the scheme with respect to nutrients beneficial in chronic disease risk also was examined by comparing foods classified as PFV with those separately classified as such based on densities of 8 nutrients protective against cancer and heart disease (ie, fiber, folate, zinc, and vitamins B6, B12, C, D, and E) (2,4).

Results
Of 47 foods studied, all but 6 (raspberry, tangerine, cranberry, garlic, onion, and blueberry) satisfied the powerhouse criterion (Table 2). Nutrient density scores ranged from 10.47 to 122.68 (median score = 32.23) and were moderately correlated with powerhouse group (ρ = 0.49, P = .001). The classification scheme was robust with respect to nutrients protective against chronic disease (97% of foods classified as PFV were separately classified as such on the basis of 8 nutrients protective against cancer and heart disease). For ease of interpretation, scores above 100 were capped at 100 (indicating that the food provides, on average, 100% DV of the qualifying nutrients per 100 kcal). Items in cruciferous (watercress, Chinese cabbage, collard green, kale, arugula) and green leafy (chard, beet green, spinach, chicory, leaf lettuce) groups were concentrated in the top half of the distribution of scores (Table 2) whereas items belonging to yellow/orange (carrot, tomato, winter squash, sweet potato), allium (scallion, leek), citrus (lemon, orange, lime, grapefruit), and berry (strawberry, blackberry) groups were concentrated in the bottom half (4–7).

Association of the Neighborhood Retail Food Environment with Sodium and Potassium Intake Among US Adults

June 2, 2014 Comments off

Association of the Neighborhood Retail Food Environment with Sodium and Potassium Intake Among US Adults
Source: Preventing Chronic Disease (CDC)

Introduction
High sodium intake and low potassium intake, which can contribute to hypertension and risk of cardiovascular disease, may be related to the availability of healthful food in neighborhood stores. Despite evidence linking food environment with diet quality, this relationship has not been evaluated in the United States. The modified retail food environment index (mRFEI) provides a composite measure of the retail food environment and represents the percentage of healthful-food vendors within a 0.5 mile buffer of a census tract.

Methods
We analyzed data from 8,779 participants in the National Health and Nutrition Examination Survey, 2005–2008. By using linear regression, we assessed the relationship between mRFEI and sodium intake, potassium intake, and the sodium–potassium ratio. Models were stratified by region (South and non-South) and included participant and neighborhood characteristics.

Results
In the non-South region, higher mRFEI scores (indicating a more healthful food environment) were not associated with sodium intake, were positively associated with potassium intake (P [trend] = .005), and were negatively associated with the sodium–potassium ratio (P [trend] = .02); these associations diminished when neighborhood characteristics were included, but remained close to statistical significance for potassium intake (P [trend] = .05) and sodium–potassium ratio (P [trend] = .07). In the South, mRFEI scores were not associated with sodium intake, were negatively associated with potassium intake (P [trend] = < .001), and were positively associated with sodium–potassium ratio (P [trend] = .01). These associations also diminished after controlling for neighborhood characteristics for both potassium intake (P [trend] = .03) and sodium–potassium ratio (P [trend] = .40).

Conclusion
We found no association between mRFEI and sodium intake. The association between mRFEI and potassium intake and the sodium–potassium ratio varied by region. National strategies to reduce sodium in the food supply may be most effective to reduce sodium intake. Strategies aimed at the local level should consider regional context and neighborhood characteristics.

Restaurant Owners’ Perspectives on a Voluntary Program to Recognize Restaurants for Offering Reduced-Size Portions, Los Angeles County, 2012

April 8, 2014 Comments off

Restaurant Owners’ Perspectives on a Voluntary Program to Recognize Restaurants for Offering Reduced-Size Portions, Los Angeles County, 2012
Source: Preventing Chronic Disease (CDC)

Introduction
Reducing the portion size of food and beverages served at restaurants has emerged as a strategy for addressing the obesity epidemic; however, barriers and facilitators to achieving this goal are not well characterized.

Methods
In fall 2012, the Los Angeles County Department of Public Health conducted semistructured interviews with restaurant owners to better understand contextual factors that may impede or facilitate participation in a voluntary program to recognize restaurants for offering reduced-size portions.

Results
Interviews were completed with 18 restaurant owners (representing nearly 350 restaurants). Analyses of qualitative data revealed 6 themes related to portion size: 1) perceived customer demand is central to menu planning; 2) multiple portion sizes are already being offered for at least some food items; 3) numerous logistical barriers exist for offering reduced-size portions; 4) restaurant owners have concerns about potential revenue losses from offering reduced-size portions; 5) healthful eating is the responsibility of the customer; and 6) a few owners want to be socially responsible industry leaders.

Conclusion
A program to recognize restaurants for offering reduced-size portions may be a feasible approach in Los Angeles County. These findings may have applications for jurisdictions interested in engaging restaurants as partners in reducing the obesity epidemic.

Relationships Between Housing and Food Insecurity, Frequent Mental Distress, and Insufficient Sleep Among Adults in 12 US States, 2009

March 18, 2014 Comments off

Relationships Between Housing and Food Insecurity, Frequent Mental Distress, and Insufficient Sleep Among Adults in 12 US States, 2009
Source: Preventing Chronic Disease (CDC)

Introduction
Housing insecurity and food insecurity may be psychological stressors associated with insufficient sleep. Frequent mental distress may mediate the relationships between these variables. The objective of this study was to examine the relationships between housing insecurity and food insecurity, frequent mental distress, and insufficient sleep.

Methods
We analyzed data from the 2009 Behavioral Risk Factor Surveillance System in 12 states. Housing insecurity and food insecurity were defined as being worried or stressed “sometimes,” “usually,” or “always” during the previous 12 months about having enough money to pay rent or mortgage or to buy nutritious meals.

Results
Of 68,111 respondents, 26.4% reported frequent insufficient sleep, 28.5% reported housing insecurity, 19.3% reported food insecurity, and 10.8% reported frequent mental distress. The prevalence of frequent insufficient sleep was significantly greater among those who reported housing insecurity (37.7% vs 21.6%) or food insecurity (41.1% vs 22.9%) than among those who did not. The prevalence of frequent mental distress was also significantly greater among those reporting housing insecurity (20.1% vs 6.8%) and food insecurity (23.5% vs 7.7%) than those who did not. The association between housing insecurity or food insecurity and frequent insufficient sleep remained significant after adjustment for other sociodemographic variables and frequent mental distress.

Conclusion
Sleep health and mental health are embedded in the social context. Research is needed to assess whether interventions that reduce housing insecurity and food insecurity will also improve sleep health and mental health.

Disability Status as an Antecedent to Chronic Conditions: National Health Interview Survey, 2006–2012

February 24, 2014 Comments off

Disability Status as an Antecedent to Chronic Conditions: National Health Interview Survey, 2006–2012
Source: Preventing Chronic Disease (CDC)

Introduction
A strong relationship exists between disability and poor health. This relationship could exist as a result of disabilities emerging from chronic conditions; conversely, people with disabilities may be at increased risk of developing chronic conditions. Studying health in relation to age of disability onset can illuminate the extent to which disability may be a risk factor for future poor health.

Methods
We used data from the 2006–2012 National Health Interview Survey and conducted weighted logistic regression analyses to compare chronic conditions in adults with lifelong disabilities (n = 2,619) and adults with no limitations (n = 122,395).

Results
After adjusting for sociodemographic differences, adults with lifelong disabilities had increased odds of having the following chronic conditions compared with adults with no limitations: coronary heart disease (adjusted odds ratio [AOR] = 2.92; 95% confidence interval [CI], 2.33–3.66) cancer (AOR = 1.61; 95% CI, 1.34–1.94), diabetes (AOR = 2.57; 95% CI, 2.10–3.15), obesity (AOR = 1.81; 95% CI, 1.63–2.01), and hypertension (AOR = 2.18; 95% CI, 1.94–2.45). Subpopulations of people with lifelong disabilities (ie, physical, mental, intellectual/developmental, and sensory) experienced similar increased odds for chronic conditions compared with people with no limitations.

Conclusion
Adults with lifelong disabilities were more likely to have chronic conditions than adults with no limitations, indicating that disability likely increases risk of developing poor health. This distinction is critical in understanding how to prevent health risks for people with disabilities. Health promotion efforts that target people living with a disability are needed.

From Menu to Mouth: Opportunities for Sodium Reduction in Restaurants

January 24, 2014 Comments off

From Menu to Mouth: Opportunities for Sodium Reduction in Restaurants
Source: Preventing Chronic Disease (CDC)

Restaurant foods can be a substantial source of sodium in the American diet. According to the Institute of Medicine, the significant contribution made by restaurants and food service menu items to Americans’ sodium intake warrants targeted attention. Public health practitioners are uniquely poised to support sodium-reduction efforts in restaurants and help drive demand for lower-sodium products through communication and collaboration with restaurant and food service professionals and through incentives for restaurants. This article discusses the role of the public health practitioner in restaurant sodium reduction and highlights select strategies that have been taken by state and local jurisdictions to support this effort.

Monitoring Progress in Population Health: Trends in Premature Death Rates

January 7, 2014 Comments off

Monitoring Progress in Population Health: Trends in Premature Death Rates
Source: Preventing Chronic Disease (CDC)

Introduction
Trends in population health outcomes can be monitored to evaluate the performance of population health systems at the national, state, and local levels. The objective of this study was to compare and contrast 4 measures for assessing progress in population health improvement by using age-adjusted premature death rates as a summary measure of the overall health outcomes in the United States and in all 50 states.

Methods
To evaluate the performance of statewide population health systems during the past 20 years, we used 4 measures of age-adjusted premature (<75 years of age) death rates: current rates (2009), baseline trends (1990s), follow-up trends (2000s), and changes in trends from baseline to the follow-up periods (ie, “bending the curve”).

Results
Current premature death rates varied by approximately twofold, with the lowest rate in Minnesota (268 deaths per 100,000) and the highest rate in Mississippi (482 deaths per 100,000). Rates improved the most in New York during the baseline period (−3.05% per year) and in New Jersey during the follow-up period (−2.87% per year), whereas Oklahoma ranked last in trends during both periods (−0.30%/y, baseline; +0.18%/y, follow-up). Trends improved the most in Connecticut, bending the curve downward by −1.03%; trends worsened the most in New Mexico, bending the curve upward by 1.21%.

Discussion
Current premature death rates, recent trends, and changes in trends vary by state in the United States. Policy makers can use these measures to evaluate the long-term population health impact of broad health care, behavioral, social, and economic investments in population health.

The Physical and Mental Health of Head Start Staff: The Pennsylvania Head Start Staff Wellness Survey, 2012

November 1, 2013 Comments off

The Physical and Mental Health of Head Start Staff: The Pennsylvania Head Start Staff Wellness Survey, 2012
Source: Preventing Chronic Disease (CDC)

Introduction
Despite attention to the health of low-income children in Head Start, little is known about the health of adults working for the program. The objective of our study was to compare the physical and mental health of women working in Pennsylvania Head Start programs with the health of US women who have similar sociodemographic characteristics.

Methods
We used data from a web-based survey in 2012 in which 2,199 of 3,375 (65.2%) staff in 66 Pennsylvania Head Start programs participated. For the 2,122 female respondents, we determined the prevalence of fair or poor health status, frequent (≥14 d/mo) unhealthy days, frequent (≥10 d/y) work absences due to illness, diagnosed depression, and 3 or more of 6 physical health conditions. We compared these prevalences with those found in 2 national samples of employed women of similar age, education, race/ethnicity, and marital status.

Results
Among Head Start staff, 85.7% were non-Hispanic white, 62.4% were married, and 60.3% had completed college. The prevalence (% [95% confidence interval]) of several health indicators was higher in Head Start staff than in the national samples: fair or poor health (14.6% [13.1%–16.1%] vs 5.1% [4.5%–5.6%]), frequent unhealthy days (28.3% [26.3%–30.2%] vs 14.5% [14.1%–14.9%]), diagnosed depression (23.5% [21.7%–25.3%] vs 17.6% [17.1%–18.0%]), and 3 or more physical health conditions (21.8% [20.0%–23.6%] vs 12.6% [11.7%–13.5%]).

Conclusion
Women working with children in Head Start programs have poorer physical and mental health than do US women who have similar sociodemographic characteristics.

Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010

September 30, 2013 Comments off

Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010
Source: Preventing Chronic Disease (CDC)

Introduction
People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category.

Methods
Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression.

Results
Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care.

Conclusion
Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.

Radon Control Activities for Lung Cancer Prevention in National Comprehensive Cancer Control Program Plans, 2005–2011

August 29, 2013 Comments off

Radon Control Activities for Lung Cancer Prevention in National Comprehensive Cancer Control Program Plans, 2005–2011
Source: Preventing Chronic Disease (CDC)

Introduction
Radon is the second leading cause of lung cancer among smokers and the leading cause among nonsmokers. The US Environmental Protection Agency recommends that every home be tested for radon. Comprehensive Cancer Control (CCC) programs develop cancer coalitions that coordinate funding and resources to focus on cancer activities that are recorded in cancer plans. Radon tests, remediation, and radon mitigation techniques are relatively inexpensive, but it is unclear whether coalitions recognize radon as an important carcinogen.

Methods
We reviewed 65 cancer plans created from 2005 through 2011 for the terms “radon,” “radiation,” or “lung.” Plan activities were categorized as radon awareness, home testing, remediation, supporting radon policy activities, or policy evaluation. We also reviewed each CCC program’s most recent progress report. Cancer plan content was reviewed to assess alignment with existing radon-specific policies in each state.

Results
Twenty-seven of the plans reviewed (42%) had radon-specific terminology. Improving awareness of radon was included in all 27 plans; also included were home testing (n = 21), remediation (n = 11), support radon policy activities (n = 13), and policy evaluation (n = 1). Three plans noted current engagement in radon activities. Thirty states had radon-specific laws; most (n = 21) were related to radon professional licensure. Eleven states had cancer plan activities that aligned with existing state radon laws.

Conclusion
Although several states have radon-specific policies, approximately half of cancer coalitions may not be aware of radon as a public health issue. CCC-developed cancer coalitions and plans should prioritize tobacco control to address lung cancer but should consider addressing radon through partnership with existing radon control programs.

Factors Predicting Physical Activity Among Children With Special Needs

August 28, 2013 Comments off

Factors Predicting Physical Activity Among Children With Special Needs
Source: Preventing Chronic Disease

Introduction
Obesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children.

Methods
We surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child’s and their own physical activity habits, barriers to their child’s exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week.

Results
Parents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child’s lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents’ lack of time (29%). However, child’s lack of interest was the only parent-reported barrier independently associated with children’s physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01).

Conclusion
In this group of students with special needs, children’s physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs.

A Binational Overview of Reproductive Health Outcomes Among US Hispanic and Mexican Women in the Border Region

August 25, 2013 Comments off

A Binational Overview of Reproductive Health Outcomes Among US Hispanic and Mexican Women in the Border Region
Source: Preventing Chronic Disease (CDC)

Introduction
The US–Mexico border region has 15 million residents and 300,000 births annually. Reproductive health concerns have been identified on both sides of the border, but comparable information about reproductive health is not available. The objective of this study was to compare reproductive health indicators among populations in this region.

Methods
We used 2009 US Hispanic and Mexican birth certificate data to compare births inside the border region, elsewhere within the border states, and in the United States and Mexico overall. We examined trends in total fertility and birth rates using birth data from 2000 through 2009 and intercensal population estimates.

Results
Among women in the border region, US women had more lifetime births than Mexican women in 2009 (2.69 births vs 2.15 births) and throughout the decade. Birth rates in the group aged 15 to 19 years were high in both the US (73.8/1,000) and Mexican (86.7/1,000) border regions. Late or no prenatal care was nearly twice as prevalent in the border regions as in the nonborder regions of border states. Low birth weight and preterm and early-term birth were more prevalent in the US border than in the Mexican border region; US border rates were higher and Mexican rates were lower than their corresponding nonborder and national rates. We found some variations within border states.

Conclusion
These findings constitute the first population-based information on the reproductive health of the entire Hispanic US–Mexico border population. Evidence of disparities warrants exploration at state and local levels. Teen pregnancy and inadequate prenatal care are shared problems in US–Mexico border communities and suggest an area for binational cooperation.

The Economic Impact of Smoke-Free Laws on Restaurants and Bars in 9 States

August 20, 2013 Comments off

The Economic Impact of Smoke-Free Laws on Restaurants and Bars in 9 States
Source: Preventing Chronic Disease (CDC)

Introduction
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.

Methods
Using quarterly data from 2000 through 2010, we estimated dynamic panel data models for employment and sales in restaurants and bars. The models controlled for smoke-free laws, general economic activity, cigarette sales, and seasonality. We included data from 216 smoke-free cities and counties in the analysis. During the study period, only North Carolina had a statewide law banning smoking in restaurants or bars. Separate models were estimated for each state.

Results
In West Virginia, smoke-free laws were associated with a significant increase of approximately 1% in restaurant employment. In the remaining 8 states, we found no significant association between smoke-free laws and employment or sales in restaurants and bars.

Conclusion
Results suggest that smoke-free laws did not have an adverse economic impact on restaurants or bars in any of the states studied; they provided a small economic benefit in 1 state. On the basis of these findings, we would not expect a statewide smoke-free law in Alabama, Indiana, Kentucky, Missouri, Mississippi, South Carolina, Texas, or West Virginia to have an adverse economic impact on restaurants or bars in those states.

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status

August 19, 2013 Comments off

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status
Source: Preventing Chronic Disease (CDC)

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010

August 8, 2013 Comments off

Preventable Hospitalizations and Emergency Department Visits for Angina, United States, 1995–2010
Source: Preventing Chronic Disease (CDC)

Introduction
Preventable hospitalizations for angina have been decreasing since the late 1980s — most likely because of changes in guidance, physician coding practices, and reimbursement. We asked whether this national decline has continued and whether preventable emergency department visits for angina show a similar decline.

Methods
We used National Hospital Discharge Survey data from 1995 through 2010 and National Hospital Ambulatory Medical Care Survey data from 1995 through 2009 to study preventable hospitalizations and emergency department visits, respectively. We calculated both crude and standardized rates for these visits according to technical specifications published by the Agency for Healthcare Research and Quality, which uses population estimates from the US Census Bureau as the denominator for the rates.

Results
Crude hospitalization rates for angina declined from 1995–1998 to 2007–2010 for men and women in all 3 age groups (18–44, 45–64, and ≥65) and age- and sex-standardized rates declined in a linear fashion (P = .02). Crude rates for preventable emergency department visits for angina declined for men and women aged 65 or older from 1995–1998 to 2007–2009. Age- and sex-standardized rates for these visits showed a linear decline (P = .05).

Conclusion
We extend previous research by showing that preventable hospitalization rates for angina have continued to decline beyond the time studied previously. We also show that emergency department visits for the same condition have also declined during the past 15 years. Although these declines are probably due to changes in diagnostic practices in the hospitals and emergency departments, more studies are needed to fully understand the reasons behind this phenomenon.

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