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Archive for the ‘Preventing Chronic Disease (CDC)’ Category

Use of Sunscreen and Indoor Tanning Devices Among a Nationally Representative Sample of High School Students, 2001–2011

August 24, 2014 Comments off

Use of Sunscreen and Indoor Tanning Devices Among a Nationally Representative Sample of High School Students, 2001–2011
Source: Preventing Chronic Disease (CDC)

Adolescents are particularly vulnerable to engaging in poor skin-protection behaviors. The objective of this study was to examine use of sunscreen and indoor tanning devices among a nationally representative sample of high school students during a 10-year period (2001–2011) using data from the Youth Risk Behavior Surveillance System. The percentage of youth who reported using sunscreen declined from 67.7% in 2001 to 56.1% in 2011. The prevalence of using indoor tanning devices was highest among white females: 37.4% in 2009 and 29.3% in 2011. These findings indicate the need for prevention efforts aimed at adolescents to reduce risks for skin cancer.

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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.

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).

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