American Journal of Preventive Medicine

Novel Influenza A (H1N1) Outbreak at the U.S. Air Force Academy: Epidemiology and Viral Shedding Duration

2009-10-22

Background: The U.S. Air Force Academy is an undergraduate institution that educates and trains cadets for military service. Following the arrival of 1376 basic cadet trainees in June 2009, surveillance revealed an increase in cadets presenting with respiratory illness. Specimens from ill cadets tested positive for novel influenza A (H1N1 [nH1N1])–specific ribonucleic acid (RNA) by real-time reverse transcriptase–polymerase chain reaction.Purpose: The outbreak epidemiology, control measures, and nH1N1 shedding duration are described.Methods: Case patients were identified through retrospective and prospective surveillance. Symptoms, signs, and illness duration were documented. Nasal-wash specimens were tested for nH1N1-specific RNA. Serial samples from a subset of 53 patients were assessed for presence of viable virus by viral culture.Results: A total of 134 confirmed and 33 suspected cases of nH1N1 infection were identified with onset date June 25–July 24, 2009. Median age of case patients was 18 years (range, 17–24 years). Fever, cough, and sore throat were the most commonly reported symptoms. The incidence rate among basic cadet trainees during the outbreak period was 11%. Twenty-nine percent (31/106) of samples from patients with temperature <100°F and 19% (11/58) of samples from patients reporting no symptoms for ≥24 hours contained viable nH1N1 virus. Of 29 samples obtained 7 days from illness onset, seven (24%) contained viable nH1N1 virus.Conclusions: In the nH1N1 outbreak under study, the number of cases peaked 48 hours after a social event and rapidly declined thereafter. Almost one quarter of samples obtained 7 days from illness onset contained viable nH1N1 virus. These data may be useful for future investigations and in scenario planning.

Progress Toward Eliminating Disparities in Vaccination Coverage Among U.S. Children, 2000–2008

Zhen Zhao, Elizabeth T. Luman — 2010-02-01

Background: The goal year for the Healthy People 2010 initiative is approaching.Purpose: This article aims to assess progress toward reaching the overarching goal of eliminating disparities in vaccination coverage among young children in the U.S.Methods: Coverage for the 4:3:1:3:3:1 vaccine series (at least four doses of diphtheria–tetanus–pertussis, three poliovirus, one measles–mumps–rubella, three hepatitis B, three Haemophilus influenzae type B, and one varicella vaccine) was assessed among 185,516 children in the 2000–2008 National Immunization Surveys. Observed and adjusted disparities in coverage were evaluated for various sociodemographic groups previously associated with vaccination coverage. Linear trends in disparities were assessed.Results: In 2000, disparities among population segments were significant (p<0.05) for all sociodemographic factors assessed except provider participation in the Vaccines for Children program. By 2008, most disparities were smaller than those in 2000, and racial and urban/suburban/rural differences were reduced to levels below significance. Disparities between children living in suburban versus rural localities narrowed approximately 0.5% per year. Vaccination coverage increased substantially among children in all sociodemographic groups, although children without siblings were the only group to reach the 80% target by 2008.Conclusions: Progress has been made toward eliminating vaccination coverage disparities among children in various sociodemographic groups in the U.S. As the end of the Healthy People 2010 goal period approaches, maintaining and advancing these reductions will require innovative strategies to reach underserved groups.

Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity

Haomiao Jia, Erica I. Lubetkin — 2010-02-01

Background: Quality-adjusted life-years (QALYs) use preference-based measurements of health-related quality-of-life (HRQOL) to provide an assessment of the overall burden of disease using a single number.Purpose: This study estimated QALYs lost contributed by smoking and obesity for U.S. adults from 1993 to 2008.Methods: Population HRQOL data were from the 1993–2008 Behavioral Risk Factor Surveillance System. The QALYs lost contributed by a risk factor is the sum of QALYs lost due to morbidity in the current year and future QALYs lost in expected life-years due to premature deaths (mortality). Premature deaths were estimated from the National Health Interview Survey Linked Mortality Files and mortality statistics.Results: From 1993 to 2008, the proportion of smokers among U.S. adults declined 18.5% whereas the proportion of obese people increased 85%. The smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. In 1993 the QALYs lost were much smaller for obesity compared to smoking, with obesity contributing about 0.0204 QALYs lost. However, as a result of the increasing prevalence of obesity, the contribution of obesity-related QALYs lost increased consistently and had increased by 127% in 2008 when obesity resulted in 0.0464 QALYs lost, slightly more than smoking did. Smoking had a bigger impact on mortality than morbidity, whereas obesity had a bigger impact on morbidity than mortality.Conclusions: This study estimated the overall burden of smoking and obesity over time and results indicate that because of the marked increase in the proportion of obese people, obesity has become an equal, if not greater, contributor to the burden of disease than smoking. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.

Generation, Language, Body Mass Index, and Activity Patterns in Hispanic Children

Sharon E. Taverno, Brandi Y. Rollins, Lori A. Francis — 2010-02-01

Background: The acculturation hypothesis proposes an overall disadvantage in health outcomes for Hispanic immigrants with more time spent living in the U.S., but little is known about how generational status and language may influence Hispanic children's relative weight and activity patterns.Purpose: To investigate associations among generation and language with relative weight (BMI z-scores), physical activity, screen time, and participation in extracurricular activities (i.e., sports, clubs) in a U.S.-based, nationally representative sample of Hispanic children.Methods: Participants included 2012 Hispanic children aged 6–11 years from the cross-sectional 2003 National Survey of Children's Health. Children were grouped according to generational status (first, second, or third), and the primary language spoken in the home (English versus non-English). Primary analyses included adjusted logistic and multinomial logistic regression to examine the relationships among variables; all analyses were conducted between 2008 and 2009.Results: Compared to third-generation, English speakers, first- and second-generation, non-English speakers were more than two times more likely to be obese. Moreover, first-generation, non-English speakers were half as likely to engage in regular physical activity and sports. Both first- and second-generation, non-English speakers were less likely to participate in clubs compared to second- and third-generation, English speakers. Overall, non–English-speaking groups reported less screen time compared to third-generation, English speakers.Conclusions: The hypothesis that Hispanics lose their health protection with more time spent in the U.S. was not supported in this sample of Hispanic children.

Longitudinal Intervention Effects on Parenting of the Aventuras para Niños Study

2010-02-01

Background: Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences.Purpose: This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity.Design: The study used a 2 × 2 factorial design.Setting/participants: In 2003, a sample of 13 Southern California schools was randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro–environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade.Intervention: In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters.Main outcome measures: In 2008, intervention effects were examined on (1) parenting strategies, including limit setting, monitoring, discipline, control, and reinforcement related to children's diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to children's eating and activity.Results: At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions.Conclusions: Aspects of parenting related to children's risk for obesity and related health outcomes are modifiable with the support of a promotora and print media.

Effects of Having a Baby on Weight Gain

Wendy J. Brown, Richard Hockey, Annette J. Dobson — 2010-02-01

Background: Women often blame weight gain in early adulthood on having a baby.Purpose: The aim was to estimate the weight gain attributable to having a baby, after disentangling the effects of other factors that influence weight change at this life stage.Methods: A longitudinal study of a randomly selected cohort of 6458 Australian women, aged 18–23 years in 1996, was conducted. Self-report mailed surveys were completed in 1996, 2000, 2003, and 2006, and data were analyzed in 2008.Results: On average, women gained weight at the rate of 0.93% per year (95% CI=0.89, 0.98) or 605 g/year (95% CI=580, 635) for a 65-kg woman. Over the 10-year study period, partnered women with one baby gained almost 4 kg more, and those with a partner but no baby gained 1.8 kg more, than unpartnered childless women (after adjustment for other significant factors: initial BMI and age; physical activity, sitting time, energy intake (2003); education level, hours in paid work, and smoking).Conclusions: Having a baby has a marked effect on 10-year weight gain, but there is also an effect attributable to getting married or living with a partner. Social and lifestyle as well as energy balance variables should be considered when developing strategies to prevent weight gain in young adult women.

Congestion Road Tax and Physical Activity

2010-02-01

Background: Large-scale policy and environmental changes, such as congestion road taxes, may be a way to promote active transportation.Purpose: This study aimed to examine the potential effect of a congestion road tax on physical activity.Methods: Baseline data were collected during October–November 2003, follow-up data in May 2006, and analysis was performed in September 2008. The short self-administered version of the International Physical Activity Questionnaire was used to assess physical activity. Data from those with access to motorized vehicles in the Stockholm region (n=165), where the tax was in place, were compared with those from the Göteborg/Malmö regions (n=138). Within each region before and during the road tax implementation, the data were analyzed for differences in time spent at different intensity levels of physical activity, in addition to sitting, as well as for changes in reported time in overall (weighted) physical activity.Results: There were no significant differences in the magnitude of the changes of the intensity levels of physical activity, weighted overall physical activity, or sitting, between Stockholm and Göteborg/Malmö. Among those exposed to the congestion road tax and with access to motorized vehicles, an increase in moderate physical activity (p=0.036); overall physical activity (p=0.015); and a reduction in time spent sitting (p=0.009) was observed. No differences were observed among those unexposed.Conclusions: The results from this study on the influence of a congestion road tax on levels of physical activity, though inconclusive, suggest that policy changes such as a congestion road tax might promote improvements in physical activity levels in individuals with motorized vehicles.

Mapping the Walk to School Using Accelerometry Combined with a Global Positioning System

2010-02-01

Background: Walking to school is associated with higher levels of physical activity, but the contribution of the journey itself to physical activity before school is unknown.Purpose: This study combined accelerometer and GPS data to investigate the level and location of physical activity in children walking to school.Methods: Participants were 137 children (aged 11.3±0.3 years) from London, England, measured in June–July 2006. Physical activity was measured by accelerometry, and location was determined with a GPS receiver. Travel mode was self-reported. Accelerometer and GPS data were time-matched to provide activity level and location for each 10-second epoch where both were available. Journeys were mapped in a GIS.Results: Mean accelerometer counts per minute before school (8:00am to 9:00am) were 43% higher in those who walked to school than those traveling by car (878.8±387.6 vs 608.7±264.1 counts per minute [cpm], p<0.001). Eleven percent (4.5 minutes) of daily moderate to vigorous physical activity (MVPA) occurred in this hour, with walkers recording 2.1 minutes more than car travelers (p=0.004). Children followed direct routes between home and the school playground. Total activity during the walk to school was twice that in the playground (2131.3±1170.7 vs 1089.7±938.6 cpm, p<0.001), with the journey contributing three times as much MVPA as time in the playground.Conclusions: Our results provide evidence that the journey to school is purposeful and contributes to higher total physical activity and MVPA in children. Combining accelerometer and GPS data may aid our understanding of the environmental context of physical activity.

Racial and Ethnic Trends of Colorectal Cancer Screening Among Medicare Enrollees

2010-02-01

Background: Colorectal cancer (CRC) screening rates have remained lower than the Healthy People 2010 goal, particularly among minority populations.Purpose: This study aimed to examine the racial–ethnic trends in CRC screening and the continued impact of healthcare access indicators on screening differences after Medicare expanded coverage.Methods: The study used data from the Medicare Current Beneficiary Survey for 2000, 2003, and 2005. The sample was restricted to non-Hispanic whites, non-Hispanic blacks, and Hispanics. The primary outcome was the proportion of enrollees who underwent lower-gastrointestinal endoscopy within 5 years and/or home fecal occult blood test within 1 year.Results: Over the 6-year period under study, the proportion screened increased among each of the three racial–ethnic groups, but lower proportions of blacks and Hispanics underwent screening compared with whites at each time point. Hispanic–white differences persisted but black–white differences narrowed in 2003 and widened in 2005. In each survey year, racial differences attenuated after adjustment for type of supplemental health insurance and disappeared after further adjustment for educational and income levels.Conclusions: Despite expanding benefits for CRC screening, which would be expected to disproportionally benefit racial and ethnic minorities, racial disparities in use of screening persist in part because of differences in the types of health insurance coverage, education, and income. There was a slight reversal of the initial attenuation of the black–white difference after the Medicare policy change. Efforts are needed to increase the reach of CRC screening to minority populations, particularly those lacking adequate health insurance coverage or with less education or income.

Longitudinal Effect of Smoking Cessation on Physical and Laboratory Findings

2010-02-01

Background: Detailed information on the expected physiologic changes after smoking cessation is practically useful to encourage people to stop smoking. Furthermore, weight increase after cessation may affect such physiologic changes.Purpose: This article aims to evaluate the effect of smoking cessation on annual changes in body weight, blood pressure, and blood biochemistry.Methods: This study analyzed the results of annual health examinations from 1991 to 2005 in male Japanese workers in 2009. Subjects classified as stopping smoking (n=445) responded initially as smokers in a self-administered questionnaire (baseline year) and then answered consistently as nonsmokers for 3 subsequent years. Of the 2672 smokers identified in the study, 2403 subjects who had data available for at least 4 successive years were selected as controls. The time course of physiologic and laboratory data was analyzed using a linear mixed model.Results: Data adjusted for age, type of job schedule, drinking and physical activity showed that subjects who stopped smoking had significantly greater increases in weight, BMI, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and uric acid and a greater decrease in hemoglobin in the 3 years following smoking cessation than continuing smokers. Additional adjustment for change in BMI from baseline negated the significant deterioration in systolic and diastolic blood pressure and total cholesterol that occurred following smoking cessation.Conclusions: Increase in body weight, blood pressure, and blood biochemistry can continue for at least 3 years after smoking cessation. This study also indicated that these increases were related to the weight increase that occurred after smoking cessation.

The Intensity of Binge Alcohol Consumption Among U.S. Adults

Timothy S. Naimi, David E. Nelson, Robert D. Brewer — 2010-02-01

Background: Binge drinking (consuming five or more drinks during a drinking occasion) is responsible for more than half of the 79,000 annual deaths due to excessive drinking in the U.S. Although studies show a strong dose–response relationship between the intensity of binge drinking (i.e., the number of drinks consumed per binge episode) and adverse outcomes, there are no population-based studies assessing this measure.Purpose: This study aims to analyze population-based data from a module of questions on binge drinking among U.S. adults to assess the number of drinks consumed by binge drinkers and the associated independent risk factors for consuming more drinks.Methods: Data were analyzed from 14,143 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge drinking module in 2003 and 2004. Total drinks were calculated by summing the total number of beer, wine, and liquor-containing drinks consumed during a respondents' most recent binge drinking episode.Results: Binge drinkers consumed an average of 8.0 drinks (median 6) during their most recent binge drinking episode; 70.0% of binge drinkers consumed six or more drinks, and 38.4% consumed eight or more drinks. Men consumed more drinks during their last binge episode than women (M=8.3 vs 7.0, median=7 vs 6), and those aged 18–34 years consumed more drinks than those aged >34 years for both men and women. Independent risk factors for consuming eight or more drinks included being male; being aged <35 years; being other than white race/ethnicity; having less education; not being married; binge drinking three or more times in the past 30 days; and drinking mostly beer.Conclusions: Most adult binge drinkers drink in excess of the five-drink threshold defining this risky behavior. The intensity of binge drinking should be monitored regularly by health agencies to improve surveillance and to better assess the impact of interventions designed to reduce binge drinking and its consequences.

Pedometer-Measured Physical Activity Patterns of Youth: A 13-Country Review

2010-02-01

Context: Insufficient physical activity among young people aged 5–18 years is a global public health issue, with considerable disparities among countries. A systematic review was conducted to identify studies reporting pedometer daily steps (steps·day−1) in order to compile comparative, global cross-sectional data on youth physical activity patterns.Evidence acquisition: Articles were included if they were in English, published by April 2009, and reported steps·day−1 for boys and girls, separately, and reported steps·day−1 for age groupings of no more than 4 years (e.g., 5–8 years) or combined no more than three grade levels (e.g., third- to fifth-graders). Studies could have been intervention-based but had to have reported baseline steps·day−1, which would reflect unadulterated physical activity steps·day−1 estimates. Inverse variance weighted estimates (steps·day−1w) were calculated for each country, and random effects models were estimated. Analyses were conducted in May and June 2009.Evidence synthesis: Forty-three studies, representing young people in 13 countries (N=14,200), were included. The majority of studies were from the U.S. (17/43). Overall, there was considerable variation within and among countries in steps·day−1w. Boys and girls from European and Western Pacific regions had significantly more steps·day−1w than young people from the U.S. and Canada. Significantly lower steps·day−1w estimates for girls were observed for studies that combined measured steps·day−1 for weekdays and weekend days, in comparison to weekdays only.Conclusions: Limited sample sizes and non–population-based data preclude definitive statements regarding projected steps·day−1 within countries. Nevertheless, these findings provide preliminary information for policymakers and researchers on the extent of the disparities among countries in the physical activity patterns of young people.

The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms

2010-02-01

Abstract: A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups.

Increasing Alcoholic Beverage Taxes Is Recommended to Reduce Excessive Alcohol Consumption and Related Harms

Task Force on Community Preventive Services — 2010-02-01

Excessive use of alcohol is the third-leading cause of preventable death in the nation, and it presents a public health challenge that is being approached from many directions. The serious toll that alcohol-related injuries and disease impose on the population of the U.S. led the Task Force on Community Preventive Services (Task Force) to include reduction of excessive alcohol consumption and related harms as a priority topic in its earliest planning sessions. The Task Force has studied and made recommendations () on ways to reduce alcohol-impaired driving and excessive alcohol consumption, including interventions to regulate alcohol outlet density, maintain limits on the days on which and the hours in which alcohol can be sold, enhance enforcement of laws prohibiting sales to minors, and increase taxes on alcoholic beverages. A detailed report on the systematic review of the effectiveness of increasing alcohol taxes can be found in the accompanying article in this issue of the American Journal of Preventive Medicine.

The Need for Targeted Weight-Control Approaches in Young Women and Men

Catherine M. Loria, Caroline Signore, S. Sonia Arteaga — 2010-02-01

In this issue of the American Journal of Preventive Medicine, Brown et al. investigate the role that pregnancy plays in 10-year weight gain among a cohort of Australian women who were initially aged 18–23 years. Their results, based on women who were mostly nulliparous and unmarried at baseline, are consistent with previous findings suggesting that childbearing is a significant predictor of later weight gain. More than 40% of pregnant women in the U.S. gain weight in excess of recommended amounts; the IOM recently updated their guidelines for how much weight women should gain during pregnancy. Once gained, excess pregnancy weight is difficult to lose and may be associated with an increased risk of developing obesity, diabetes, and cardiovascular disease (CVD) later in life. Given that women who enter pregnancy overweight or obese are at higher risk of adverse pregnancy outcomes, such as preeclampsia, gestational diabetes, fetal macrosomia, cesarean delivery, and postpartum weight retention, it would be beneficial for women to attain a healthy weight before they consider pregnancy. However, about 50% of U.S. women of childbearing age are overweight or obese, and nearly 50% of pregnancies are unplanned.

Editorial Board

2010-02-01