Associations of Vitamin D Intake with 25-Hydroxyvitamin D in Overweight and Racially/Ethnically Diverse US Children

Overweight children and minorities are at risk of vitamin D deficiency. Little information exists on whether overweight children and minorities who do not meet dietary vitamin D recommendations are at risk for low 25-hydroxyvitamin D (25OHD) status. Vitamin D intake from foods and dietary supplements was estimated in 3,310 children/adolescents who were examined as part of the 2005-2006 National Health and Nutrition Examination Survey. Weight status was dichotomized into healthy weight or overweight/obese. Parent-reported race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Mexican American, or other. Adjusted logistic regression was used to determine whether children who did not achieve the Estimated Average Requirement (EAR) were at increased risk for inadequate 25OHD. Nearly 75% of children failed to meet the EAR. Overall, not meeting the EAR was associated with inadequate 25OHD (odds ratio=2.5; 95% CI 1.4 to 4.5). However, this association differed by weight status (P=0.02) and race/ethnicity (P=0.02). Overweight/obese children who failed to meet the EAR were five times more likely to be at risk for inadequate 25OHD than overweight/obese children who met it (95% CI 2.0 to 12.7; P<0.001). Non-Hispanic blacks with intakes below the EAR were nearly four times more likely to be at risk for inadequate 25OHD than those who met the EAR (95% CI 1.5 to 9.7; P<0.01). The majority of US children failed to meet current vitamin D recommendations. Overweight/obese and non-Hispanic black children were especially likely to be at risk for inadequate 25OHD when not consuming the EAR.     

Orange Juice,a Marker of Diet Quality,Contributes to Essential Micronutrient and Antioxidant Intakes in the United States Population

ObjectiveTo evaluate the impact of 100% orange juice (OJ) on the healthy diet and micronutrient intakes of the United States population.MethodsCross-sectional study of 13,971 people in the United States aged ≥ 4 years using 2 24-hour diet recalls from the National Health and Nutrition Examination Survey, 2003-2006.ResultsConsumption of OJ was higher among 4- to 8-year-old children, older adults (> 50 y old), non-Hispanic blacks, those with lower body mass index, those of lower income level, nonsmokers, dietary supplement users, and those participating in regular exercise (P < .05). Consumption of OJ was positively associated with the percentage of participants meeting MyPyramid recommendations for fruit consumption. Increased OJ consumption was correlated with increased daily intakes of certain micronutrients and antioxidants (P < .05). Percentages of participants with intakes below Estimated Average Requirements for these micronutrients decreased with increased OJ consumption (P < .001).Conclusions and ImplicationsThe implicated nutritional and potential health benefits of OJ warrant further investigation in clinical research studies.     

Disparities in Consumption of Sugar-Sweetened and Other Beverages by Race/Ethnicity and Obesity Status among United States Schoolchildren

ObjectiveIdentify disparities by race/ethnicity and obesity status in the consumption of sugar-sweetened beverages (SSBs) and other beverages among United States schoolchildren to help tailor interventions to reduce childhood obesity.DesignSecondary data analysis using beverage intake data from 24-hour dietary recalls and measured height and weight from the third School Nutrition Dietary Assessment Study, a 2004-2005 nationally representative sample of school-aged children and schools.SettingSchools participating in the National School Lunch Program (n = 287).ParticipantsChildren in grades 1-12 with a completed 24-hour dietary recall (n = 2,314).Main Outcome Measure(s)Percentage of children consuming beverages in 8 beverage categories by school level and consumption location.AnalysisTwo-tailed t tests to determine significant differences (P < .05) between the proportions of children consuming beverages by race/ethnicity and weight status.ResultsBeverage consumption patterns did not substantially differ across weight status groups, but they differed by race/ethnicity in the home. Non-Hispanic black elementary schoolchildren consumed nonsoda SSBs more often and unflavored, low-fat milk less often at home than non-Hispanic white schoolchildren.Conclusions and ImplicationsHigher consumption of SSBs coupled with a lower consumption of milk is disproportionately affecting non-Hispanic black schoolchildren. Targeted interventions by racial/ethnic group are needed to promote more healthful beverage choices among schoolchildren, particularly at home.     

Dietary Intakes of Preschool-Aged Children in Relation to Caregivers’ Race/Ethnicity, Acculturation, and Demographic Characteristics: Results from the 2007 California Health Interview Survey

Few studies have examined the influence of acculturation on dietary behaviors of young children while controlling for other demographic variables. The purpose of this study was to assess reported dietary intakes of preschool-aged children (3?C5?years) and subsequent associations with caregivers?? race/ethnicity, acculturation and demographic characteristics, using data from the 2007 California Health Interview Survey (CHIS). Analysis was restricted to Hispanic and non-Hispanic white caregivers and their preschool-aged children (n?=?1,105). Caregivers?? acculturation was assessed using place of birth, duration of United States residence, and language spoken at home. Proxy-reports by caregivers to a dietary screener were used to estimate children??s intakes of fruit, 100% fruit juice, vegetables, sweets, and sugar-sweetened beverages consumed. In multivariate analyses, Hispanic caregivers reported their children consumed fewer servings of vegetables than did the children of non-Hispanic white caregivers; there were no other statistically significant differences in children??s dietary intakes by caregivers?? race/ethnicity. Caregivers?? acculturation was associated with caregiver-reported consumption of sweets by children (???=?0.09, 95%CI?=?0.01?C0.18). Demographic characteristics that were associated with reported dietary intakes of children included caregivers?? age, education, and geographic region of residence. In contrast to past studies of acculturation and diet in older children and adults, this study suggests that for 3?C5?year olds, caregivers?? level of acculturation does not play as strong a role in the dietary intakes of the younger children under their care.     

Race/Ethnicity and Income in Relation to the Home Food Environment in US Youth Aged 6 to 19 Years

BackgroundThe home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity.ObjectiveTo examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures).DesignA cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES).ParticipantsA total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10.Statistical analyses performedPrevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures.ResultsNon-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR.ConclusionsRace/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people.     

Vitamin D intakes by children and adults in the United States differ among ethnic groups

Concerns about vitamin D status in the United States have resurfaced due to increasing reports of insufficiency and deficiency. Few foods contain vitamin D naturally, and currently few foods are fortified in the United States. Intakes of vitamin D in the United States from food and food plus supplements by age, sex, and race/ethnicity group were estimated. Individuals > or = 1 y old who participated in the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000) were included in the analysis. Vitamin D intake by non-Hispanic (NH) white, NH black, Mexican American, and all individuals in the United States was estimated and compared with recommended levels. Vitamin D intakes were highest among children and teenagers, and lowest in the oldest age categories. Among children age 1-8 y, adequate intake (AI) levels for vitamin D from food were met or exceeded by 69% of Mexican American, 59% of NH white, and 48% of NH black subpopulations. Among adults > or = 51 y old, only 4% met or exceeded the AI from food alone. Few women 19-50 y old or men and women > or = 51 y old were estimated to consume recommended vitamin D levels from food. Mean dietary intakes of vitamin D from food plus supplements were consistently highest among NH white populations, although only small proportions of all those > or = 51 y old had intakes above the recommended levels. The large discrepancy between vitamin D intake by older individuals from food plus supplements and recommended levels, especially for NH black and Mexican American adults, warrants intervention.     

US Adults Fall Short of the Dietary Guidelines for Cancer Prevention Regardless of BMI Category

BackgroundCancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk.ObjectiveThe objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status.DesignThis was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES).Participants/settingDietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed.Main outcome measuresDifferences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories.Statistical analyses performedLogistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate.ResultsRegarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P < .001). Adults with obesity consumed significantly less dietary fiber and more processed meat than adults with normal BMI and overweight (P < 0.001).ConclusionsFew U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.     

Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction,transmission risk group,and race/ethnicity,United States, 2015

PurposeEffectively measuring progress in delivering HIV pre-exposure prophylaxis (PrEP) requires subnational estimates of the number of adults with indications for its use that account for differences in HIV infection rates by transmission risk (risk) group and race/ethnicity.MethodsWe applied a multiplier method with 2015 Centers for Disease Control and Prevention surveillance data on proportions of HIV diagnoses by race/ethnicity and risk group and population-based estimates of risk group sizes to derive estimated numbers of adults with indications by risk group (men who have sex with men [MSM], heterosexually active adults [HET], and persons who inject drugs [PWID]) by race/ethnicity in each jurisdiction.ResultsAn estimated 1.1 million adults had indications for PrEP use in 2015: 813,970 MSM, 258,080 HET, and 72,510 persons who inject drugs, and 500,340 blacks, 282,260 Latinos, and 303,230 whites. Among HET, 176,670 females and 81,410 males had indications. The proportions of adults with indications in each risk and race/ethnicity group varied by jurisdiction.ConclusionsBlacks comprised the highest number of adults with indications showing that increasing PrEP use in this population must be the highest priority. MSM remain a priority because of the high number with indications. These estimates can be used as denominators to assess PrEP coverage and impact on HIV incidence at subnational levels.     

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey

BackgroundLittle is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension.ObjectiveThe aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness.DesignAnalysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population.Participants/settingA total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included.Main outcome measuresDiet quality was assessed by Healthy Eating Index 2015 (HEI-2015).Statistical analysis performedWeighted χ² tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates.ResultsAmong the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status.ConclusionsThere were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.     

Disparities in national and state estimates of COVID-19 vaccination receipt and intent to vaccinate by race/ethnicity,income, and age group among adults ≥ 18 years,United States

IntroductionCOVID-19 morbidity and mortality has disproportionately affected vulnerable populations such as minority racial/ethnic groups. Understanding disparities in vaccine intentions and reasons for vaccine hesitancy are important for developing effective strategies for ameliorating racial/ethnic COVID-19 inequities.MethodsUsing six waves of the large, nationally representative Census Bureau’s Household Pulse Survey data from January 6-March 29, 2021 (n = 459,235), we examined national and state estimates for vaccination intent, defined as receipt of ≥ 1 dose of the COVID-19 vaccine or definite intent to be vaccinated, by race/ethnicity with stratification by household income and age group. In separate logistic regression models, we also examined the interaction between race/ethnicity and household income, and race/ethnicity and age group, and its association with vaccination intent. Lastly, we examined reasons for not vaccinating by race/ethnicity.ResultsVaccination intent differed by racial/ethnic group, household income, and age group nationally and by Health and Human Services (HHS) region and state. A significant interaction was observed between race/ethnicity and household income (F(8,72) = 4.50, p < 0.001), and race/ethnicity and age group (F(8,72) = 15.66, p < 0.001). Non-Hispanic Black adults with lower income (<$35,000) and younger age (18–49 years) were least likely to intend to vaccinate. Similar disparities across racial/ethnic groups were seen across most HHS regions and states. Concerns about possible side effects and effectiveness were significantly higher among all minority groups compared to non-Hispanic White adults.ConclusionDisparities in vaccination intent by racial/ethnic groups underscore the need for interventions and recommendations designed to improve vaccination coverage and confidence in underserved communities, such as younger and lower income racial/ethnic minority groups. Efforts to reduce disparities and barriers to vaccination are needed to achieve equity in vaccination coverage, and ultimately, to curb COVID-19 transmission.     

The relationship between household income and dietary intakes of 1-10 year old urban Malaysian

BACKGROUND/OBJECTIVES

Diet plays an important role in growth and development of children. However, dietary intakes of children living in either rural or urban areas can be influenced by household income. This cross-sectional study examined energy, nutrient and food group intakes of 749 urban children (1-10 years old) by household income status.

SUBJECTS/METHODS

Children''s dietary intakes were obtained using food recall and record for two days. Diet adequacy was assessed based on recommended intakes of energy and nutrients and food group servings.

RESULTS

For toddlers, all nutrients except dietary fiber (5.5 g) exceeded recommended intakes. Among older children (preschoolers and school children), calcium (548 mg, 435 mg) and dietary fiber (7.4 g, 9.4 g) did not meet recommendations while percentage of energy from total fat and saturated fats exceeded 30% and 10%, respectively. The mean sodium intakes of preschoolers (1,684 mg) and school children (2,000 mg) were relatively high. Toddlers in all income groups had similar energy and nutrient intakes and percentages meeting the recommended intakes. However, low income older children had lowest intakes of energy (P < 0.05) and most nutrients (P < 0.05) and highest proportions that did not meet recommended energy and nutrient intakes. For all food groups, except milk and dairy products, all age groups had mean intakes below the recommended servings. Compared to middle and high income groups, low income preschoolers had the lowest mean intake of fruits (0.07 serving), meat/poultry (0.78 serving) and milk/dairy products (1.14 serving) while low income toddlers and school children had the least mean intake of fruits (0.09 serving) and milk/dairy products (0.54 serving), respectively.

CONCLUSION

Low socioeconomic status, as indicated by low household income, could limit access to adequate diets, particularly for older children. Parents and caregivers may need dietary guidance to ensure adequate quantity and quality of home food supply and foster healthy eating habits in children.     

Racial–ethnic disparities in the association between risk factors and diabetes: The Northern Manhattan Study

PurposeTo identify risk factors (RF) for diabetes within a multiethnic cohort and to examine whether race–ethnicity modified their effects.MethodsParticipants in the Northern Manhattan Study without diabetes at baseline were studied from 1993 to 2014 (n = 2430). Weibull regression models with interval censoring data were fit to calculate hazard ratios and 95% confidence intervals for incident diabetes. We tested for interactions between RF and race–ethnicity.ResultsDuring a mean follow-up period of 11 years, there were 449 diagnoses of diabetes. Being non-Hispanic black (HR 1.69 95% CI 1.11–2.59) or Hispanic (HR 2.25 95% CI 1.48–3.40) versus non-Hispanic white, and body mass index (BMI; HR 1.34 per SD 95% CI 1.21–1.49) were associated with greater risk of diabetes; high-density lipoprotein cholesterol (HR 0.75 95% CI 0.66–0.86) was protective. There were interactions by race–ethnicity. In stratified models, the effects of BMI, current smoking, and C-reactive protein (CRP) on risk of diabetes differed by race–ethnicity (p for interaction < 0.05). The effects were greater among non-Hispanic whites than non-Hispanic blacks and Hispanics.ConclusionsAlthough Hispanics and non-Hispanic blacks had a greater risk of diabetes than whites, there were variations by race–ethnicity in the association of BMI, smoking, and CRP with risk of diabetes. Unique approaches should be considered to reduce diabetes as traditional RF may not be as influential in minority populations.     

Vitamin D intakes of children differ by race/ethnicity,sex, age,and income in the United States, 2007 to 2010

The 2007-2010 National Health and Nutrition Examination Survey was used to estimate vitamin D intakes of children 1 to 18 years old in the United States by race/ethnicity, sex, age, and family using 24-hour dietary intake recalls and dietary supplement use questionnaires. We hypothesized that total, dietary, and supplemental vitamin D intakes of children would differ by race/ethnicity, sex, age, and income. Statistical analyses of weighted data were performed using Statistical Analysis Software (V 9.2) to estimate means ± SE. Race and ethnic intake differences controlling for poverty income ratio (PIR), sex, and age were assessed by analysis of covariance. Total (dietary and supplement) vitamin D intake was greater in the high (7.9 ± 0.3 μg/d) vs the medium (6.5 ± 0.3 μg/d) income group, but not the low (7.2 ± 0.2 μg/d) PIR group. Total vitamin D intake of non-Hispanic (NH) white children (8.1 ± 0.2 μg/d) was greater than Hispanic (7.0 ± 0.2 μg/d) and NH black (5.9 ± 0.2 μg/d) children. Total vitamin D intake declined with age, and intake by boys was higher than girls. Only 17.4% of the children consumed supplements containing vitamin D. Overall, mean intake of vitamin D by all children in each age and ethnic group was lower than the estimated average requirement for vitamin D. Public health efforts should encourage consumption of foods high in vitamin D, expand the number of foods fortified, and target health messages to parents to increase use of vitamin D supplements by children.     

Urinary Concentrations of 2,4-Dichlorophenol and 2,5-Dichlorophenol in the U.S. Population (National Health and Nutrition Examination Survey, 2003–2010): Trends and Predictors

Background: 2,4-Dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), and their precursors are widely used in industry and in consumer products. Urinary concentrations of these dichlorophenols (DCPs) have been measured as part of four National Health and Nutrition Examination Survey (NHANES) cycles in order to assess the exposure to these compounds or their precursors among the general U.S. population.Objectives: We identified predictors and evaluated trends in DCP concentrations according to race/ethnicity, age, sex, family income, and housing type.Methods: We used analysis of covariance to examine associations of various demographic parameters and survey cycle with urinary concentrations of DCPs during NHANES 2003–2010. We also conducted weighted logistic regressions to estimate associations of DCP concentrations above the 95th percentile with housing type, race/ethnicity, and income.Results: We detected DCPs in at least 81% of participants. Geometric mean (GM) urinary concentrations were higher for 2,5-DCP (6.1–12.9 μg/L) than 2,4-DCP (0.8–1.0 μg/L) throughout 2003–2010. Adjusted GM concentrations of the DCPs among children (6–11 years of age) and adults > 60 years of age were higher than among adolescents and other adults. Adjusted GM concentrations among non-Hispanic whites were lower than among non-Hispanic blacks and Mexican Americans, although differences according to race/ethnicity were less pronounced among participants in high-income households. Among non-Hispanic blacks and Mexican Americans, adjusted GM concentrations were lowest among high-income participants relative to other income groups, with a monotonic decrease with increasing income among Mexican Americans. Type of housing and race/ethnicity were significant predictors of DCP urinary concentrations above the 95th percentile. Furthermore, urinary DCP concentrations have showed a downward trend since 2003.Conclusions: Exposure to DCPs and their precursors was prevalent in the general U.S. population in 2003–2010. We identified age and race/ethnicity, family income, and housing type as predictors of exposure to these compounds.Citation: Ye X, Wong LY, Zhou X, Calafat AM. 2014. Urinary concentrations of 2,4-dichlorophenol and 2,5-dichlorophenol in the U.S. population (National Health and Nutrition Examination Survey, 2003–2010): trends and predictors. Environ Health Perspect 122:351–355; http://dx.doi.org/10.1289/ehp.1306816     

The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results

BackgroundFood insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity.ObjectiveThis study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity.DesignCross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys.ParticipantsThe study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes ≤300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls.Main outcome measuresDiet quality was assessed using the Healthy Eating Index-2015.Statistical analyses performedAssociations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates.ResultsCompared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI –3.35 to –1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit.ConclusionsFood insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.     

Pneumococcal vaccination coverage among persons ≥65 years—United States, 2013

BackgroundInvasive pneumococcal disease is a major cause of illness in the United States, and rates are higher among persons ≥65 years. Pneumococcal vaccination has been recommended to adults ≥65 years since 1997.MethodsData from the 2005–2013 Behavioral Risk Factor Surveillance System were analyzed. Weighted estimates of pneumococcal vaccination coverage were calculated by state and race/ethnicity and tests for linear trend were performed.ResultsIn 2013, the median state vaccination coverage among adults ≥65 years was 69.5%, and coverage ranged from 61.9% in New Jersey to 75.6% in Oregon. Coverage overall among non-Hispanic whites (71.1%) was higher than coverage for non-Hispanic blacks (57.7%), Hispanics (51.9%), and non-Hispanic persons of other race (65.4%). Coverage increased from 2005 to 2013 overall and by racial/ethnic subgroups.ConclusionAlthough pneumococcal vaccination coverage has improved in the past several years, coverage remains below the Healthy People 2020 target of 90% and racial/ethnic disparities exist.     

Watching Television while Eating: Associations with Dietary Intake and Weight Status among a Diverse Sample of Young Children

BackgroundTelevision (TV) watching at family meals has been associated with poorer dietary quality and weight outcomes in children. Most research has been limited to family meals, overlooking the influence of TV at any meal.ObjectiveThis study assesses how often children are eating meals at home while watching TV, the association between child dietary intake while watching TV during meals eaten at home and whether the association depends on meal type (eg, breakfast) or child race/ethnicity, and whether the number of meals consumed while watching TV at home is associated with overall child dietary quality or weight status.DesignThe Family Matters study utilized a cross-sectional design and was conducted between 2015 and 2016.Participants/settingThree 24-hour dietary recalls were conducted on children aged 5 to 7 years (n=150; 25 each from non-Hispanic white, African American, Latino, Native American, Somali, and Hmong households).Main outcome measuresMain outcomes of this study were dietary intake at meals, overall dietary quality, and child weight status.Statistical analysis performedConditional fixed effects estimators were used to address correlated error terms to model within-person variation between TV and dietary intake and race/ethnicity differences in child dietary outcomes.ResultsTV was watched during 30% of meals eaten at home, which differed significantly by race/ethnicity (P<0.001). Although effect sizes were small, TV watching at meals was associated with unhealthier intake of some foods groups (eg, increased sugar-sweetened beverages and chips/crackers and decreased fruits), dependent on the meal occasion (eg, snacks). However, TV watching during meals at home was not significantly associated with dietary intake for other food groups. These associations did not depend on race/ethnicity. An association between number of meals consumed while watching TV with overall dietary quality or weight status was not found.ConclusionsAlthough more research is needed, results suggest TV watching while eating meals at home is relatively common, depends on race/ethnicity, and that TV watching at some meal occasions is associated with child intake of certain food groups, with a majority being unhealthy.     

Demographics,not beverage consumption,is associated with diet quality

Background Demographic characteristics and beverage choices may affect diet quality.

Objective To estimate the independent associations between consumption of food categories of the US Department of Agriculture Food Guide Pyramid, beverage consumption, gender, age, family income, and race/ethnicity with the Healthy Eating Index (HEI).

Methods Data from the Continuing Survey of Food Intake by Individuals 1994–96, 1998 were used to develop multiple regression models of demographics and food and beverage consumption regressed on the HEI.

Results After adolescence (13–19 years), males consistently had a lower diet quality than females. Young adults (20–29 years) had the poorest diet quality. Family income had a positive association with the HEI. Controlling for income, African-Americans had lower HEI scores than other race/ethnicity groups. Caucasians consumed significantly more milk products than did the other race/ethnicity groups. Consumption of beverages had a weak but positive association with the HEI.

Conclusions Family income and race/ethnicity have unique and independent associations with the HEI and dietary patterns.     

Population Nutrient Intake Approaches Dietary Recommendations: 1991 to 1995 Framingham Nutrition Studies

Objective To estimate population nutrient intake levels and to assess adherence to current dietary recommendations for health promotion and disease prevention.Design Cross-sectional analysis of nutrient intake estimated from 3-day food records. Median macronutrient and micronutrient intake levels for men, women, and the total population are reported along with the proportions of men and women who achieved intakes compatible with nutrient goals defined by published guidelines.Setting Adult participants (2,520: 1,375 women and 1,145 men) in the Framingham Offspring-Spouse Study surveyed between 1991 and 1995.Statistical analyses χ² Analyses were used to test for gender differences in the proportions of persons who had intakes that met nutrient guidelines.Results Population intake levels of certain key nutrients, including total and saturated fat, appear to be approaching recommended levels. High proportions of the Framingham population (70% or more) met current recommendations for intakes of protein, polyunsaturated and monounsaturated fat, cholesterol, alcohol, vitamins C and B-12, and folacin. About half or fewer met guidelines for carbohydrate; total and saturated fat; fiber; beta carotene; vitamins A, E, and B-6; calcium; and sodium. Important gender differences in the proportion of those meeting nutrient guidelines were observed for 12 of the 18 nutrients examined, including carbohydrate; total, saturated, and monounsaturated fat; cholesterol; fiber; sodium; calcium; and several vitamins.Conclusions Although progress has been made toward achieving population adherence to preventive nutrition recommendations, large proportions of adults fall short of guidelines for some key nutrients. Differences in adherence rates between men and women suggest areas for gender-specific, targeted nutrition messages and behavioral interventions.