COVID-19 vaccine confidence and reasons for vaccination among health care workers and household members

BackgroundThe majority of healthcare workers (HCW) in the US report being fully vaccinated against COVID-19, yet little is known about vaccine decision-making for their household members, including children.MethodsCross-sectional survey July–August 2021 of HCW and their household members in Minnesota.Results94 % of eligible participants were vaccinated with the most common reasons being wanting to protect oneself, family and loved ones. Safety concerns were the most commonly reported reasons for not being vaccinated; a significantly higher proportion of unvaccinated compared to vaccinated HCW (58 % vs 12 %, p = 0.0035) and household adults (25 % vs 5 %, p = 0.03) reported prior SARS-CoV-2 infection. Nearly half of unvaccinated adults and two-thirds of unvaccinated children would be vaccinated if a vaccine mandate were in place.ConclusionsDespite high COVID-19 vaccine acceptance among HCWs, more research is required to identify and address the needs and concerns of healthcare workers who decline COVID-19 vaccination despite availability.     

Child and adult disability in the 2000 Census: Disability is a household affair

BackgroundSurvey data indicate that individuals with disabilities in the United States often experience less advantageous economic and social resources than individuals without disabilities. Furthermore, they often reside with other individuals with disabilities in the same household. However, less is known about resource availability when multiple child and adult household members have a disability.ObjectiveWe use child-level data from the 2000 Census to examine the relationship between aggregation of disability in households with children and education, labor force participation, poverty level, and inadequate housing.MethodsWe utilize tabular analysis and Kruskal–Wallis tests to examine how resources in education, employment, income, and housing adequacy compare for children with disabilities who are the only member of their household with a disability, children with disabilities who live in a household with at least one other member with a disability, children without disabilities who live in a household where no other member has a disability, and children without disabilities who live in a household where at least one other member has a disability.ResultsAmong children without a disability, 86% live in a household in which no other member has a disability. Among children with a disability, 53% live in a household in which no other adult or child has a disability. Poverty, inadequate housing, and low adult education were more than two times more likely – and adult unemployment over five times more likely – in households with multiple members with disability versus households without disability.ConclusionThere is a high prevalence of aggregation of adults and children with disability in households of children with disability. These households have substantially fewer resources than households who do not have children or adults with disabilities.     

Increased Tobacco Exposure in Older Children and Its Effect on Asthma and Ear Infections

PurposeTo examine selected social determinants of children's exposure to household tobacco use and smoking inside the home and to assess the effect of second-hand smoke exposure on asthma and ear infections across children's age groups.MethodsA total of 90,961 parents of children aged 0–17 years from the 2007 National Survey of Children's Health were included in the study.ResultsIn all, 26.2% of parents reported that anyone in the household used tobacco products. Parents of children aged 6–11 and 12–17 years were 1.97 (adjusted OR; 95% CI, 1.65–2.36) and 2.93 (2.46–3.49) times more likely, respectively, to report that someone smoked inside the house than parents of younger children. Second-hand smoke exposure varied by children's race/ethnicity, and children from more disadvantaged circumstances were more likely to be exposed. For all children, they were more likely to ever have asthma if someone in their household used tobacco. Although young children's likelihood of recurrent ear infections did not increase with household tobacco use, children aged 12–17 were 1.67 (1.02–2.72) times more likely to have recurrent ear infections if someone smoked inside their home.ConclusionFamily members are increasingly likely to smoke indoors as children age, which may increase adolescents' vulnerability to ear infections. Parents and health professionals should monitor second-hand smoke exposure at home and encourage a smoke-free environment.     

“If You Don't Ask,I'm Not Going to Tell You”: Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care

BackgroundPublic health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings.MethodsThis community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context.ResultsParticipants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI.ConclusionsFuture work should examine the experience and effectiveness of implementing these community-based participatory research–derived recommendations in primary care.     

Does Alcohol Outlet Density Affect Youth Access to Alcohol?

PurposeTo investigate how community alcohol outlet density may be associated with alcohol access among adolescents.MethodsData were collected through a three-wave panel study with youth aged 14–16 at baseline using computer-assisted telephone interviews. Study participants were recruited from 50 zip codes with varying alcohol outlet density and median household income in California. Data analyses were conducted using multilevel, linear growth models and data from 1028 youth (52% male, 51% white).ResultsAfter taking into account individual-level factors and zip code median household income, zip code alcohol outlet density was significantly and positively related to the initial levels of the likelihood and frequency of getting alcohol through various sources including commercial outlets, shoulder tapping, home or family members, and underage acquaintances.ConclusionsHigh levels of alcohol outlets in the community enable youth access to alcohol through commercial outlets, family, and social networks.     

Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative

ObjectiveTo develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice.DesignBasic qualitative research design, semistructured phone interviews with community health coalition members.SettingFive rural Southern counties (obesity prevalence > 40%).ParticipantsThirty-nine community coalition members.InterventionThe Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model.Phenomenon of InterestSocial norms and cultural influences surrounding community members’ food preferences, physical activity behavior, and future hopes for community development.AnalysisAbductive content analysis.ResultsMajor categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives.Conclusions and ImplicationsBecause of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.     

Severity of household food insecurity and lifetime racial discrimination among African-American households in South Carolina

Objectives: In 2014, 30% of African-American households with children had low or very low food security, a rate double that of white households with children. A household has low food security if its members experience food shortages and reductions in food quality attributable to a lack of household resources or access and very low food security if its members also experience reductions in food intake and disrupted eating patterns. Households that are either low or very low food secure are known collectively as food insecure. We examined the association between the severity of household food insecurity and reports of lifetime racial discrimination among a sample of food-insecure African-American households in South Carolina.

Design: Data were collected from 154 African-American respondents. Food insecurity was measured using the US Department of Agriculture’s Household Food Security Survey Module. Lifetime racial discrimination was measured using the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). We used logistic regression to test the association between severity of food insecurity (low vs. very low food secure), PEDQ-CV score and PEDQ-CV subscales. All models were adjusted for demographic and socioeconomic variables.

Results: A one-unit increase in the frequency of lifetime racial discrimination was associated with a 5% increase in the odds of being very low food secure (odds ratio (OR) 1.05, P?P?P?P?P?>?.05).

Conclusions: Severity of household food insecurity is associated with lifetime racial discrimination among African-American households in South Carolina.     

Amélioration de la gestion d’un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda

BackgroundIn order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training.MethodsThe prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition.ResultsOur findings show that children from 12–35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan.ConclusionCommunity based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.     

“The flu… is a little more complicated than a cold”: Knowledge,beliefs, and practices related to influenza and influenza vaccination among at-risk populations and health professionals in Peru

BackgroundInfluenza is a major source of morbidity and mortality with an annual global attack rate estimated at 5–10% in adults and 20–30% in children. Influenza vaccination is the main strategy for reducing influenza-related morbidity and mortality. Like several other countries, Peru has low vaccination coverage, estimated at 25–50% among young children and older adults. Therefore, the study objective was to explore the knowledge, beliefs, attitudes, and practices related to influenza vaccination among populations at higher risk for infection and/or complications and health professionals in Peru, and their perspectives on health communication channels.MethodsThis qualitative study was carried out in three cities. We held nine focus groups with pregnant and postpartum women, parents of young children, and older adults. We carried out 25 in-depth interviews with health professionals (HPs) working in, leading or advising immunization-related programs.ResultsHPs correctly identified the causes of influenza and HPs and at risk community members identified major symptoms. Community members had poor awareness of the potential severity of influenza and were generally unaware of influenza-related mortality. Both HPs and community members greatly underestimated the prevalence of influenza in Peru. HPs in our study overestimated major side effects of the influenza vaccine and community members perceived that the vaccine caused illness. HPs missed important opportunities to promote vaccination in patients with minor illness (runny nose, allergies, colds) and community members did not understand that the vaccine should be received annually.ConclusionsThere is no single strategy that will increase influenza vaccination rates to World Health Organization recommended levels. Instead, it requires multi-faceted commitment from HPs, other healthcare authorities and the government. Addressing important knowledge barriers, specifically negative views regarding the influenza vaccine and the severe morbidity and mortality associated with influenza illness, both in the community and especially among HPs, could have significant impacts.     

Establishment of a Community Advisory Board (CAB) for tuberculosis control and research in the Inanda,Ntuzuma and KwaMashu (INK) area of KwaZulu-Natal,South Africa

ObjectivesTo strengthen community mobilization, education, awareness and involvement in research to improve Tuberculosis (TB) control, by building partnership between communities and the health sector through the establishment of a Community Advisory Board (CAB) in the Inanda, Ntuzuma and KwaMashu (INK) area.MethodsKey stakeholders from multiple sectors of the target community were identified. Two workshops were held with the aim of communicating the need for CAB and selecting its members. A 22 member INK CAB with representatives from different sectors in the community was selected. CAB members were trained through a 2-day workshop on TB and research.ResultsVarious activities were successfully initiated and spearheaded by the INK CAB, and these involved training of Traditional Healers, recruiting of more TB tracer teams, organizing awareness campaigns during TB World Day, establishing TB school peer educators and links with NGOs to support impoverished TB patients all with positive outcomes.ConclusionsThe INK CAB is a successful example of providing a mechanism for community consultation and participation that contributes to promoting and facilitating relevant research and TB control activities.     

Validity of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment (HIA) in sustainable development projects

BackgroundParticipation in home, school, and community activities is an important indicator of child health and well-being. Evaluating environmental influences on children's participation can inform efforts to develop sustainable built environments, but few validated measures exist.ObjectiveTo examine the concurrent validity and utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment in non-urban sustainable development projects affecting children with disabilities.MethodsEighty-nine parents of children and youth with disabilities who identified as residing in a small town or rural community were sampled. Sixty-six caregivers completed the PEM-CY online, and 23 caregivers completed the PEM-CY and CHIEF-CP paper forms. Spearman correlational analyses were conducted to establish the concurrent validity of the PEM-CY environment sections against the CHIEF-CP. Group comparisons by child's age, number of functional limitations, and annual household income were used to examine differences in summary and item-level responses on the PEM-CY community section.ResultsModerate to strong associations were found between CHIEF-CP Total Product and Magnitude Scores and all PEM-CY Environment Summary Scores. CHIEF-CP Physical/Structural and Policies Subscale Scores were most consistently associated with PEM-CY Environment Summary Scores. Group differences by household income were found for participation frequency and number of supports, including perceived availability and adequacy of money and information about programs and services, even when controlling child's age and number of functional limitations.ConclusionStudy results lend support to the use of the PEM-CY in HIA to reliably assess for environmental impact on children's participation. Implications for using the PEM-CY to inform decision-making in non-urban sustainable development projects affecting families of children and youth with disabilities are discussed.     

Assessment of temporally-related acute respiratory illness following influenza vaccination

BackgroundA barrier to influenza vaccination is the misperception that the inactivated vaccine can cause influenza. Previous studies have investigated the risk of acute respiratory illness (ARI) after influenza vaccination with conflicting results. We assessed whether there is an increased rate of laboratory-confirmed ARI in post-influenza vaccination periods.MethodsWe conducted a cohort sub-analysis of children and adults in the MoSAIC community surveillance study from 2013 to 2016. Influenza vaccination was confirmed through city or hospital registries. Cases of ARI were ascertained by twice-weekly text messages to household to identify members with ARI symptoms. Nasal swabs were obtained from ill participants and analyzed for respiratory pathogens using multiplex PCR. The primary outcome measure was the hazard ratio of laboratory-confirmed ARI in individuals post-vaccination compared to other time periods during three influenza seasons.ResultsOf the 999 participants, 68.8% were children, 30.2% were adults. Each study season, approximately half received influenza vaccine and one third experienced ≥1 ARI. The hazard of influenza in individuals during the 14-day post-vaccination period was similar to unvaccinated individuals during the same period (HR 0.96, 95% CI [0.60, 1.52]). The hazard of non-influenza respiratory pathogens was higher during the same period (HR 1.65, 95% CI [1.14, 2.38]); when stratified by age the hazard remained higher for children (HR 1·71, 95% CI [1.16, 2.53]) but not for adults (HR 0.88, 95% CI [0.21, 3.69]).ConclusionAmong children there was an increase in the hazard of ARI caused by non-influenza respiratory pathogens post-influenza vaccination compared to unvaccinated children during the same period. Potential mechanisms for this association warrant further investigation. Future research could investigate whether medical decision-making surrounding influenza vaccination may be improved by acknowledging patient experiences, counseling regarding different types of ARI, and correcting the misperception that all ARI occurring after vaccination are caused by influenza.     

Influenza vaccination among adults living with persons at high-risk for complications from influenza during early 2016–17 influenza season

BackgroundThe Advisory Committee on Immunization Practices (ACIP) recommends all persons aged ≥6 months get vaccinated for influenza annually, placing particular emphasis on persons who are at increased risk for influenza-related complications and persons living with or caring for them.MethodsData from the 2016 National Internet Flu Survey (NIFS), a nationally representative, probability-based Internet panel survey of the noninstitutionalized U.S. civilian population aged ≥18 years, was used to compare influenza vaccination coverage among adults who live with household members at high-risk for complications from influenza with those who do not. Logistic regression was used to evaluate the difference in the adjusted vaccination coverage prevalence between persons living with and without high-risk household members.ResultsFrom the 2016 NIFS (n = 4,113), we estimated that 29.2% of noninstitutionalized U.S. adults had at least one household member at increased risk for influenza-related complications. Unadjusted influenza vaccination coverage was significantly higher for adults with a high-risk household member compared with those without (46.7% vs 38.6%, respectively). After adjustment for demographic and access-to-care factors, adults with high-risk household members were more likely to be vaccinated than those without (adjusted prevalence difference = 5.3 [0.3, 10.3]). Among vaccinated respondents with high-risk household members, 88.7% reported that protection of their family and close contacts was one of the reasons they were vaccinated.ConclusionApproximately half of adults living with someone at increased risk of complications from influenza did not report receiving an influenza vaccination. Vaccination reminder/recall for persons at increased risk should include reminders for their household contacts.     

Soliciting views of various communities on health research: a prelude to engagement in specific research projects

BackgroundMembers of the public are increasingly engaged in health‐service and biomedical research and provide input into the content of research, design and data sharing. As there is variation among different communities on how research is perceived, to engage all sectors of the general public research institutions need to customize their approach.ObjectiveThis paper explores how research institutions and community leaders can partner to determine the best ways to engage different sectors of the public in research.DesignFollowing a literature review, a research institution engaged with four different sectors of the public through their respective representative community‐based organizations (CBOs) by interviews with leaders, community member focus groups and a joint project.SettingSan Diego and Imperial Counties, California, United States of America (USA).ConclusionBefore embarking on more specific research projects, investigators can gain valuable insights about different communities'' attitudes to, and understanding of, health services and biomedical research by interacting directly with members of the community, collaborating with community leaders, and jointly identifying steps of engagement tailored to the community.     

Do Parents Perceive That Organized Activities Interfere with Family Meals? Associations between Parent Perceptions and Aspects of the Household Eating Environment

BackgroundResearch has related child participation in organized activities to health and academic benefits; however, participation may interfere with family meals.ObjectiveExamine whether parents perceive child participation in organized activities to interfere with family meals and how perceptions are related to the household eating environment.DesignA cross-sectional analysis was completed using survey data collected in 2015-2016 as part of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study.ParticipantsSurvey participants were originally recruited in Minneapolis–St Paul schools in 1998-1999. The analytic subsample of parents (one per household, n=389, 69% female, 31% nonwhite race, mean age=31) had one or more children involved in an organized activity. Approximately 33% of households included a child aged 2 to 5 and no older child; two thirds of households included school-aged children (6 to 18 years).Main outcome measuresParents reported family meal frequency, family meal scheduling difficulties, frequency of at-home meal preparation, and their own intake of fast food, fruit, and vegetables.Statistical analyses performedAnalyses compared household environment characteristics reported by parents who perceived low interference between organized activities and family meals to characteristics reported by parents who perceived moderate to high interference from at least one form of activity. Regression models included a dichotomous indicator of interference as the independent variable and were adjusted for parental and household characteristics.ResultsAmong parents with children at any age, moderate to high interference was associated with lower family meal frequency, greater difficulty scheduling family meals, and more fast-food intake (all P≤0.01). The perception of moderate to high interference was more common among parents who reported involvement in both sport and nonsport activities (P<0.001) and those with a school-aged child (P<0.001) vs those with only preschool-aged children.ConclusionsFollow-up research, including qualitative studies, is needed to identify the specific aspects of child participation in organized activities (eg, scheduled time of day) that may interfere with family meals.     

Improving influenza vaccination in chronically ill children using a tertiary-care based vaccination clinic: Is there a role for the live-attenuated influenza vaccine (LAIV)?

BackgroundChildren with underlying medical conditions should receive influenza vaccine (IV) yearly; yet this remains sub-optimal. We aimed to describe our experience with a tertiary-care hospital-based influenza vaccination clinic for this at-risk population.MethodsFrom October to December 2012, 2013, and 2014, we ran an influenza vaccination clinic at the Montreal Children's Hospital, where children with high-risk conditions come for their follow-up. Both injectable IV (IIV) and live-attenuated IV (LAIV) were offered free of charge to patients and their household contacts. Upon vaccination, parents were asked to fill a pre-piloted questionnaire.ResultsWe vaccinated a total of 2640 high-risk children and 1912 household members during the three influenza vaccination seasons. In 2012 and 2013, 631 and 630 patients with chronic illnesses were vaccinated, compared to 1379 in 2014. Caregivers preferred LAIV primarily because no needle was involved (49.0%) and because it was perceived as less painful (46.9%). LAIV was administered to 69% (2012), 55% (2013) and 47% (2014) of high-risk children. The main reason for not receiving LAIV was because it was contra-indicated. A small fraction of children previously vaccinated with LAIV who did not present any contraindication to LAIV opted for IIV: 12/101 (11.8%) in 2013 and 16/272 (5.9%) in 2014. In 2014, this was mainly due to a previous negative experience with LAIV (11/16).ConclusionHaving an influenza vaccination clinic on site at a tertiary care hospital, where children come for their scheduled visits, facilitates yearly influenza vaccination in children with chronic illnesses. LAIV is preferred by caregivers and patients, when not contraindicated.     

Community awareness and predictors of uptake of pertussis booster vaccine in South Australian adults

ObjectivePertussis is a highly virulent vaccine preventable disease that remains a global challenge. This study aimed to assess community knowledge of pertussis infection as well as awareness and uptake of adult pertussis booster vaccine.MethodsA cross-sectional survey was conducted of randomly selected households in South Australia by Computer Assisted Telephone Interviews in 2011. Survey data were weighted to the age, gender and geographical area profile of the population.ResultsFrom 3124 randomly sampled contactable households, 1967 interviews were conducted (participation rate 63%) with individuals aged 18–93 years, including 608 parents of children aged <18 years. The majority of respondents (97%) had heard of pertussis (whooping cough) and 18% reported that a household member had previously contracted whooping cough infection. Most respondents considered whooping cough to be highly contagious (73%) and severe for infants (89%). Over half (51%) of those surveyed were aware that family members commonly transmit pertussis to infants. Despite high knowledge, pertussis vaccine uptake was low, with only 10% of respondents reporting pertussis vaccination in the previous five years. Whilst 61% of respondents were aware of the availability of an adult pertussis booster vaccine, only 8% (n = 154) reported their Family Physician had discussed it with them. If provided free, 77% agreed that they would be more likely to accept a booster pertussis vaccination. Independent predictors of recent pertussis vaccination included higher education, larger household size, perception of greater disease severity for infants and discussion with a Family Physician about pertussis vaccination.ConclusionsWhilst knowledge regarding transmission and severity of Bordetella pertussis was high, uptake of pertussis vaccination for adults is remarkably low amongst the South Australian community. Improved awareness regarding the availability of a booster pertussis vaccine through Family Physicians and/or provision of funded pertussis vaccination for adults has the potential to improve pertussis vaccine coverage.     

Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State,Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention

Background

The Mexican arm of the Camino Verde trial of community mobilisation for dengue prevention covered three coastal regions of Guerrero state: Acapulco, Costa Grande and Costa Chica. A baseline cross-sectional survey provided data for community mobilisation and for adapting the intervention design to concrete conditions in the intervention areas.

Methods

Trained field teams constructed community profiles in randomly selected clusters, based on observation and key informant interviews. In each household they carried out an entomological inspection of water containers, collected information on socio-demographic variables and cases of dengue illness among household members in the last year, and gathered paired saliva samples from children aged 3–9 years, which were subjected to ELISA testing to detect recent dengue infection. We examined associations with dengue illness and recent dengue infection in bivariate and then multivariate analysis.

Results

In 70/90 clusters, key informants were unable to identify any organized community groups. Some 1.9% (1029/55,723) of the household population reported dengue illness in the past year, with a higher rate in Acapulco region. Among children 3–9 years old, 6.1% (392/6382) had serological evidence of recent dengue infection. In all three regions, household use of anti-mosquito products, household heads working, and households having less than 5 members were associated with self-reported dengue illness. In Acapulco region, people aged less than 25 years, those with a more educated household head and those from urban sites were also more likely to report dengue illness, while in Costa Chica and Costa Grande, females were more likely to report dengue illness. Among children aged 3–9 years, those aged 3–4 years and those living in Acapulco were more likely to have evidence of recent dengue infection.

Conclusions

The evidence from the baseline survey provided important support for the design and implementation of the trial intervention. The weakness of community leadership and the relatively low rates of self-reported dengue illness were challenges that the Mexican intervention team had to overcome. The higher dengue illness occurrence among women in Costa Grande and Costa Chica may help explain why women participated more than men in activities during the Camino Verde trial.

     

The Special Supplemental Nutrition Program for Women,Infants, and Children Spillover Effect: Do Siblings Reap the Benefits?

BackgroundParticipation in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) among 0- to 5-year-old children is associated with healthier diets. Extension of dietary benefits to older, age-ineligible children (5-18 years old) residing in WIC households has not been fully investigated.ObjectiveExamine the association between household WIC participation and dietary behaviors of age-ineligible children.DesignCross-sectional secondary analysis of data collected from 2 independent panels (2009-2010 and 2014) of the New Jersey Child Health Study, using household surveys. Questions derived from national surveys assessed consumption frequency of specific foods among 5- to 18-year-old children.Participants/settingThe analytic sample included 616 age-ineligible children from households with incomes below 200% of the federal poverty level, 398 of whom were from WIC-participating households.Main outcome measuresEating behaviors were measured as frequency of daily consumption of fruit, vegetables, 100% juice, sugar-sweetened beverages, and sweet and salty snacks.Statistical analysisMultivariable negative binomial models examined the association between eating behaviors and household WIC participation status adjusting for child’s age, sex, and race; mother’s education; city of residence; household size; and panel. Results are expressed as incidence rate ratios (IRRs).ResultsHousehold WIC participation was not associated with dietary behaviors among age-ineligible children (5-18 years old) in the overall sample. However, healthier dietary patterns were observed for specific demographic groups. Compared with age-ineligible children in non-WIC households, age-ineligible children in WIC households had (1) a higher frequency of vegetable consumption among 12- to 18-year-old children (IRR = 1.29; 95% confidence interval [CI] 1.05-1.58; P = .015); (2) a marginally significant higher frequency of 100% juice consumption among females (IRR = 1.27; 95% CI 1.00-1.62; P = .053); and (3) a lower frequency of sugar-sweetened beverages consumption among Hispanic children (IRR = 0.61; 95% CI 0.43-0.86; P = .004).ConclusionsHousehold WIC participation may positively influence dietary behaviors of age-ineligible children, suggesting a possible WIC spillover effect. Revisions to WIC package composition should consider the possible dietary implications for all children in the household.