Changes in Racial and Ethnic Disparities of HIV Diagnoses Among Adolescents and Young Adults Aged 13–24 Years, 2015–2019

PurposeWe examined changes in racial/ethnic disparities in HIV diagnoses among adolescents and young adults aged 13–24 years from 2015 through 2019.MethodsWe used national surveillance data for 2015–2019 from AtlasPlus to calculate 12 absolute and relative disparity measures for 7 racial/ethnic groups to understand HIV diagnosis trends over time. We calculated four absolute measures (Black-to-White rate difference, Hispanic-to-White rate difference, Absolute Index of Disparity [ID], population-weighted Absolute ID) and eight relative measures (Black-to-White rate ratio, Hispanic-to-White rate ratio, ID, population-weighted ID, population attributable proportion, Gini coefficient, Theil index, and mean log deviation).ResultsHIV diagnosis rates decreased by 15.9% across all racial/ethnic groups combined. All the absolute disparity measures we examined indicated substantial reductions (13.5%–18.5%) in absolute disparities. Most of the relative disparity measures (eight of eight population-unadjusted measures and five of eight population-adjusted measures) declined as well, but the change was relatively modest and ranged from a 3.3% decrease to a 2.1% increase across the measures.DiscussionDespite progress, racial/ethnic disparities in HIV diagnoses among adolescents and young adults remain. Programs and services that are culturally relevant and tailored for this population may assist with continued progress toward reducing racial/ethnic disparities.     

Outdoor Air Quality Awareness,Perceptions, and Behaviors Among U.S. Children Aged 12–17 Years, 2015–2018

PurposeThis study aimed to assess U.S. adolescents' perceptions and knowledge about air quality and their behaviors aimed to reduce air pollution exposure and whether they vary by demographic characteristics.MethodsWe analyzed data from the Porter Novelli Public Services YouthStyles survey, a nationally representative survey of U.S. adolescents aged 12–17 years. In survey years 2015–2018, a total of 3,547 adolescents self-reported awareness, perceptions, and behaviors related to air pollution. We calculated weighted percentages of respondents reporting each aspect of air quality awareness, perception, and behaviors overall and by categories of age, gender, parental education, metropolitan status, region, and survey year.ResultsOverall, an estimated 81% of U.S. adolescents thought outdoor air pollution could impact health, 52% thought there were things they could do to limit their or their family's exposure, 19% were aware of air quality alerts, 46% of those who thought or were informed air quality was bad did something differently, and 19% always or usually avoided busy roads to reduce air pollution exposure; differences were reported by some demographic variables.ConclusionsAmong U.S. adolescents, awareness that air pollution could impact health was relatively high. However, gaps were found in the awareness of the potential impacts and other aspects of awareness and perceptions related to air pollution and the engagement in behaviors to reduce exposure, some of which varied by demographic characteristics. These results can be used to inform interventions that increase awareness and behaviors to reduce air pollution exposures among U.S. adolescents.     

Enrollment of Adolescents Aged 16–17 Years Old in Microbicide Trials: An Evidence-Based Approach

PurposeThis article explores the ethics and feasibility of enrolling adolescent females in microbicide trials using data from 16- to 17-year-old participants of the Phase 3 trial of the candidate vaginal microbicide, Carraguard.MethodsSecondary analysis was conducted to compare health, behavioral, and operational outcomes between 16- to 17-year-olds and 18- to 19-year-olds screened for and enrolled in the trial. Analytical approaches included Kaplan–Meier survival analysis, Cox proportional hazards modeling, and generalized estimating equations for nonsurvival end points.ResultsResults reveal no significant differences between the two age groups for health (sexually transmitted infection, adverse event), risk behavior, or operational (adherence, follow-up) outcomes. However, data suggest that after 1 year of trial participation, human immunodeficiency virus (HIV) and pregnancy incidence were higher and increased more rapidly for the 16- to 17-year-olds than for 18- to 19-year-olds; this finding is entirely consistent with other incidence data for HIV infection among South African youth and cannot be attributed to study participation without a comparison outside the trial.ConclusionsData from the Carraguard trial provide no evidence that inclusion of 16- to 17-year-olds in the trial had any detrimental effect on trial participants or on the conduct of research. These data provide an argument motivating the inclusion of sexually active adolescents aged 16–17 years into future trials in order to avoid delaying access to an effective product for adolescents at high risk of HIV acquisition. Careful support for adolescent-inclusive protocols (including appropriate counseling) must be incorporated into study design.     

Relationship Between Plate Waste and Food Preferences Among Primary School Students Aged 7–10 Years

ObjectiveTo assess differences in the amount of plate waste (PW) and food preferences among food categories containing vegetables and fruit and which of the student-centered reasons may influence PW.DesignA cross-sectional study (from December, 2017 to June, 2018); the aggregate selective plate waste method; the taste-and-rate method (food preferences); the multiple-choice survey (student-centered reasons for the PW occurrence).SettingFourteen primary schools (Zagreb).ParticipantsStudents aged 7–10 years; 17,163 meals (PW); 11,960 meals (PW and food preferences for meals containing vegetables and fruit); 6,507 meals (student-centered factors).Main Outcome MeasuresPlate waste, preferences, and student-centered reasons for PW occurrence.AnalysisContinuous and categorical data were analyzed using a 1-way analysis of variance for nonnormal distribution with post hoc Dunnett's test and chi-square test of homogeneity, respectively. Spearman's rank correlation coefficient was performed to examine the correlation between the amount of PW and served food. All statistical analyses were constructed with robust standard errors clustered at the school level.ResultsAmong the different types of vegetables and fruit meals, students wasted lower amounts of fruit (10.3%; P = 0.005). Plate waste was positively correlated with the amount of served food (r = 0.93; P < 0.001) containing vegetables and fruit. Students preferred fruit and starchy food with vegetables. Among personal factors for not finishing meals, the most frequent reason was they did not like the taste of the food.Conclusion and ImplicationsFindings highlight the importance of food preferences and other student-centered reasons in explaining PW by primary school students.     

Validity and Reliability of a Nutrition Knowledge Questionnaire for High School–Aged Adolescents

ObjectiveTo determine the validity and reliability of a nutrition knowledge questionnaire for adolescents.MethodsAn adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school.ResultsThe questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P < 0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled.Conclusions and ImplicationsResults suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school–aged adolescents.     

A Cross-sectional Study to Examine the Association Between Dietary Patterns and Risk of Overweight and Obesity in Hong Kong Chinese Adolescents Aged 10–12 Years

Objective: To describe the dietary patterns and examine the associations of these patterns with risk of overweight and obesity in Chinese adolescents.

Methods: Baseline data collected between November 2003 and October 2004 from 171 boys and 180 girls aged 10–12 years who participated in the Hong Kong Adolescent Bone Health Cohort Study were analyzed. Dietary intake was assessed using a food frequency questionnaire and dietary pattern calculated using factor analysis. Data on demographic characteristics, weight, height, and Tanner stage were collected. Overweight and obesity were defined using The International Obesity Task Force cutoff values. Cardiovascular fitness expressed as peak oxygen consumption was predicted using the postexercise heart rate by the 3-minute step test and was used as an objective measure of physical activity. Association between dietary patterns and risk of overweight and obesity was examined using multivariate logistic regression with adjustment for demographics, puberty, and physical activity.

Results: The mean (SD) age of the study sample was 11.2 (0.6) years and there were 57 (16.2%) participants who were overweight/obese. Three dietary patterns were identified, namely, vegetables–fruits, snacks–beverages, and animal foods, fats, and condiments dominated. There was no significant linear association between each dietary pattern and the risk of overweight and obesity in this sample. Instead, the risk of overweight and obesity in this sample was positively associated with pubertal stage and inversely associated with physical activity.

Conclusions: Pubertal stage and physical activity, but not dietary patterns, were important factors contributing to the risk of overweight and obesity in this population.     

Prevalence of Vision Loss and Associations With Age-Related Eye Diseases Among Nursing Home Residents Aged ≥65 Years

ObjectivesTo examine data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment, and blindness and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes.DesignThis is a cross-sectional, retrospective study of nursing home patients.Setting and ParticipantsTwenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants.MethodsSummary statistics and regression analyses.ResultsThe overall prevalence of vision impairment or blindness was 63.8% and was above 60% for each age, sex, and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma, and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15.0% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, we found wide variation in vision and eye factors reported and wide variation in the prevalence of those factors. Only 4 studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and 7 reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%.Conclusions and ImplicationsComprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported and wide variation in the prevalence of vision impairment or blindness and AREDs. This investigation suggests the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.     

The Effectiveness of a Community-Based Mentoring Program for Children Aged 5–11 Years: Results from a Randomized Controlled Trial

Prevention Science - The study, a two-arm, randomized controlled, parallel group, superiority trial, aimed to evaluate the implementation and effectiveness of a 12-month one-to-one volunteer...     

Frailty Assessment in the Emergency Department for Risk Stratification of COVID-19 Patients Aged ≥80 Years

ObjectivesTo evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission.DesignSingle-center prospective observational cohort study.Setting and ParticipantsThe study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021.MethodsClinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes.ResultsA total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death.Conclusions and ImplicationsThe ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation.     

Prevalence and Risk of Moderate Stunting Among a Sample of Children Aged 0–24 Months in Brunei

Objectives Globally, one-fifth of the world’s children are stunted, however this statistic may be an underestimate as many countries lack comprehensive monitoring of height-for-age. Until a recent national health survey, Negara Brunei Darussalam has lacked the data to offer a comprehensive assessment of height-for-age among children. The aim of this study is to determine the prevalence of and factors associated with stunting among children aged 0–24 months in Negara Brunei Darussalam (Brunei). Methods A cross-sectional analyses of 396 children aged <24 months. Demographic, dietary and anthropometric measurements were recorded. Multivariate logistic regression was used to analyse factors associated with moderate stunting. Results Almost one-quarter of infants (24%) were stunted. Male children and children who were preterm (<37 weeks gestation) were more than twice as likely to be stunted as their counterparts, respectively (OR 2.48; 95% CI 1.49–4.12; OR 2.14; 95% CI 1.06–4.33, respectively). Those who were born low birth weight (<2.5 kg) were three times more likely to be stunted than those born normal birth weight (OR 2.99; 95% CI 1.44–6.17). Conclusions for Practice This study presents data on prevalence of stunting in Brunei based upon the World Health Organization’s growth charts. In addition it is also the first time that the factors associated with stunting among infants aged <24 months have been examined in Brunei. The stunting prevalence in Brunei is of concern due to the reported short and long-term negative impact on health later in life. The authors recommend close monitoring of pregnant women who are at risk of delivering low birth weight infants and frequent monitoring of low birth weight infants in line with World Health Organization nutrition goals. Existing height-for-age data should be integrated into global databases.     

Source of Parental Reports of Child Height and Weight During Phone Interviews and Influence on Obesity Prevalence Estimates Among Children Aged 3–17 Years

Objective

We compared parental reports of children’s height and weight when the values were estimated vs. parent-measured to determine how these reports influence the estimated prevalence of childhood obesity.

Methods

In the 2007 and 2008 North Carolina Child Health Assessment and Monitoring Program surveys, parents reported height and weight for children aged 3–17 years. When parents reported the values were not measured (by doctor, school, or home), they were asked to measure their child and were later called back. We categorized body mass index status using standard CDC definitions, and we used Chi-square tests and the Stuart-Maxwell test of marginal homogeneity to examine reporting differences.

Results

About 80% (n=509) of the 638 parents who reported an unmeasured height and/or weight participated in a callback and provided updated measures. Children originally classified as obese were subsequently classified as obese (67%), overweight (13%), and healthy weight (19%). An estimated 28% of younger children (<10 years of age) vs. 6% of older children (aged ≥10 years) were reclassified on callback. Having parents who guessed the height and weight of their children and then reported updated values did not significantly change the overall population estimates of obesity.

Conclusion

Our findings demonstrate that using parent-reported height and weight values may be sufficient to provide reasonable estimates of obesity prevalence. Systematically asking the source of height and weight information may help improve how it is applied to research of the prevalence of childhood obesity when gold-standard measurements are not available.Measuring the effects of public health interventions to reduce the prevalence of childhood obesity will depend on accurate measurement of body mass index (BMI). BMI for age is the most commonly used measure of obesity in children, as it is a valid estimate of adiposity¹ and is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) when assessing childhood obesity.^2,3 In large community surveys, classification of BMI status often relies on parental report of their children’s height and weight. To accurately estimate obesity prevalence, it is critical to determine the validity of these height and weight measures.Studies to assess whether self-reported height and weight measures from adolescents or parents can be used to correctly classify a child’s BMI status have shown mixed results. One study of parents and adolescents demonstrated that adolescent self-report accurately classifies adolescents into weight categories.⁴ Correct classification of young children using parent-reported height and weight is more problematic. In a Canadian study, preschoolers’ mothers overestimated weight when they were asked to report child height and weight without measuring their children, but were generally accurate in reporting height.⁵ Another study comparing two U.S. nationally representative survey populations showed that parents indeed overestimated weight to a small degree, but more significantly underestimated height, particularly among younger children.⁶ When used systematically for BMI calculations, these specific inaccuracies in the parent-reported measures can lead to an overestimation in the prevalence of childhood obesity among young children.There is limited information about how parents derive the information they provide for their reports of child height and weight, and whether height, weight, and BMI classification differ based on their source of information. Furthermore, no studies to our knowledge have examined how parental reports may change subsequent to their own measurements of their children. We used a statewide health assessment monitoring program with a unique data collection method with regard to children’s height and weight to achieve the following goals: (1) examine the source of information used by parents reporting their child’s height and weight in a population-based telephone survey, in which parents were asked prior to the survey to measure their child, and demographic characteristics associated with that source; (2) describe change in BMI status among children whose parents reported unmeasured initial height and weight to measured follow-up height and weight; and (3) compare estimated prevalence of childhood obesity using parent-reported unmeasured and measured height and weight.     

Multidirectional Pathways of Tobacco and Marijuana Use,Including Comorbid Use,Among Young Adults (Aged 18–25 Years) in Texas: A Six-Wave Cross-Lagged Model

PurposePrevalence of past 30-day tobacco and marijuana use are highest among young adults in the U.S., and comorbid use of these products is common. However, it is unclear whether the use of one product precedes the other—an important consideration, given the new climate surrounding marijuana legalization and the popularity of e-cigarette products.MethodsSix-panel cross-lagged regression models, with 6 months between each panel/wave, were used to model bidirectional paths between past 30-day use and comorbid use of marijuana and tobacco products from 2014 to 2017 among young adults (N = 5,221 college students, aged 18–25 years).ResultsCombustible tobacco use and e-cigarette use were prospectively associated with greater risk of future marijuana use while controlling for the stability of use over time, age, race/ethnicity, and sex. Marijuana use was prospectively associated with greater risk of future combustible tobacco and e-cigarette use. Comorbid use was common, but while the odds of comorbid use decreased with increasing age, odds of tobacco use increased.ConclusionsMore young adults may be consolidating their use than are successfully ceasing their tobacco or marijuana use as they mature through young adulthood. Although we observed decreases in comorbid use of combustible tobacco with marijuana and e-cigarettes with marijuana, we simultaneously observed strong stability in single use of these products over time. Taken together, these results should help structure interventions specific to young adults that target use and comorbid use in early young adulthood to discourage initiation, encourage cessation, and curb subsequent escalation in later young adulthood.     

Longitudinal Impact of Substance Use and Depressive Symptoms on Bone Accrual Among Girls Aged 11–19 Years

PurposeOsteoporosis is primarily evident in postmenopausal women, but its roots are traceable to periods of growth, including during adolescence. Depression, anxiety, and smoking are associated with lower bone mineral density (BMD) in adults. These associations have not been studied longitudinally across adolescence, when more than 50% of bone accrual occurs.MethodsTo determine the impact of depressive and anxiety symptoms, smoking, and alcohol use on bone accrual in girls 11–19 years, 262 healthy girls were enrolled in age cohorts of 11, 13, 15, and 17 years. Using a cross-sequential design, girls were seen for three annual visits. Outcome measures included total body bone mineral content and BMD of the total hip and lumbar spine using dual energy x-ray absorptiometry. Depressive and anxiety symptoms and smoking and alcohol use were by self-report.ResultsHigher-frequency smoking was associated with a lower rate of lumbar spine and total hip BMD accrual from ages 13–19. Higher depressive symptoms were associated with lower lumbar spine BMD across 11–19 years of age. There was no effect of depressive symptoms on total body bone mineral content, and there was no effect of alcohol intake on any bone outcome.ConclusionAdolescent smokers are at higher risk for less than optimal bone accrual. Even in the absence of diagnosable depression, depressive symptoms may influence adolescent bone accrual. These findings have import for prevention of later osteoporosis and fractures.