Nutritional Comparison of Packed and School Lunches in Pre-Kindergarten and Kindergarten Children Following the Implementation of the 2012–2013 National School Lunch Program Standards

ObjectiveApproximately 40% of children bring a packed lunch to school. Little is known about the quality of these lunches. This study examined the nutritional quality of packed lunches compared with school lunches for pre-kindergarten and kindergarten children after the implementation of 2012–2013 National School Lunch Program standards.MethodsThe researchers collected observational data for packed and school lunches from 3 schools in rural Virginia for 5 consecutive school days and analyzed them for macro and micro nutrients.ResultsOf the 1,314 observations collected; 42.8% were packed lunches (n = 562) and 57.2% were school lunches (n = 752). Energy, fat, saturated fat, sugar, vitamin C, and iron were significantly higher whereas protein, sodium, fiber, vitamin A, and calcium were significantly lower for packed lunches than school lunches.Conclusions and ImplicationsPacked lunches were of less nutritional quality than school lunches. Additional research is needed to explore factors related to choosing packed over school lunches.     

Impact of the National School Lunch Program on Fruit and Vegetable Selection in Northeastern Elementary Schoolchildren, 2012–2013

Increasing children''s fruit and vegetable (FV) consumption is an important goal of the U.S. Department of Agriculture''s (USDA''s) National School Lunch Program. Since 2012, the USDA''s requirement that children select FVs at lunch as part of the reimbursable school meal has been met with concern and evidence of food waste. We compared elementary schoolchildren''s FV selection, consumption, and waste before (10 school visits, 498 tray observations) and after (11 school visits, 944 tray observations) implementation of this requirement using validated dietary assessment measures. More children selected FVs in higher amounts when FVs were required compared with when they were optional (0.69 cups vs. 0.89 cups, p<0.001); however, consumption decreased slightly (0.51 cups vs. 0.45 cups, p=0.01) and waste increased (0.25 cups vs. 0.39 cups, p<0.001) when FVs were required compared with when they were optional. More exposure to FVs in schools through programmatic efforts and in the home environment may help familiarize children with FV offerings and encourage consumption.The majority of U.S. children do not consume recommended amounts of fruit and vegetables (FVs).¹ Increasing children''s consumption of FVs is an important goal of the National School Lunch Program, which feeds nearly 31 million children each school day.² As of the 2012 school year, the U.S. Department of Agriculture (USDA) requires schoolchildren to select either a fruit or a vegetable with a reimbursable meal.³ Implementation of this requirement raised concerns among school nutrition professionals surrounding operational challenges, FV waste, and increased costs.⁴ Two years later, school districts and states reported increased waste by students.^5,6 In a recent survey completed by 240 school nutrition directors, more than 80% subjectively reported an increase in the amount of FVs (especially vegetables) wasted by students.⁶ However, a limited number of studies exist that used rigorous, validated dietary assessment methods to measure schoolchildren''s FV selection, consumption, and waste.^7,8 Such studies are critical to inform and evaluate interventions aimed at increasing children''s FV consumption. We aimed to compare schoolchildren''s FV selection, consumption, and waste using validated dietary assessment methods when FVs were optional compared with when they were required with school lunch by the USDA.     

Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003–2012 National Health and Nutrition Examination Surveys

ObjectiveThis study examined whether sexual orientation-related smoking disparities in males and females varied by household smoking behaviors in a nationally representative sample of American adults.MethodsData were drawn from the 2003–2012 National Health and Nutrition Examination Surveys, which assessed 14,972 individuals ages 20 to 59 years for sexual orientation, current smoking status, and household smoking. Weighted multivariable logistic models were fit to examine whether differences in current smoking status among sexual minority adults compared to heterosexuals was moderated by household smoking and sex, adjusting for covariates.ResultsThe main effects of identifying as a sexual minority, being male, and living with a household smoker were all associated with a significantly higher odds of being a current smoker. However, there also was a significant three-way interaction among these variables (adjusted odds ratio = 3.75, 95% confidence interval: 1.33, 10.54). Follow-up analyses by sex indicated that the interaction between sexual identity and household smoking was significant for both males (AOR = 6.40, 95% confidence interval: 1.27, 32.28) and females (AOR = 0.43, 95% confidence interval: 0.23, 0.81) but was in the opposite direction. Among males, living with a smoker was associated more strongly with greater odds of smoking among gay and bisexual males, compared to heterosexual males. In contrast, among females, living with a smoker was more strongly associated with greater odds of smoking for heterosexuals compared to lesbians and bisexuals.ConclusionsFuture research is warranted to examine characteristics of households, including smoking behaviors and composition, to guide more effective and tailored smoking cessation interventions for males and females by sexual orientation.     

International competition and the demand for health insurance in the US: evidence from the Texas–Mexico border region

Conventional economic explanations for uninsurance should apply to all geographic regions in the United States. However, the border states of California, Arizona, New Mexico and Texas have the highest rates of uninsurance in the US, accounting for over 30% of the total US uninsured population. We use survey data from the fourth wave of the Border Epidemiologic Study on Aging (BESA), a survey from a predominantly Mexican American region of South Texas from 2005 to 2006, to analyze how health insurance coverage in the US is related to the use of health care services in Mexico. BESA includes data on the use of health care services in the US and Mexico. We estimate probit models to investigate the association between having insurance coverage in the US and having a regular doctor in Mexico, the independent variable of interest. Separate models are estimated with having private insurance, Medicare Part B insurance, and any type of public insurance as dependent variables. We deal with the endogeneity, due to reverse causality, of having a regular doctor in Mexico by using instrumental variables in a bivariate probit model. The instruments are dental care utilization in Mexico and a variable measuring frequently visiting Mexico. The results show that competition from Mexico lowers the demand for health insurance coverage in the US side of the border.      

Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002–2013

The objective of the present study was to examine trends and correlates of handgun carrying among adolescents ages 12–17 in the United States. Data was derived from the National Survey on Drug Use and Health (NSDUH) involving non-Hispanic White, African American, and Hispanic respondents ages 12–17 (n = 197,313) and spanning the years 2002–2013. Logistic regression was used to examine significance of trend year and correlates of previous 12-month handgun carrying. The overall self-reported prevalence of handgun carrying was 3.4%. The prevalence of handgun carrying during 2004–2005 was significantly higher for African-Americans (4.39%) compared to non-Hispanic Whites (3.03%). However, by 2012–2013, non-Hispanic Whites (4.08%) completely diverged and reported carrying handguns significantly more than both African-American (2.96%) and Hispanic (2.82%) youth. Male gender and a number of externalizing behaviors were significant correlates of handgun carrying; however, we also found evidence of differential correlates with regard to such factors as drug selling, parental affirmation, and income by race/ethnicity. To our knowledge, this is the largest study of handgun carrying among youth in the United States. Findings indicate that although at historically low levels handgun carrying is on the rise but only among non-Hispanic Whites. Differential correlates among racial/ethnic groups suggest prevention programming and policies may need modifications depending on group and geographic locale targeted.     

Social Class, Race/Ethnicity and All-Cause Mortality in the US: Longitudinal Results from the 1986–1994 National Health Interview Survey

BACKGROUND: Occupational social class has become a leading indicator of social inequalities in health. In the US, economic sectors are distinct with respect to wages, benefits, job security, promotion ladders and working conditions. The growing economic sector of self-employed workers is characterized by lower wages and benefits, and greater job insecurity. Little attention has been given to the association between economic sector measures of social class and all-cause mortality, and there have been no studies of mortality among the self-employed. METHODS: To determine risk of death associated with economic sector social class, this study entails a longitudinal analysis of the National Health Interview Survey (NHIS), an annual household survey representative of the US population for the period 1986-1994 (n = 377,129). The sample includes 201,566 men and 175,563 women, aged 24-65 years of age, in the civilian labor force. RESULTS: Non- professionals are at higher risk of death than professionals across all sectors and self-employed professionals are at higher risk of death than professionals employed in government and production. Additional social class differences are accounted for by age, race, gender and marital status. Results are also partially explained by income. After controlling for income, Black professionals did not show a lower risk of death than Black non-professionals and self-employed Hispanic professionals had a higher risk of death than Hispanic professionals employed in the private sector. CONCLUSIONS: Given the growth of self-employment in the US, the noted increased risk of death among self-employed professionals merits further investigation and monitoring.     

Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006–2010 and 2011–2013 National Survey of Family Growth

Objective

Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m² or greater. However, obese women with a BMI of 40 kg/m² or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy.

Per- and polyfluoroalkyl substances in sera from children 3 to 11 years of age participating in the National Health and Nutrition Examination Survey 2013–2014

Several per- and polyfluoroalkyl substances (PFAS) have been measured in U.S. National Health and Nutrition Examination Survey (NHANES) participants 12 years of age and older since 1999–2000, but PFAS data using NHANES individual samples among children younger than 12 years do not exist. To obtain the first nationally representative PFAS exposure data in U.S. children, we quantified serum concentrations of 14 PFAS including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), in a nationally representative subsample of 639 3–11 year old participants in NHANES 2013–2014. We used on-line solid-phase extraction coupled to isotope dilution-high performance liquid chromatography-tandem mass spectrometry; limits of detection were 0.1 ng/mL for all analytes. We calculated geometric mean concentrations, determined weighted Pearson correlations, and used linear regression to evaluate associations of sex, age (3–5 vs 6–11 years), race/ethnicity (Hispanic vs non-Hispanic), household income, and body mass index with concentrations of PFAS detected in more than 60% of participants. We detected PFOS, PFOA, PFHxS, and PFNA in all children at concentrations similar to those of NHANES 2013–2014 adolescents and adults, suggesting prevalent exposure to these PFAS or their precursors among U.S. 3–11 year old children, most of whom were born after the phase out of PFOS in the United States in 2002. PFAS concentration differences by sex, race/ethnicity, and age suggest lifestyle differences that may impact exposure, and highlight the importance of identifying exposure sources and of studying the environmental fate and transport of PFAS.     

An examination of the shift in school-level clustering of US adolescent electronic cigarette use and its multilevel correlates, 2011–2013

The percent of US high school students reporting use of electronic cigarettes (i.e., e-cigarettes) tripled in recent years. Little is known about the temporal shifts in school-level e-cigarette prevalence or the multilevel correlates of teen e-cigarette use. Using multilevel regression techniques and data from the 2011 and 2013 US National Youth Tobacco Surveys, we investigate how the school-level clustering of e-cigarette use has shifted between 2011 and 2013, whether school-level e-cigarette use is associated with individual-level use, and whether this association is explained by perceptions of harm attributed to e-cigarettes. Results indicate that school-level clustering of pastmonth e-cigarette use increased between 2011 and 2013. Multilevel models show that school-level e-cigarette use is positively associated with individual use, with a small proportion of this relationship explained by perceived harm of e-cigarettes. Our findings suggest that schools could have become more differentiated from each other based on their prevalence of e-cigarette use, and that certain types of school environments facilitate e-cigarette use more efficiently than others.     

Human papillomavirus vaccine uptake among males 11–26 years in United States: Findings from the National Health and Nutrition Examination Survey, 2011–2012

Anogenital human papillomavirus (HPV) infection is the leading sexually transmitted infection in the United States. In October 2011, the quadrivalent HPV vaccine (HPV4) was recommended for males in the U.S. We analyzed a subsample of 11–26 year old (N = 1012) males, from the National Health and Nutritional Examination Survey 2011–2012 dataset, to examine HPV vaccine uptake. The initiation rates in the 11–17 years and the 18–26 years age-groups were 10.7% (95% confidence interval (CI): 8.09–16.6%) and 5.5% (95%CI: 3.1–9.5%) respectively. The corresponding HPV vaccine completion rates were 39.3% (16.7–67.7%) for the 11–17 year old males and 59.1% (37.2–77.6) for the 18–26-year-old males. Despite a slight increase, HPV vaccine uptake remained low among males. These findings can help in HPV vaccination policy in the United States, with a focus on informational messages directed toward young males and their parents in order to increase uptake of HPV vaccine.     

Safety of the 2011–12, 2012–13, and 2013–14 seasonal influenza vaccines in pregnancy: Preterm delivery and specific malformations,a study from the case-control arm of VAMPSS

BackgroundPregnant women have higher risks of influenza complications, but vaccine coverage is incomplete. Because concern about fetal harm limits uptake, we investigated risks for preterm delivery (PTD) and specific birth defects following vaccination in the 2011–12 through 2013–14 influenza seasons.MethodsWe used data from the Slone Epidemiology Center’s Birth Defects Study. For PTD, propensity score-adjusted time-varying hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for exposure anytime in pregnancy and for each trimester. For 42 specific major birth defects or birth defect categories, propensity score-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.ResultsFor PTD (1803 fullterm deliveries, 107 PTD for all seasons combined), an elevated adjusted risk was observed for only the 2nd trimester of the 2011–12 season (HR = 2.60, 95% CI 1.21, 5.61) – a reduction in gestational length of <2 days. For the 42 specific defects or categories of defects (2866 cases, 1411 controls for all seasons combined) most adjusted risks were close to 1.0; the highest was 2.38 for omphalocele and the lowest was 0.50 for atrioventricular canal defects. None had lower confidence bounds >1.0. For each season separately, only one elevated OR had a lower 95% CI >1.0: omphalocele in 2011–12 (OR = 5.19, 95% CI 1.44, 18.7).ConclusionsOur results regarding risks for PTD and birth defects are generally reassuring. The few risks that were observed are compatible with chance, but warrant testing in other data. Given that vaccine components and manufacturing processes vary, continuing studies are needed to evaluate risks and safety of each season’s vaccine and specific products.     

Obesity and contraceptive use among women 20–44 years of age in the United States: results from the 2011–15 National Survey of Family Growth (NSFG)

Objective

Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates.

Alcohol energy intake is related to low body mass index in Japanese older adults: Data from the 2010–2011 National Health and Nutrition Survey

Objective

The objective of this study was to identify lifestyle and nutritional factors associated with low BMI in Japanese older adults, with a focus on alcohol energy intake.

Design

Cross-sectional study. Participants: Data from 1,093 respondents (711 men and 382 women) to the National Health and Nutrition Survey aged 65 years and older were included in this study.

Measurements

Data were analyzed for associations between BMI and lifestyle, energy, and nutrient intake. Alcohol energy intake was calculated from total energy and participants were categorized into BMI quartiles. Energy-adjusted nutrient intakes were calculated as residuals from a regression model, with BMI as the independent variable and lifestyle factors and nutrient intake as dependent variables. Between-BMI quartile differences were assessed for each sex using multivariate logistic regression analysis. In addition, the nutrient intakes of men consuming more than 280 kcal and less than 280 kcal of alcohol energy per day were compared.

Results

Men and women in the lowest BMI quartile had lower total energy intake but higher alcohol energy intake than men in the other BMI quartiles. In multivariate logistic regression analysis, the lowest BMI quartile was associated with total energy (OR: 0.81, p = 0.0310) and alcohol energy intake (OR: 1.22, p = 0.0472) in men. In men, protein, carbohydrate, fat, calcium, iron, and vitamin intakes were less in those that consumed ≥ 280 kcal than in those that consumed < 280 kcal of alcohol per day.

Conclusion

Our results demonstrate an association between alcohol energy intake and low BMI in older Japanese individuals.

     

Estimated Latent Tuberculosis Infection Prevalence and Tuberculosis Reactivation Rates Among Non-U.S.-Born Residents in the United States,from the 2011–2012 National Health and Nutrition Examination Survey

Journal of Immigrant and Minority Health - Increased testing and treatment of latent tuberculosis infection (LTBI) among US-residents who were born (or lived) in countries with high rates of TB can...     

Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007–2013

Background

Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.

Methods

Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose.

Results

Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death.

Conclusion

Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.

     

Safety of the 2010–11, 2011–12, 2012–13, and 2013–14 seasonal influenza vaccines in pregnancy: Birth defects,spontaneous abortion,preterm delivery,and small for gestational age infants,a study from the cohort arm of VAMPSS

IntroductionThere is a need for pregnancy safety information overall and for each seasonal formulation of the influenza vaccine.MethodsAs part of the cohort arm of the Vaccines and Medications in Pregnancy Surveillance System, vaccine-exposed and unexposed women in the U.S. or Canada were recruited during pregnancy in the 2010–2014 vaccine seasons and followed to pregnancy outcome. For the four seasons combined, crude and adjusted relative risks (RRs) were estimated with 95% confidence intervals (CIs) for major birth defects overall and infants small for gestational age. Crude and adjusted hazard ratios (HRs) were estimated with 95% CIs for spontaneous abortion and preterm delivery. Specific influenza season subanalyses were also conducted.ResultsOf 1730 women, 1263 were exposed to an influenza vaccine and 467 were unexposed to any influenza vaccine. Among pregnancies with first-trimester exposure excluding lost-to-follow-up, 26/457 (5.7%) resulted in an infant with a major birth defect compared to 13/427 (3.0%) in the unexposed (RR 1.87, 95% CI 0.97, 3.59). No specific pattern of defects was evident in the vaccine-exposed cohort. The overall risk of spontaneous abortion was not elevated (HR 1.09, 95% CI 0.49, 2.40). Adjusted HRs for preterm delivery approximated 1.0 (adjusted HR 1.23, 95% CI 0.75, 2.02). RRs for small for gestational age infants on weight, length and head circumference ranged from 1.19 to 1.49 with all CIs including 1. Season-by-season analyses resulted in variation by season; however, estimates were based on small numbers.ConclusionsCombining the 2010–2014 influenza seasons, we found a moderately elevated RR for major birth defects overall, but no evidence of a specific pattern; 95% CIs included 1, and this finding could be due to chance. In the combined seasons, we found no meaningful evidence of an increased risk for spontaneous abortion or preterm delivery following exposure to the seasonal influenza vaccine.