Curtis Blanton

Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people reported being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues.

PURPOSE The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.

Sexual violence and its health consequences for female children in Swaziland: a cluster survey study

BACKGROUND Despite concern, few studies have been done about sexual violence against girls younger than 18 years of age in sub-Saharan Africa. We report the prevalence and circumstances of sexual violence in girls in Swaziland, and assess the negative health consequences. METHODS We obtained data from a nationally representative sample of girls and women aged 13-24 years from selected households in Swaziland between May 15, 2007, and June 16, 2007, with a two-stage cluster design. The questionnaire examined demographics, type of sexual violence that took place before the respondent was 18 years of age, circumstances of the incident, and health-related conditions. Information was gathered from 1244 women and girls (response rate 96.3%), of whom 1242 provided retrospective responses to questions about sexual violence. We used regression models adjusted for relevant demographics to estimate the odds ratios for the associations between sexual violence and health-related conditions. FINDINGS 33.2% (95% CI 29.9-36.7) of respondents reported an incident of sexual violence before they reached 18 years of age. The most common perpetrators of the first incident were men or boys from the respondents neighbourhood (32.3% [28.8-36.1]) and boyfriends or husbands (26.2% [22.2-30.7]). The first incident most often took place in the respondents own home (26.1% [21.6-31.2]). Sexual violence was associated with reported lifetime experience of sexually transmitted diseases (adjusted OR 3.69 [95% CI 1.78-7.66]), pregnancy complications or miscarriages (3.54 [1.47-8.55]), unwanted pregnancy (2.92 [1.87-4.55]), and self-report of feeling depressed (2.30 [1.70-3.11]). INTERPRETATION Knowledge of the high prevalence of sexual violence against girls in Swaziland and its associated serious health-related conditions and behaviours should be used to develop effective prevention strategies. FUNDING UNICEF.

Perceived Barriers to Exercise and Stage of Exercise Adoption in Older Women of Different Racial/Ethnic Groups

ABSTRACT The purpose of this study was to determine whether barriers to exercise differ among racial/ethnic groups at the same stage of exercise adoption and adjacent stages within racial/ethnic groups. Questions about stage of exercise adoption and perceived barriers to exercise were administered to a cross sectional sample of 745 African American, 660 Hispanic, 738 Native American/Native Alaskan, and 769 Caucasian U.S. women aged 40 years and older. Correlations between rankings of barriers among racial/ethnic groups within the same stage ranged from .43 to .89. For each racial/ethnic group, significant differences existed between adjacent stages in the percentage of women reporting barriers to interfere with exercise (p < .10). Barriers were not similar enough among racial/ethnic groups to recommend that the same barriers be addressed for all races/ethnicities.

Measuring physical activity with the behavioral risk factor surveillance system

PURPOSE AND METHODS Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.

Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka

CONTEXT Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons. OBJECTIVES To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka. DESIGN, SETTING, AND PARTICIPANTS Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health. MAIN OUTCOME MEASURES Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure. CONCLUSION Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure.

Novel Risk Factors Associated with Hepatitis E Virus Infection in a Large Outbreak in Northern Uganda: Results from a Case-Control Study and Environmental Analysis

An outbreak of hepatitis E virus (HEV) began in October 2007 in northern Uganda. To determine risk factors and sources for ongoing transmission, we conducted both a case-control study and an environmental investigation. A case patient was defined as having serologic evidence of HEV infection, whereas controls were seronegative. We identified risk factors for infection by univariable and multivariable analyses using conditional logistic regression. Several water sources were tested for HEV RNA. Among 112 cases and 145 controls, storage of drinking water in large-mouthed vessels (adjusted odds ratios [AOR] = 2.83; 95% confidence interval [CI] = 1.16-6.94) and washing hands in a group basin (AOR = 1.90; 95% CI = 1.07-3.38) were associated with HEV infection. HEV RNA was detected from communal hand-rinse and surface-water samples. The epidemiologic and environmental water-testing results suggest that household-level factors played an important role in the transmission of HEV-modalities that have been previously underappreciated.

Social Class and Race Disparities in Premature Stroke Mortality among Men in North Carolina

The purpose of this work was to examine the association between social class and premature stroke mortality among blacks and whites. For black men and white men in North Carolina, aged 35-54 years, mortality data from vital statistics files and population data from Census Public Use Microdata Sample files were matched according to social class for the years 1984-1993. Four categories of social class were defined based upon a two-dimensional classification scheme of occupations. For each category of social class, race-specific age-adjusted stroke mortality rates were calculated, and race-specific prevalences of income, wealth, education, unemployment, and disability were estimated. Women were excluded because comparable information on social class was not available from the mortality and population data sources. For both black men and white men, the highest rates of premature stroke mortality were observed among the lowest social classes. The rate ratios (RR) between the lowest and highest social class were 2.8 for black men and 2.3 for white men. Within each social class, black men had substantially higher rates of premature stroke mortality than white men (black-to-white RR ranged from 4.0 to 4.9). Among both black men and white men, the highest social class consistently had the most favorable levels of income, wealth, education, and employment. The inverse association between social class and stroke mortality for both black men and white men supports the need for stroke prevention efforts that address the structural inequalities in economic and social conditions.

Physical activity patterns of Chippewa and Menominee Indians: the Inter-Tribal Heart Project.

INTRODUCTION Leisure-time (LTPA), occupational, transportation, and household physical activity were evaluated among participants in the Inter-Tribal Heart Project (ITHP). METHODS Age-stratified random samples of persons aged > or =25 years were drawn from three communities of Chippewa and Menominee Indians in Minnesota and Wisconsin. Participants (843 women and 501 men) completed an interviewer-administered questionnaire. Logistic regression analyses were performed to assess age-adjusted associations between no reported LTPA and potential correlates. RESULTS During leisure time, 12% of women and 17% of men were active 7-12 months in the past year; 33% of women and 21% of men reported no LTPA. During a typical workday for employed persons, approximately 90% of both genders walked > or =20 minutes, for carrying/lifting moderate to heavy objects the median value for men was 1 hour and women 0 hours. The median value of weekly household activity for men was 3 hours compared to 10 hours for women. Little transportation activity was reported by either gender. Age, household income, smoking, and poor/fair self-perceived health were associated with leisure-time inactivity in women (p < 0.05). Age, poor/fair self-perceived health, and smoking were associated with leisure-time inactivity in men (p < 0.05). Walking was the most prevalent activity in the population. CONCLUSIONS Prevalence of leisure-time inactivity is higher than the national health objective of 15%, however, ITHP participants obtain a substantial amount of occupational and household activity that may lower risks of chronic diseases. Health promotion efforts to increase LTPA may lead not only to reduced chronic disease risk, but to additional benefits of enjoyment and improved psychological well-being.

Risk factors associated with sexual violence towards girls in Swaziland

OBJECTIVE To explore risk factors for sexual violence in childhood in a nationally representative sample of females aged 13 to 24 years in Swaziland. METHODS During a household survey respondents were asked to report any experiences of sexual violence before the age of 18 years. The association between childhood sexual violence and several potential demographic and social risk factors was explored through bivariate and multivariate logistic regression. FINDINGS Participants totalled 1244. Compared with respondents who had been close to their biological mothers as children, those who had not been close to her had higher odds of having experienced sexual violence (crude odds ratio, COR: 1.89; 95% CI: 1.14-3.14), as did those who had had no relationship with her at all (COR: 1.93; 95% CI: 1.34-2.80). In addition, greater odds of childhood sexual violence were noted among respondents who were not attending school at the time of the survey (COR: 2.26; 95% CI: 1.70-3.01); who were emotionally abused as children (COR: 2.04; 95% CI: 1.50-2.79); and who knew of another child who had been sexually assaulted (COR: 1.77; 95% CI: 1.31-2.40) or was having sex with a teacher (COR: 2.07; 95% CI: 1.59-2.69). Childhood sexual violence was positively associated with the number of people the respondent had lived with at any one time (COR: 1.03; 95% CI: 1.01-1.06). CONCLUSION Inadequate supervision or guidance and an unstable environment put girls at risk of sexual violence. Greater educational opportunities and an improved mother-daughter relationship could help prevent it.