Diana M. Bensyl

The Impact of the Availability of School Vending Machines on Eating Behavior during Lunch: The Youth Physical Activity and Nutrition Survey

Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ2 tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.

Racial and Ethnic Disparities in Hospitalizations and Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infections in the United States

PURPOSE Concerns have been raised regarding possible racial-ethnic disparities in 2009 pandemic influenza A (H1N1) (pH1N1) illness severity and health consequences for U.S. minority populations. METHODS Using data from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System, Emerging Infections Program Influenza-Associated Hospitalization Surveillance, and Influenza-Associated Pediatric Mortality Surveillance, we calculated race-ethnicity-specific, age-adjusted rates of self-reported influenza-like illness (ILI) and pH1N1-associated hospitalizations. We used χ(2) tests to evaluate racial-ethnic disparities in ILI-associated health care-seeking behavior and pH1N1 hospitalization. To evaluate pediatric deaths, we compared racial-ethnic proportions of deaths against U.S. population distributions. RESULTS Prevalence of self-reported ILI was lower among Hispanics (6.5%), higher among American Indians/Alaska Natives (16.2%), and similar among non-Hispanic blacks (7.7%) compared with non-Hispanic whites (8.5%). No racial-ethnic differences were identified in ILI-associated health care-seeking behavior. Age-adjusted pH1N1-associated Emerging Infections Program hospitalization rates were higher among all minority populations (range: 8.1-10.9/100,000 population) compared with non-Hispanic whites (3.0/100,000). The proportion of pH1N1-associated pediatric deaths was higher than expected among Hispanics (31%) and lower than expected among non-Hispanic whites (45%) given the proportions of the U.S. population they comprise (22% and 58%, respectively). CONCLUSIONS Racial-ethnic disparities in pH1N1-associated hospitalizations and pediatric deaths were identified. Vaccination remains the primary intervention for preventing influenza.

A Longitudinal Study of Youth Assets, Neighborhood Conditions, and Youth Sexual Behaviors

PURPOSE To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors.

Malaria Prevention Knowledge, Attitudes, and Practices (KAP) Among International Flying Pilots and Flight Attendants of a US Commercial Airline

BACKGROUND In 2010, malaria caused approximately 216 million infections in people and 655,000 deaths. In the United States, imported malaria cases occur every year, primarily in returning travelers and immigrants from endemic countries. In 2010, five Plasmodium falciparum malaria cases occurred among crew members of one US commercial airline company (Airline A). This investigation aimed to assess the malaria prevention knowledge, attitudes, and practices (KAP) of Airline A crew members to provide information for potential interventions. METHODS The web link to a self-administered on-line survey was distributed by internal company communications to Airline A pilots and flight attendants (FA) eligible for international travel. The survey collected demographic information as well as occupation, work history, and malaria prevention education. RESULTS Of approximately 7,000 nonrandomly selected crew members, 220 FA and 217 pilots completed the survey (6%). Respondents correctly identified antimalarial medication (91% FA, 95% pilots) and insect repellents (96% FA, 96% pilots) as effective preventive measures. While in malaria-intense destinations, few FA and less than half of pilots always took antimalarial medication (4% FA, 40% pilots) yet many often spent greater than 30 minutes outdoors after sundown (71% FA, 66% pilots). Less than half in both groups always used insect repellents (46% FA, 47% pilots). Many respondents were unaware of how to get antimalarial medications (52% FA, 30% pilots) and were concerned about their side effects (61% FA, 31% pilots). CONCLUSION Overall, FA and pilots demonstrated good knowledge of malaria prevention, but many performed risky activities while practicing only some recommended malaria preventive measures. Malaria prevention education should focus on advance notification if traveling to a malaria-endemic area, how to easily obtain antimalarial medications, and the importance of practicing all recommended preventive measures.

Forewarning of Poliovirus Outbreaks in the Horn of Africa: An Assessment of Acute Flaccid Paralysis Surveillance and Routine Immunization Systems in Kenya

BACKGROUND Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process. METHODS Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance. RESULTS Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. CONCLUSIONS Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.

The association of attendance at religious services and involvement in church/religious activities and youth assets, by gender, with youth's engagement in sexual intercourse

Purpose – Previous research has shown that religion plays a role in the lives of many youths. This paper aims to extend previous research and examine attendance at religious services and involvement in religious/church activities as separate items to determine if one aspect was more strongly associated with never having had sexual intercourse among youth in the USA. It also aims to consider the effect of other youth assets, and analyze all by gender.Design/methodology/approach – Cross‐sectional data were examined to assess youth assets and risk behaviors. Multivariate regression was used to determine whether the assets or religion questions were significant in the presence of the other assets/religion questions. The eight assets examined, in addition to church attendance and involvement in religious groups were adult role models, peer role models, family communication, involvement in sports and groups, community involvement, aspirations for the future, responsible choices, and good health – diet and exerc...

Building the pipeline: programs to introduce middle school, high school, medical, and veterinary students to careers in epidemiology and public health

PURPOSE This report describes Centers for Disease Control and Prevention programs that expose students to epidemiology and public health sciences (EPHS). METHODS The Science Ambassador workshop targets middle and high school teachers and promotes teaching EPHS in the classroom. The National Science Olympiad Disease Detectives event is an extracurricular science competition for middle and high school students based on investigations of outbreaks and other public health problems. The Epidemiology Elective Program provides experiential learning activities for veterinary and medical students. RESULTS As of 2016, 234 teachers from 37 states and territories and three other countries participated in SA workshops. Several are teaching units or entire courses in EPHS. The National Science Olympiad Disease Detectives event exposed approximately 15,000 middle and high school students to EPHS during the 2015-2016 school year. The Epidemiology Elective Program has exposed 1,795 veterinary and medical students to EPHS. CONCLUSIONS Students can master fundamental concepts of EPHS as early as middle school and educators are finding ways to introduce this material into their classrooms. Programs to introduce veterinary and medical students to EPHS can help fill the gap in exposing older students to the field. Professional organizations can assist by making their members aware of these programs.