Timothy J. Bungum

The relationship of body mass index, medical costs, and job absenteeism.

OBJECTIVES To assess the relationship between body mass index, as categorized by the recently released guidelines of the NHLBI, and health care costs and absenteeism in a sample of municipal workers. METHODS A cross-sectional study was employed that compared the obesity-related health care costs and absences of normal and overweight/obese city workers. RESULTS While accounting for age, gender, race, smoking behavior, and educational attainment, BMI predicted both average annual health-care costs and work absence hours. CONCLUSIONS The NHLBI guidelines for overweight and obesity effectively predicted absences and health care costs.

Mortality and longevity of elite athletes

The health benefits of leisure-time physical activity are well known, however the effects of engaging in competitive sports on health are uncertain. This literature review examines mortality and longevity of elite athletes and attempts to understand the association between long-term vigorous exercise training and survival rates. Fourteen articles of epidemiological studies were identified and classified by type of sport. Life expectancy, standardised mortality ratio, standardised proportionate mortality ratio, mortality rate, and mortality odds ratio for all causes of death were used to analyse mortality and longevity of elite athletes. It appears that elite endurance (aerobic) athletes and mixed-sports (aerobic and anaerobic) athletes survive longer than the general population, as indicated by lower mortality and higher longevity. Lower cardiovascular disease mortality is likely the primary reason for their better survival rates. On the other hand, there are inconsistent results among studies of power (anaerobic) athletes. When elite athletes engaging in various sports are analysed together, their mortality is lower than that of the general population. In conclusion, long-term vigorous exercise training is associated with increased survival rates of specific groups of athletes.

American Adults' Knowledge of Exercise Recommendations

Abstract Physical inactivity is a major risk factor for cardiovascular disease, stroke, hypertension, diabetes, obesity, osteoporosis, and some cancers. Approximately 950,000 Americans die annually from cardiovascular diseases. The purpose of this study was to determine whether American adults know which traditional and lifestyle physical activities affect health and how they should be physically active to achieve a health benefit. Secondary purposes were to determine whether this knowledge is a function of gender, ethnicity, education, or age and if those who are sufficiently active for a health benefit possess different knowledge levels than those not sufficiently active for a health benefit. Items based on the Centers for Disease Control and Prevention/American College of Sports Medicine principles included knowledge of exercise guidelines and traditional and lifestyle physical activities. This information was obtained from 20 questions that were part of a national random telephone survey of 2,002 American households in the 48 contiguous states and the District of Columbia. Respondents were most aware of traditional physical activities (M = 94%) that provide a health benefit and less aware of specific exercise guidelines (M = 68%) and lifestyle physical activities (M = 71%) that can result in a health benefit. Knowledge was not related to physical activity behavior sufficient for a health benefit and only slightly related to ethnicity, education, and age. These data suggest that physical activity knowledge alone is not sufficient to elicit a behavior; however, it provides educators with an understanding of the publics physical activity knowledge that could be helpful in developing health promotion and physical activity interventions.

The Association of Distraction and Caution Displayed by Pedestrians at a Lighted Crosswalk

The rates of deaths and injuries among pedestrians have fallen in recent years, but still remain public health problems as about 5000 pedestrians die each year. Because pedestrians have been shown to be responsible or partially responsible for many of the crashes in which they are involved, we sought to assess the relationship of distracted walking and performing routine cautionary behaviors of pedestrians crossing a busy street in a southwestern city at an intersection, adjacent a university. The behavior of 866 individuals was recorded by trained observers as pedestrians walked across a 105-foot wide street served by a stop light and zebra painted crosswalk. We defined distracted pedestrians as those wearing headphones, talking on a cell phone, eating, drinking, smoking or talking as they crossed the street. Caution was measured by looking left and right, and entering the crosswalk only when the white proceed light was illuminated. We found that only 13.5% of walkers looked left and right and entered the crosswalk while the white light was flashing. Approximately 20% of walkers were distracted as they crossed the street. Regression analysis indicated that distraction was negatively, but weakly associated with displaying cautious pedestrian behaviors. Because traffic lights were routinely ignored and lack of caution was predicted by distraction, we suggest that inexpensive education efforts target pedestrians near college campuses.

Prevalence and Correlates of Walking and Biking to School Among Adolescents

Increasing the rates that our adolescents walk and bicycle to school, also called active transport to school (ATS), could increase the physical activity (PA) levels of that age group. This type of activity has been identified as a missed opportunity for PA. It is currently estimated that 15% of American youth walk or bicycle to school. These rates of ATS are lower than those of European and Asian youth. Efforts to enhance levels of non-motorized transport to school could aid in reducing obesity rates among American youth, decrease traffic congestion and attenuate emission of greenhouse gasses. The objective was to identify demographic, environmental and psychosocial predictors of ATS. A 30-questionnaire was completed by 2,692 students. Logistic regression was used to identify psychosocial, demographic and environmental predictors of ATS. Only 4.6% of students used ATS. Predictors of ATS were street connectedness (density of street intersections) and gender, (boys had higher ATS rates). Public health officials should be alert for opportunities to select sites for new schools that are in neighborhoods with well connected street systems. Interventions promoting ATS will need to target male and female students and there appears to be an opportunity to increase rates that students bicycle to school.

Health Disparities Experienced by People with Disabilities in the United States: A Behavioral Risk Factor Surveillance System Study

The Americans with Disabilities Act became law in 1990; since then research has shown that people with disabilities continue to experience barriers to health care. The purpose of this study was to compare utilization of preventive services, chronic disease rates, and engagement in health risk behaviors of participants with differing severities of disabilities to those without disabilities. This study was a secondary analysis of 2010 data collected in the Behavioral Risk Factor Surveillance System national survey in the United States. Rao Chi square test and logistic regression were employed. Participants with disabilities had significantly higher adjusted odds ratios for all chronic diseases, for physical inactivity, obesity and smoking. They were significantly more likely to participate in some preventive services (flu/pneumonia vaccination, HIV test) and significantly less likely to participate in other preventive services (mammogram, Pap test). Our findings suggest that people with disabilities are less able to fully participate in all preventive services offered.

The Impact of Unemployment on Mental and Physical Health, Access to Health Care and Health Risk Behaviors

The purpose of this study was to examine the impact of employment status and unemployment duration on perceived health, access to health care, and health risk behaviors. Data from Nevadas 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. We compared participants who were unemployed (greater than and less than one year) to those who were employed and those who were voluntarily out of the labor force (OLF). Unemployed participants had significantly worse perceived mental health profiles, were more likely to delay health care services due to cost, and were less likely to have access to health care than employed participants and OLF participants. OLF participants were not significantly different from employed participants. Contrary to previous findings, unemployed participants in this study were not more likely to binge drink, smoke, or be physically inactive. Findings from this study suggest that the impetus for unemployment, be it voluntary or involuntary, may significantly impact a persons mental health.

The Effect of an Active Transport to School Intervention at a Suburban Elementary School

Background Many children do not meet physical activity (PA) guidelines. One strategy that may enhance PA is to increase active transport to school (ATS) rates. Purpose To assess the effects of an ATS intervention. Methods A quasi-experimental design was used to compare ATS and vehicle traffic rates at a school that participated in a statewide event (Nevada Moves Day [NMD]) with those of a control school. Schools were matched on enrollment, ethnicity, socioeconomic status, and neighborhood street patterns. Data collection occurred one week before, on NMD, and one week later. Children using ATS and motor vehicles were counted by university students. Results Pre-intervention ATS rates were statistically similar at the intervention (10.3%) and control schools (7.8%; P>.05). On the NMD, ATS increased to 17.9% at the intervention school and was 7.0% (P < .001) at the control school. One week later, ATS rates returned to baseline levels at both schools. The intervention had no effect on motor vehicle traffic. Discussion A one-day intervention increased ATS rates, but the effect was ephemeral. Translation to Health Education Practice To institutionalize increases in ATS rates, intervention strategies in addition to a one-day event will likely be required.

Diet, acculturation, and BMI in Hispanics living in southern Nevada.

OBJECTIVE To examine the association of fruit and vegetable intake, acculturation, and BMI in Hispanics living in southern Nevada. METHODS Logistic regression was employed to assess the relationship of acculturation to daily intake of fruit and vegetables. RESULTS Regression showed that greater acculturation (p = .002) and being male (p = .011) are predictive of lower fruit and vegetable consumption. CONCLUSIONS Our results for the HA population are consistent with national data. To understand the incentives and barriers to healthier eating within southern Nevada Hispanic populations and to effectively address the resource and programming needs, longitudinal research will be required.

Limitations in the imputation strategy to handle missing nativity data in the Surveillance, Epidemiology, and End Results program.

We recognize the innovative approach of Montealegre et al in studying cancer disparities between foreign-born and US-born ethnic minorities. In the past, this type of analysis has been plagued by data limitations. Among these, birthplace information collected by cancer registries is incomplete and this deficiency does not occur randomly. This is because birthplace information is often secured from death certificates. In other words, those with a known birthplace are disproportionately deceased whereas those without birthplace information tend to be cancer survivors. As such, in this study, the stage of disease at diagnosis and ethnicity subcategory used in the logistic regression model to determine a birth in the United States or a foreign birth reflect data disproportionately derived from deceased cases with a known birthplace, whereas the imputation is performed on a completely different group of patients, mostly cancer survivors. Thus the “missing at random” assumption that allows for the use of multiple imputation is of complex interpretation. Moreover, the authors then use the results of that imputed birthplace to study survival. However, both stage and Hispanic ethnicity are strongly associated with survival, which may raise questions about the validity of this survival analysis. In the Surveillance, Epidemiology, and End Results (SEER) program, patients have their birthplace recorded based on the information in their medical records at the time of diagnosis. However, not all the medical records contain this information. When patients die, there is an additional report of birthplace coming from the death certificate. SEER registries will collect this additional information and that is why birthplace data are more complete for deceased than for living individuals. SEER requires annual data submissions from all participating registries. These submissions include both newly diagnosed cancer cases but also updated information (such as birthplace) on cancer cases from the previous submissions. Thus, by analyzing data regarding 2 different submissions of SEER data, we can analyze the distributions of nativity for the existing cases at 2 different points in time. It follows that one can compare the proportions of US-born and foreignborn individuals in a later submission among all cases with unknown birthplace in an earlier submission to the corresponding proportions of nativity obtained from the multiple imputation procedures that Montealegre et al propose. For this purpose, we requested and analyzed a data set from SEER that was restricted to Hispanic cases diagnosed from 1995 through 2004 and who were reported in 2 different submissions: the 2006 (earlier) submission and the 2012 (later) submission. A total of 53,531 cases among Hispanics were reported in both submissions (5812 cervical cancer cases, 28,346 prostate cancer cases, and 19,373 colorectal cancer cases). Of these, a total of 2345 cases (112 cases of cervical cancer, 1403 cases of prostate cancer, and 830 cases of colorectal cancer) had an unknown birthplace in the 2006 submission but their birthplace became available in the 2012 submission (of whom 43 cervical cancer, 534 prostate cancer and 207 colorectal cancer cases, were found to be foreign-born). The proportions of unknown birthplaces allocated for foreign-born and US-born cases using the imputation developed by Montealegre et al were 12% and 88%, respectively, for cervical cancer; 14% and 86%, respectively, for prostate cancer; and 10% and 90%, respectively, for colorectal cancer. Based on observed data, our findings were significantly different. For cervical cancer, the observed data showed that 38% of cases were foreign-born and 62% were US-born (95% confidence interval [95% CI], 30%-48% and 52%-70%, respectively). For prostate cancer, we found 38% of cases were foreign-born (95% CI, 36%-41%) and 62% were US-born (95% CI, 59%-64%). Finally, for colorectal cancer cases, we determined that 25% were foreign-born (95% CI, 22%-28%) and 75% were US-born (95% CI, 72%-80%). The 2345 analyzed cases (those with an unknown birthplace in the 2006 submission but a known birthplace in the 2012 submission) were significantly older than the remaining cancer cases with an unknown birthplace in both submissions. This was expected given that between the 2 points in time, older individuals are more likely to die and birthplaces will be recovered from the death certificates of deceased subjects. However, in the total group with known birthplace in both 2006 and 2012, the foreign-born cases were significantly younger than the US-born cancer cases. This suggests that the observed proportions in our analysis are an overestimate of the US-born and an underestimate of the foreign-born cases, and therefore the differences between the proportions as estimated by Montealegre et al and the real proportions are even greater than those reported here. Overall, these results strongly suggest that the proportions of nativity obtained from multiple imputations are