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Issue 17, May 2, 2017


CDC Science Clips: Volume 9, Issue 17, May 2, 2017

Each Tuesday, to enhance awareness of emerging scientific knowledge, selected science clips will be posted here for the public health community. The focus is applied public health research and prevention science that has the capacity to improve health now.

This week, Science Clips is pleased to collaborate with CDC Vital Signs by featuring scientific articles from the May Vital Signs (www.cdc.gov/vitalsigns). The articles marked with an asterisk are general review articles which may be of particular interest to clinicians and public health professionals seeking background information in this area.

The report consists of these components:

  1. CDC Vital Signs
    • African American Health RSS Word feed
      1. *Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data
        Shiels MS, Chernyavskiy P, Anderson WF, Best AF, Haozous EA, Hartge P, Rosenberg PS, Thomas D, Freedman ND, Berrington de Gonzalez A.
        Lancet. 2017 Mar 11;389(10073):1043-1054.
        BACKGROUND: Reduction of premature mortality is a UN Sustainable Development Goal. Unlike other high-income countries, age-adjusted mortality in the USA plateaued in 2010 and increased slightly in 2015, possibly because of rising premature mortality. We aimed to analyse trends in mortality in the USA between 1999 and 2014 in people aged 25-64 years by age group, sex, and race and ethnicity, and to identify specific causes of death underlying the temporal trends. METHODS: For this analysis, we used cause-of-death and demographic data from death certificates from the US National Center for Health Statistics, and population estimates from the US Census Bureau. We estimated annual percentage changes in mortality using age-period-cohort models. Age-standardised excess deaths were estimated for 2000 to 2014 as observed deaths minus expected deaths (estimated from 1999 mortality rates). FINDINGS: Between 1999 and 2014, premature mortality increased in white individuals and in American Indians and Alaska Natives. Increases were highest in women and those aged 25-30 years. Among 30-year-olds, annual mortality increases were 2.3% (95% CI 2.1-2.4) for white women, 0.6% (0.5-0.7) for white men, and 4.3% (3.5-5.0) and 1.9% (1.3-2.5), respectively, for American Indian and Alaska Native women and men. These increases were mainly attributable to accidental deaths (primarily drug poisonings), chronic liver disease and cirrhosis, and suicide. Among individuals aged 25-49 years, an estimated 111 000 excess premature deaths occurred in white individuals and 6600 in American Indians and Alaska Natives during 2000-14. By contrast, premature mortality decreased substantially across all age groups in Hispanic individuals (up to 3.2% per year), black individuals (up to 3.9% per year), and Asians and Pacific Islanders (up to 2.6% per year), mainly because of declines in HIV, cancer, and heart disease deaths, resulting in an estimated 112 000 fewer deaths in Hispanic individuals, 311 000 fewer deaths in black individuals, and 34 000 fewer deaths in Asians and Pacific Islanders aged 25-64 years. During 2011-14, American Indians and Alaska Natives had the highest premature mortality, followed by black individuals. INTERPRETATION: Important public health successes, including HIV treatment and smoking cessation, have contributed to declining premature mortality in Hispanic individuals, black individuals, and Asians and Pacific Islanders. However, this progress has largely been negated in young and middle-aged (25-49 years) white individuals, and American Indians and Alaska Natives, primarily because of potentially avoidable causes such as drug poisonings, suicide, and chronic liver disease and cirrhosis. The magnitude of annual mortality increases in the USA is extremely unusual in high-income countries, and a rapid public health response is needed to avert further premature deaths. FUNDING: US National Cancer Institute Intramural Research Program.

      2. *Causes of death and mortality crossovers by race
        Eberstein IW, Nam CB, Heyman KM.
        Biodemography Soc Biol. 2008 Fall;54(2):214-28.
        The phenomenon of “mortality crossovers,” the intersection of age curves of mortality at older ages, has been observed in comparisons of various populations for some time. Some researchers have argued that crossovers are an artifact of deficient reporting of age that is greater for some populations than others. Other researchers attribute crossovers to selective processes by age that vary by group. We use mortality data from the National Center for Health Statistics for the U.S. at ages 55 and over, supplemented by comparable data from matched records of the National Health Interview Survey and National Death Index, to reexamine causes of death linked to mortality crossovers for Whites and Blacks in the U.S. Findings portray a more elaborate set of influences of causes of death than has been discovered heretofore; however, the major finding is that the mortality crossover for Whites and Blacks in the U.S. is real and, although observed for several causes of death, operates principally through varying trajectories of heart disease mortality.

      3. Cancer Facts & Figures for African Americans 2016-2018
        American Cancer Society .
        American Cancer Society: Atlanta, GA. 2016 .
        This report presents updated statistics on cancer incidence, mortality, survival, and risk factors for blacks. All incidence and mortality rates have been age adjusted to the US population in 2000 in order to allow comparisons between groups with different age distributions. This publication is intended to provide information to cancer control advocates, community leaders, public health and health care workers, and others interested in cancer prevention, early detection, and treatment in the black population.

      4. Disparities in the prevalence of diagnosed diabetes – United States, 1999-2002 and 2011-2014
        Beckles GL, Chou CF.
        MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1265-1269.
        The prevalence of diabetes mellitus has increased rapidly in the United States since the mid-1990s. By 2014, an estimated 29.1 million persons, or 9.3% of the total population, had received a diagnosis of diabetes (1). Recent evidence indicates that the prevalence of diagnosed diabetes among non-Hispanic black (black), Hispanic, and poorly educated adults continues to increase but has leveled off among non-Hispanic whites (whites) and persons with higher education (2). During 2004-2010, CDC reported marked racial/ethnic and socioeconomic position disparities in diabetes prevalence and increases in the magnitude of these disparities over time (3). However, the magnitude and extent of temporal change in socioeconomic position disparities in diagnosed diabetes among racial/ethnic populations are unknown. CDC used data from the National Health Interview Survey (NHIS) for the periods 1999-2002 and 2011-2014 to assess the magnitude of and change in socioeconomic position disparities in the age-standardized prevalence of diagnosed diabetes in the overall population and among blacks, whites, and Hispanics. During each period, significant socioeconomic position disparities existed in the overall population and among the assessed racial/ethnic populations. Disparities in prevalence increased with increasing socioeconomic disadvantage and widened over time among Hispanics and whites but not among blacks. The persistent widening of the socioeconomic position gap in prevalence suggests that interventions to reduce the risk for diabetes might have a different impact according to socioeconomic position.

      5. HIV care outcomes among blacks with diagnosed HIV – United States, 2014
        Dailey AF, Johnson AS, Wu B.
        MMWR Morb Mortal Wkly Rep. 2017 Feb 03;66(4):97-103.
        Since the release of the National HIV/AIDS Strategy (NHAS) (1) and the establishment of the federal Human Immunodeficiency Virus (HIV) Care Continuum Initiative (2), federal efforts have accelerated to improve and increase HIV testing, care, and treatment and to reduce HIV-related disparities in the United States. National HIV Surveillance System (NHSS)* data are used to monitor progress toward reaching NHAS goals,dagger and recent data indicate that blacks have lower levels of care and viral suppression than do persons of other racial and ethnic groups (3). Among persons with HIV infection diagnosed through 2012 who were alive at year-end 2013, 68.1% of blacks received any HIV medical care compared with 74.4% of whites (3). CDC used NHSS data to describe HIV care outcomes among blacks who received a diagnosis of HIV. Among blacks with HIV infection diagnosed in 2014, 21.9% had infection classified as HIV stage 3 (acquired immunodeficiency syndrome [AIDS]) at the time of diagnosis compared with 22.5% of whites; 71.6% of blacks were linked to care within 1 month after diagnosis compared with 79.0% of whites. Among blacks with HIV infection diagnosed through 2012 who were alive on December 31, 2013, 53.5% were receiving continuous HIV medical care compared with 58.2% of whites; 48.5% of blacks achieved viral suppression compared with 62.0% of whites. Intensified efforts and implementation of effective interventions and public health strategies that increase engagement in care and viral suppression among blacks (1,4) are needed to achieve NHAS goals.

      6. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States
        Geronimus AT, Hicken M, Keene D, Bound J.
        Am J Public Health. 2006 May;96(5):826-33.
        OBJECTIVES: We considered whether US Blacks experience early health deterioration, as measured across biological indicators of repeated exposure and adaptation to stressors. METHODS: Using National Health and Nutrition Examination Survey data, we examined allostatic load scores for adults aged 18-64 years. We estimated probability of a high score by age, race, gender, and poverty status and Blacks’ odds of having a high score relative to Whites’ odds. RESULTS: Blacks had higher scores than did Whites and had a greater probability of a high score at all ages, particularly at 35-64 years. Racial differences were not explained by poverty. Poor and nonpoor Black women had the highest and second highest probability of high allostatic load scores, respectively, and the highest excess scores compared with their male or White counterparts. CONCLUSIONS: We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.

      7. Reduced prevalence of obesity in 14 disadvantaged black communities in the United States: A successful 4-year place-based participatory intervention
        Liao Y, Siegel PZ, Garraza LG, Xu Y, Yin S, Scardaville M, Gebreselassie T, Stephens RL.
        Am J Public Health. 2016 Aug;106(8):1442-8.
        OBJECTIVES: To assess the impact of a large-scale place-based intervention on obesity prevalence in Black communities. METHODS: The Racial and Ethnic Approaches to Community Health across the United States (REACH US) project was conducted in 14 predominantly Black communities in California, Illinois, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia. We measured trends from 2009 to 2012 in the prevalence of obesity. We used Behavioral Risk Factor Surveillance System data to compare these trends with trends among non-Hispanic Whites and non-Hispanic Blacks in the United States and in the 10 states where REACH communities were located, and with a propensity score-matched national sample of non-Hispanic Blacks. RESULTS: The age-standardized prevalence of obesity decreased in REACH US communities (P = .045), but not in the comparison populations (P = .435 to P = .996). The relative change was -5.3% in REACH US communities versus +2.4% in propensity score-matched controls (P value for the difference = .031). The net effect on the reduction of obesity prevalence was about 1 percentage point per year for REACH. CONCLUSIONS: Obesity prevalence was reduced in 14 disadvantaged Black communities that participated in the REACH project.

      8. “Fundamental causes” of social inequalities in mortality: a test of the theory
        Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B.
        J Health Soc Behav. 2004 Sep;45(3):265-85.
        Medicine and epidemiology currently dominate the study of the strong association between socioeconomic status and mortality. Socioeconomic status typically is viewed as a causally irrelevant “confounding variable” or as a less critical variable marking only the beginning of a causal chain in which intervening risk factors are given prominence. Yet the association between socioeconomic status and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. This suggests that the effect of socioeconomic status on mortality essentially cannot be understood by reductive explanations that focus on current mechanisms. Accordingly, Link and Phelan (1995) proposed that socioeconomic status is a “fundamental cause” of mortality disparities-that socioeconomic disparities endure despite changing mechanisms because socioeconomic status embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections, that protect health no matter what mechanisms are relevant at any given time. We identified a situation in which resources should be less helpful in prolonging life, and derived the following prediction from the theory: For less preventable causes of death (for which we know little about prevention or treatment), socioeconomic status will be less strongly associated with mortality than for more preventable causes. We tested this hypothesis with the National Longitudinal Mortality Study, which followed Current Population Survey respondents (N = 370,930) for mortality for nine years. Our hypothesis was supported, lending support to the theory of fundamental causes and more generally to the importance of a sociological approach to the study of socioeconomic disparities in mortality.

      9. Reduced disparities in birth rates among teens aged 15-19 years – United States, 2006-2007 and 2013-2014
        Romero L, Pazol K, Warner L, Cox S, Kroelinger C, Besera G, Brittain A, Fuller TR, Koumans E, Barfield W.
        MMWR Morb Mortal Wkly Rep. 2016 Apr 29;65(16):409-14.
        Teen childbearing can have negative health, economic, and social consequences for mothers and their children (1) and costs the United States approximately $9.4 billion annually (2). During 1991-2014, the birth rate among teens aged 15-19 years in the United States declined 61%, from 61.8 to 24.2 births per 1,000, the lowest rate ever recorded (3). Nonetheless, in 2014, the teen birth rate remained approximately twice as high for Hispanic and non-Hispanic black (black) teens compared with non-Hispanic white (white) teens (3), and geographic and socioeconomic disparities remain (3,4), irrespective of race/ethnicity. Social determinants associated with teen childbearing (e.g., low parental educational attainment and limited opportunities for education and employment) are more common in communities with higher proportions of racial and ethnic minorities (4), contributing to the challenge of further reducing disparities in teen births. To examine trends in births for teens aged 15-19 years by race/ethnicity and geography, CDC analyzed National Vital Statistics System (NVSS) data at the national (2006-2014), state (2006-2007 and 2013-2014), and county (2013-2014) levels. To describe socioeconomic indicators previously associated with teen births, CDC analyzed data from the American Community Survey (ACS) (2010-2014). Nationally, from 2006 to 2014, the teen birth rate declined 41% overall with the largest decline occurring among Hispanics (51%), followed by blacks (44%), and whites (35%). The birth rate ratio for Hispanic teens and black teens compared with white teens declined from 2.9 to 2.2 and from 2.3 to 2.0, respectively. From 2006-2007 to 2013-2014, significant declines in teen birth rates and birth rate ratios were noted nationally and in many states. At the county level, teen birth rates for 2013-2014 ranged from 3.1 to 119.0 per 1,000 females aged 15-19 years; ACS data indicated unemployment was higher, and education attainment and family income were lower in counties with higher teen birth rates. State and county data can be used to understand disparities in teen births and implement community-level interventions that address the social and structural conditions associated with high teen birth rates.

      10. Understanding associations among race, socioeconomic status, and health: Patterns and prospects
        Williams DR, Priest N, Anderson NB.
        Health Psychol. 2016 Apr;35(4):407-11.
        Race/ethnicity and socioeconomic status (SES) are social categories that capture differential exposure to conditions of life that have health consequences. Race/ethnicity and SES are linked to each other, but race matters for health even after SES is considered. This commentary considers the complex ways in which race combines with SES to affect health. There is a need for greater attention to understanding how risks and resources in the social environment are systematically patterned by race, ethnicity and SES, and how they combine to influence cardiovascular disease and other health outcomes. Future research needs to examine how the levels, timing and accumulation of institutional and interpersonal racism combine with other toxic exposures, over the life-course, to influence the onset and course of illness. There is also an urgent need for research that seeks to build the science base that will identify the multilevel interventions that are likely to enhance the health of all, even while they improve the health of disadvantaged groups more rapidly than the rest of the population so that inequities in health can be reduced and ultimately eliminated. We also need sustained research attention to identifying how to build the political support to reduce the large shortfalls in health. (PsycINFO Database Record

  2. CDC Authored Publications
    The names of CDC authors are indicated in bold text.
    Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
    • Chronic Diseases and Conditions RSS Word feed
      1. State-level awareness of chronic kidney disease in the U.S
        Dharmarajan SH, Bragg-Gresham JL, Morgenstern H, Gillespie BW, Li Y, Powe NR, Tuot DS, Banerjee T, Burrows NR, Rolka DB, Saydah SH, Saran R.
        Am J Prev Med. 2017 Apr 11.
        INTRODUCTION: This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD. METHODS: Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005-2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15-59 mL/minute/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease. RESULTS: Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%). CONCLUSIONS: Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.

      2. Prioritizing US cervical cancer prevention with results from a geospatial model
        Kish JK, Rolin AI, Zou Z, Cucinelli JE, Tatalovich Z, Saraiya M, Altekruse SF.
        J Glob Oncol. 2016 Oct;2(5):275-283.
        PURPOSE: To determine if differences in screening and vaccination patterns across the population may accentuate ethnic and geographic variation in future burden of disease. METHODS: Using Cancer in North America data provided by the North American Association of Central Cancer Registries, county cervical cancer incidence trends from 1995 to 2009 were modeled for the entire United States using ecologic covariates. Rates for health service areas were also modeled by ethnicity. State-level incidence was mapped together with Papanicolaou (Pap) screening, past 3 years (women >/= 18 years old), and three-dose human papillomavirus (HPV) vaccine coverage (girls 13 to 17 years old) to identify potential priority areas for preventive services. RESULTS: US cervical cancer incidence decreased more during the periods 1995 to 1999 and 2000 to 2004 than during the period 2005 to 2009. During these 15 years, the most affected areas became increasingly confined to Appalachia, the lower Mississippi Valley, the Deep South, Texas, and Florida. Hispanic and black women experienced a higher incidence of cervical cancer than both white and Asian and Pacific Islander women during each period. Women in 10 of 17 states/districts with a high incidence (>/= 8.14/100,000) reported low Pap testing (< 78.5%), HPV vaccine coverage (< 33.9%), or both prevention technologies. CONCLUSION: The decline in cervical cancer incidence has slowed in recent years. Access to HPV vaccination, targeted screening, and treatment in affected populations is needed to reduce cervical cancer disparities in the future.


      3. The Kenya Cancer Research And Control Stakeholder Program: Evaluating a bilateral partnership to strengthen national cancer efforts
        Morgan C, Cira M, Karagu A, Asirwa FC, Brand NR, Buchanan Lunsford N, Dawsey SM, Galassi A, Korir A, Kupfer L, Loehrer PJ, Makumi D, Muchiri L, Sayed S, Topazian H, Welch J, Williams MJ, Duncan K.
        J Cancer Policy. 2017 .
        Background: In response to a growing cancer burden and need for improved coordination among stakeholders in Kenya, the US National Cancer Institute and the Kenya Ministry of Health collaboratively hosted a stakeholder meeting in 2014 which identified four priority areas of need (research capacity building, pathology and cancer registries, cancer awareness and education, and health system strengthening) and developed corresponding action plans. Methods: Surveys were conducted with participants to collect input on the progress and impact of the 2014 stakeholder meeting. Findings: Of 69 eligible participants, 45 responded from academia, healthcare institutions, civil society, government, and international agencies. Of the four technical focus areas, three have continued to conduct working group meetings and two have conducted in-person meetings to review and update their respective action plans. Accomplishments linked to or enhanced by the meeting include: Kenyan and international support for expansion of population-based cancer registries, increased availability of prioritized diagnostic tests in selected regional referral hospitals, a greater focus on development of a national cancer research agenda, strategic planning for a community education strategy for cancer awareness, and improved coordination of partners through in-country technical assistance. Interpretation: The Stakeholder Program has successfully united individuals and organizations to improve cancer control planning in Kenya, and has enhanced existing efforts and programs across the country. This model of partners working in parallel on prioritized track activities has supported development of long term coordination of cancer research and control activities sustainable by the Kenyan government and Kenyan institutions.

      4. Prevalence of diabetes and impaired fasting glucose in Costa Rica: Costa Rican National Cardiovascular Risk Factors Survey, 2010
        Wong-McClure R, Gregg EW, Barcelo A, Sanabria-Lopez L, Lee K, Abarca-Gomez L, Cervantes-Loaiza M, Luman ET.
        J Diabetes. 2016 Sep;8(5):686-92.
        BACKGROUND: The projected rising prevalence of diabetes and impaired fasting glucose (IFG) in developing countries warrants careful monitoring. The aim of this study was to present the results of the Costa Rican National Cardiovascular Risk Factors Surveillance System, which provides the first national estimates of diabetes and IFG prevalence among adults in Costa Rica. METHODS: A cross-sectional survey of 3653 non-institutionalized adults aged >/=20 years (87.8% response rate) following the World Health Organization STEPwise approach was built on a probabilistic sample of the non-institutionalized population during 2010. Known diabetes was defined as self-reported diagnosis, the use of insulin, or hypoglycemic oral treatment as consequence of diabetes during at least the previous 2 weeks before the survey. Unknown diabetes was defined no self-reported diabetes but with venous blood concentrations of fasting glucose >125 mg/dL determined by laboratory testing. Impaired fasting glucose was defined as fasting glucose between 100 and 125 mg/dL among those without diabetes. The prevalence of diabetes and IFG prevalence was estimated according gender, body mass index (BMI), waist circumference (WC), educational level, and physical activity level. RESULTS: Overall diabetes prevalence was 10.8% (9.5% known and 1.3% unknown diabetes) and IFG prevalence was 16.5%. The prevalence of known diabetes was higher among women >65 years compared with men of the same age group. Both known and unknown diabetes were significantly associated with higher BMI, increased WC, and low education level (P = 0.01). CONCLUSIONS: The prevalence of diabetes and IFG in Costa Rica is comparable to that in developed countries and indicates an urgent need for effective preventive interventions.

      5. Prediction of atherosclerotic cardiovascular disease mortality in a nationally representative cohort using a set of risk factors from pooled cohort risk equations
        Zhang Z, Gillespie C, Bowman B, Yang Q.
        PLoS One. 2017 ;12(4):e0175822.
        The American College of Cardiology/American Heart Association developed Pooled Cohort equations to estimate atherosclerotic cardiovascular disease (ASCVD) risk. It is unclear how well the equations predict ASCVD mortality in a nationally representative cohort. We used the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and Linked Mortality through 2006 (n = 6,644). Among participants aged 40-79 years without ASCVD at baseline, we used Cox proportional hazard models to estimate the 10-year probability of ASCVD death by sex and race-ethnicity (non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA)). We estimated the discrimination and calibration for each sex-race-ethnicity model. We documented 288 ASCVD deaths during 62,335 person years. The Pooled Cohort equations demonstrated moderate to good discrimination for ASCVD mortality, with modified C-statistics of 0.716 (95% CI 0.663-0.770), 0.794 (0.734-0.854), and 0.733 (0.654-0.811) for NHW, NHB and MA men, respectively. The corresponding C-statistics for women were 0.781 (0.718-0.844), 0.702 (0.633-0.771), and 0.789 (CI 0.721-0.857). Modified Hosmer-Lemeshow chi2 suggested adequate calibration for NHW, NHB and MA men, and MA women (p-values: 0.128, 0.295, 0.104 and 0.163 respectively). The calibration was inadequate for NHW and NHB women (p<0.05). In this nationally representative cohort, the Pooled Cohort equations performed adequately to predict 10-year ASCVD mortality for NHW and NHB men, and MA population, but not for NHW and NHB women.

    • Communicable Diseases RSS Word feed
      1. Notes from the Field: Varicella fatality on a cargo vessel – Puerto Rico, 2015
        Ellis M, Luna-Pinto C, George T, Regan JJ, Marin M, Lopez A, Rivera-Garcia B, Tardivel K.
        MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):410.
        [No abstract]

      2. Lessons learned from the field-testing of Healthy Love: An HIV prevention intervention for black women
        Galindo CA, Few TE, Daniels B, Parks CP, Diallo DD, Moss LN, Wilkes AL, Carraway GC.
        Health Promot Pract. 2017 May;18(3):381-390.
        BACKGROUND: Healthy Love is a brief, highly interactive, single-session, group-level HIV prevention intervention designed for African American women that is effective at reducing sex risk behaviors and increasing condom use and HIV testing among participants. The Centers for Disease Control and Prevention, through a contract, developed a user-friendly intervention package that would allow organizations to adopt and implement Healthy Love with fidelity. METHOD: Training and implementation materials were developed to support original research protocols, and piloted and revised to conduct field-testing with case study agencies (CSAs). Three CSAs were selected to deliver the intervention over a 3-month period to test the utility of intervention materials and feasibility of implementation. RESULTS: All CSAs were able to successfully deliver 10 sessions with a total of 185 women ranging from 18 to 59 years of age. Successes and challenges encountered in training, preimplementation activities, and intervention delivery are described. DISCUSSION: Lessons learned from training, technical assistance, and process monitoring and evaluation informed final package revisions. Research to practice recommendations are shared as is guidance for future implementations of Healthy Love. The research to practice process used is a model approach for developing a comprehensive intervention package and will support the adoption of Healthy Love by other organizations.

      3. On the battlefield: The black church, public health, and the fight against HIV among African American gay and bisexual men
        Jeffries Iv WL, Sutton MY, Eke AN.
        J Urban Health. 2017 Apr 13.
        HIV affects African American gay and bisexual men (AAGBM) more disproportionately than any other group in the USA. The Black Church, which has been a historic mainstay for African American empowerment and well-being, has the potential to be a public health partner for HIV prevention with AAGBM. Public health partnerships with the Black Church can strengthen HIV prevention efforts with AAGBM by [1] adapting church-based prevention strategies developed for other African American subgroups [2], providing prevention and referral services [3], considering how scripture supports prevention efforts, and [4] emphasizing the tenets of liberation theology. Public health should consider how thoughtful engagement, research, and interventions can support these approaches. Developing partnerships with the Black Church and African American clergy can promote effective HIV prevention efforts for AAGBM.

      4. Establishing seasonal and alert influenza thresholds in Cambodia using the WHO method: implications for effective utilization of influenza surveillance in the tropics and subtropics
        Ly S, Arashiro T, Ieng V, Tsuyuoka R, Parry A, Horwood P, Heng S, Hamid S, Vandemaele K, Chin S, Sar B, Arima Y.
        Western Pac Surveill Response J. 2017 Jan-Mar;8(1):22-32.
        OBJECTIVE: To establish seasonal and alert thresholds and transmission intensity categories for influenza to provide timely triggers for preventive measures or upscaling control measures in Cambodia. METHODS: Using Cambodia’s influenza-like illness (ILI) and laboratory-confirmed influenza surveillance data from 2009 to 2015, three parameters were assessed to monitor influenza activity: the proportion of ILI patients among all outpatients, proportion of ILI samples positive for influenza and the product of the two. With these parameters, four threshold levels (seasonal, moderate, high and alert) were established and transmission intensity was categorized based on a World Health Organization alignment method. Parameters were compared against their respective thresholds. RESULTS: Distinct seasonality was observed using the two parameters that incorporated laboratory data. Thresholds established using the composite parameter, combining syndromic and laboratory data, had the least number of false alarms in declaring season onset and were most useful in monitoring intensity. Unlike in temperate regions, the syndromic parameter was less useful in monitoring influenza activity or for setting thresholds. CONCLUSION: Influenza thresholds based on appropriate parameters have the potential to provide timely triggers for public health measures in a tropical country where monitoring and assessing influenza activity has been challenging. Based on these findings, the Ministry of Health plans to raise general awareness regarding influenza among the medical community and the general public. Our findings have important implications for countries in the tropics/subtropics and in resource-limited settings, and categorized transmission intensity can be used to assess severity of potential pandemic influenza as well as seasonal influenza.

      5. Help and care seeking for sexually transmitted infections among youth in low- and middle-income countries
        Newton-Levinson A, Leichliter JS, Chandra-Mouli V.
        Sex Transm Dis. 2017 .
        BACKGROUND: The ability to seek help or medical care for sexually transmitted infections (STIs) is vital for sexually active youth; yet, their needs are often unmet. METHODS: We conducted a qualitative systematic review of studies to assess youth and provider views about the behaviors of young people in help seeking and care seeking for STI services in low- and middle-income countries. We searched peer-reviewed literature for studies published between 2001 and 2014 with a study population of youth (age, 10-24 years) and/or health service providers. Eighteen studies were identified for inclusion from 18 countries. Thematic analyses identified key themes across the studies. RESULTS: The majority of studies included discussion of youth not seeking treatment, resorting to self-treatment, or waiting to access care, suggesting that many youth still do not seek timely care for STIs. Youth desired more information on sexual health and cited barriers related to fear or taboos in obtaining help or information, especially from providers or parents. Many did not recognize symptoms or waited until symptoms worsened. However, many youth were able to identify a number of sources for STI related care including public and private clinics, pharmacies, alternative healers, and nongovernmental organizations. Youth?s help seeking and care seeking preferences were frequently influenced by desires for confidentiality, friendliness, and cost. CONCLUSIONS: Youth in low- and middle-income countries experience significant barriers in help seeking for STIs and often do not seek or postpone medical care. Improving uptake may require efforts to address clinic systems, provider attitudes, confidentiality, and cultural norms related to youth sexuality.

      6. Community Mitigation Guidelines to Prevent Pandemic Influenza – United States, 2017
        Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M, Reed C, Uzicanin A.
        MMWR Recomm Rep. 2017 Apr 21;66(1):1-34.
        When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

      7. Small-group randomized controlled trial to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men
        Rhodes SD, Alonzo J, Mann L, Song EY, Tanner AE, Arellano JE, Rodriguez-Celedon R, Garcia M, Freeman A, Reboussin BA, Painter TM.
        Am J Public Health. 2017 Apr 20:e1-e8.
        OBJECTIVES: To evaluate the HOLA en Grupos intervention, a Spanish-language small-group behavioral HIV prevention intervention designed to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men. METHODS: In 2012 to 2015, we recruited and randomized 304 Hispanic/Latino men who have sex with men, aged 18 to 55 years in North Carolina, to the 4-session HOLA en Grupos intervention or an attention-equivalent general health education comparison intervention. Participants completed structured assessments at baseline and 6-month follow-up. Follow-up retention was 100%. RESULTS: At follow-up, relative to comparison participants, HOLA en Grupos participants reported increased consistent condom use during the past 3 months (adjusted odds ratio [AOR] = 4.1; 95% confidence interval [CI] = 2.2, 7.9; P < .001) and HIV testing during the past 6 months (AOR = 13.8; 95% CI = 7.6, 25.3; P < .001). HOLA en Grupos participants also reported increased knowledge of HIV (P < .001) and sexually transmitted infections (P < .001); condom use skills (P < .001), self-efficacy (P < .001), expectancies (P < .001), and intentions (P < .001); sexual communication skills (P < .01); and decreased fatalism (P < .001). CONCLUSIONS: The HOLA en Grupos intervention is efficacious for reducing HIV risk behaviors among Hispanic/Latino men who have sex with men. (Am J Public Health. Published online ahead of print April 20, 2017: e1-e8. doi:10.2105/AJPH.2017.303814).

      8. Examining acceptability of self-collection for human papillomavirus testing among women and healthcare providers with a broader lens
        Senkomago V, Saraiya M.
        J Womens Health (Larchmt). 2017 Apr 17.
        [No abstract]

      9. Immigrant arrival and tuberculosis among large immigrant- and refugee-receiving countries, 2005-2009
        White Z, Painter J, Douglas P, Abubakar I, Njoo H, Archibald C, Halverson J, Robson J, Posey DL.
        Tuberc Res Treat. 2017 ;2017:8567893.
        Objective. Tuberculosis control in foreign-born populations is a major public health concern for Australia, Canada, New Zealand, United Kingdom, and the United States, large immigrant- and refugee-receiving countries that comprise the Immigration and Refugee Health Working Group (IRHWG). Identifying and comparing immigration and distribution of foreign-born tuberculosis cases are important for developing targeted and collaborative interventions. Methods. Data stratified by year and country of birth from 2005 to 2009 were received from these five countries. Immigration totals, tuberculosis case totals, and multidrug-resistant tuberculosis (MDR TB) case totals from source countries were analyzed and compared to reveal similarities and differences for each member of the group. Results. Between 2005 and 2009, there were a combined 31,785,002 arrivals, 77,905 tuberculosis cases, and 888 MDR TB cases notified at the federal level in the IRHWG countries. India, China, Vietnam, and the Philippines accounted for 41.4% of the total foreign-born tuberculosis cases and 42.7% of the foreign-born MDR tuberculosis cases to IRHWG. Interpretation. Collaborative efforts across a small number of countries have the potential to yield sizeable gains in tuberculosis control for these large immigrant- and refugee-receiving countries.

      10. Water exposure is a common risk behavior among soft and gas-permeable contact lens wearers
        Zimmerman AB, Richdale K, Mitchell GL, Kinoshita BT, Lam DY, Wagner H, Sorbara L, Chalmers RL, Collier SA, Cope JR, Rao MM, Beach MJ, Yoder JS.
        Cornea. 2017 Apr 13.
        PURPOSE: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers’ behaviors and knowledge regarding exposure of lenses to water. METHODS: The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions. RESULTS: GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P < 0.001; storing: 33% GP, 15% SCL P < 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P < 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P < 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P < 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P < 0.0001) and GP lens wearers (P < 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses. CONCLUSIONS: Despite previously published evidence of Acanthamoeba keratitis’ association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.

    • Disease Reservoirs and Vectors RSS Word feed
      1. Habitat and density of oviposition opportunity influences Aedes aegypti (Diptera: Culicidae) flight distance
        Brown HE, Cox J, Comrie AC, Barrera R.
        J Med Entomol. 2017 Apr 15.
        Understanding the dispersal of Aedes (aegypti (L.) Diptera: Culicidae) after consuming a potentially infectious bloodmeal is an important part of controlling the spread of the arboviruses it transmits. Because of the impact on abundance, removal of oviposition sites is a key component of vector control. However, source reduction around a case may encourage dispersal of potentially infected vectors. We compare the effect of oviposition site availability on Ae. aegypti dispersal behavior within 30-m linear cages in three model ecosystems at the University of Arizona’s Biosphere 2 research facility. We found a significant interaction effect in which, when oviposition site density was sparse, dispersal was greater in the highly vegetated humid rainforest and limited in the low vegetation, arid desert model ecosystem. When oviposition site density was dense, no significant effect on dispersal was observed. These analyses support the idea that source reduction has an important influence on the distance that gravid, potentially infected, females will travel.

      2. Tiger on the prowl: Invasion history and spatio-temporal genetic structure of the Asian tiger mosquito Aedes albopictus (Skuse 1894) in the Indo-Pacific
        Maynard AJ, Ambrose L, Cooper RD, Chow WK, Davis JB, Muzari MO, van den Hurk AF, Hall-Mendelin S, Hasty JM, Burkot TR, Bangs MJ, Reimer LJ, Butafa C, Lobo NF, Syafruddin D, Maung Maung YN, Ahmad R, Beebe NW.
        PLoS Negl Trop Dis. 2017 Apr 14;11(4):e0005546.
        BACKGROUND: Within the last century, increases in human movement and globalization of trade have facilitated the establishment of several highly invasive mosquito species in new geographic locations with concurrent major environmental, economic and health consequences. The Asian tiger mosquito, Aedes albopictus, is an extremely invasive and aggressive daytime-biting mosquito that is a major public health threat throughout its expanding range. METHODOLOGY/PRINCIPAL FINDINGS: We used 13 nuclear microsatellite loci (on 911 individuals) and mitochondrial COI sequences to gain a better understanding of the historical and contemporary movements of Ae. albopictus in the Indo-Pacific region and to characterize its population structure. Approximate Bayesian computation (ABC) was employed to test competing historical routes of invasion of Ae. albopictus within the Southeast (SE) Asian/Australasian region. Our ABC results show that Ae. albopictus was most likely introduced to New Guinea via mainland Southeast Asia, before colonizing the Solomon Islands via either Papua New Guinea or SE Asia. The analysis also supported that the recent incursion into northern Australia’s Torres Strait Islands was seeded chiefly from Indonesia. For the first time documented in this invasive species, we provide evidence of a recently colonized population (the Torres Strait Islands) that has undergone rapid temporal changes in its genetic makeup, which could be the result of genetic drift or represent a secondary invasion from an unknown source. CONCLUSIONS/SIGNIFICANCE: There appears to be high spatial genetic structure and high gene flow between some geographically distant populations. The species’ genetic structure in the region tends to favour a dispersal pattern driven mostly by human movements. Importantly, this study provides a more widespread sampling distribution of the species’ native range, revealing more spatial population structure than previously shown. Additionally, we present the most probable invasion history of this species in the Australasian region using ABC analysis.

    • Environmental Health RSS Word feed
      1. Urinary triclosan concentrations during pregnancy and birth outcomes
        Etzel TM, Calafat AM, Ye X, Chen A, Lanphear BP, Savitz DA, Yolton K, Braun JM.
        Environ Res. 2017 Apr 17;156:505-511.
        BACKGROUND: Triclosan is an antimicrobial chemical used in consumer products, and exposure is ubiquitous among pregnant women in the United States. Triclosan may reduce the levels of thyroid hormones that are important for fetal growth and development. OBJECTIVE: We investigated the relationship of prenatal triclosan exposure with birth anthropometry and gestational duration. METHODS: We used data from 378 mother-child pairs participating in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort from Cincinnati, OH. We measured triclosan concentrations in maternal urine samples collected at 16 and 26 weeks of pregnancy. We abstracted information on neonatal anthropometry and gestational duration from medical records. We used multivariable linear regression to estimate the covariate-adjusted association between the average of the two urinary triclosan concentrations and gestational age standardized weight z-score, length, head circumference, and gestational age at birth. RESULTS: Median urinary triclosan concentrations were 16ng/mL (range: <2.4 to 1501ng/mL). Each 10-fold increase in triclosan was associated with a predicted 0.15 standard deviation decrease (95% CI: -0.30, 0.00) in birth weight z-score, 0.4-cm decrease (95% CI: -0.8, 0.1) in birth length, 0.3-cm decrease (95% CI: -0.5, 0.0) in head circumference, and 0.3-week decrease (95% CI: -0.6, -0.1) in gestational age. Child sex did not modify the associations between triclosan and birth outcomes. CONCLUSIONS: In this cohort, maternal urinary triclosan concentrations during pregnancy were inversely associated with infants’ birth weight, length, head circumference, and gestational age.

      2. Association of prenatal urinary phthalate metabolite concentrations and childhood BMI and obesity
        Harley KG, Berger K, Rauch S, Kogut K, Henn BC, Calafat AM, Huen K, Eskenazi B, Holland N.
        Pediatr Res. 2017 Apr 20.
        BACKGROUND: Although experiments in animals suggest phthalates may have obesogenic effects, studies of prenatal exposure in children show inconsistent results. METHODS: We measured urinary concentrations of 11 phthalate metabolites collected twice during pregnancy from mothers in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort study (N=345). Height, weight, waist circumference, and percent body fat were assessed in their children between 5 and 12 years of age. We used generalized estimating equations to examine associations at each age and tested for interaction by sex. RESULTS: Metabolites of diethyl phthalate (DEP), di-n-butyl phthalate (DBP), butyl benzyl phthalate, and di(2-ethylhexyl) phthalate (DEHP) were positively associated with body mass index z-score, waist circumference z-score, and percent body fat at multiple ages. At age 12, we observed increased odds of being overweight/obese with each doubling of prenatal concentrations of DEP (OR=1.3; 95% CI: 1.1, 1.4), DBP (1.2; 1.0, 1.4), and DEHP (1.3; 1.0, 1.6) metabolites. Results were similar in boys and girls except for DBP metabolites and the non-specific metabolite mono-(3-carboxypropyl) phthalate, which showed positive associations only in boys. CONCLUSIONS: In utero exposure to certain phthalates is associated with increased BMI and risk of overweight/obesity in childhood.Pediatric Research accepted article preview online, 20 April 2017. doi:10.1038/pr.2017.112.

      3. Prenatal concentrations of perfluoroalkyl substances and early communication development in British girls
        Jeddy Z, Hartman TJ, Taylor EV, Poteete C, Kordas K.
        Early Hum Dev. 2017 Apr 12;109:15-20.
        Perfluoroalkyl substances (PFAS), found in many household products and classed as endocrine disrupting chemicals, can be transferred through the placenta and are associated with multiple developmental deficits in offspring. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the association between intrauterine exposure to PFAS and early communication development in 432 mother-daughter dyads at 15 and 38months of age. Concentrations of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) were measured in maternal serum collected during pregnancy. Early communication development was measured with the ALSPAC-adapted MacArthur Communicative Development Inventories for Infants and Toddlers. The infant questionnaire measured verbal comprehension, vocabulary comprehension and production, nonverbal communication, and social development. The toddler questionnaire measured language, intelligibility, and communicative sub-scores. Multivariable linear regression was used to examine associations between each PFAS exposure and each communication sub-scale score. The association between maternal PFAS concentrations and early communication development at 15 and 38months of age varied by maternal age at delivery. In daughters of younger mothers (<25years of age), every 1ng/mL of PFOS was associated with a 3.82 point (95% confidence interval (CI): -6.18, -1.47) lower vocabulary score at 15months and a 0.80 point (95% CI: -1.74, 0.14) lower language score at 38months. Prenatal exposure to select PFAS was positively and negatively associated with communication development among girls, with inconsistent pattern of association across all measured PFAS and endpoints.

      4. In utero exposure to atrazine analytes and early menarche in the Avon Longitudinal Study of Parents and Children Cohort
        Namulanda G, Taylor E, Maisonet M, Boyd Barr D, Flanders WD, Olson D, Qualters JR, Vena J, Northstone K, Naeher L.
        Environ Res. 2017 Apr 11;156:420-425.
        BACKGROUND: Evidence from experimental studies suggests that atrazine and its analytes alter the timing of puberty in laboratory animals. Such associations have not been investigated in humans. OBJECTIVE: To determine the association between in utero exposure to atrazine analytes and earlier menarche attainment in a nested case-control study of the population-based Avon Longitudinal Study of Parents and Children. METHODS: Cases were girls who reported menarche before 11.5 years while controls were girls who reported menarche at or after 11.5 years. Seven atrazine analyte concentrations were measured in maternal gestational urine samples (sample gestation week median (IQR): 12 (8-17)) during the period 1991-1992, for 174 cases and 195 controls using high performance liquid chromatography-tandem mass spectrometry. We evaluated the study association using multivariate logistic regression, adjusting for potential confounders. We used multiple imputation to impute missing confounder data for 29% of the study participants. RESULTS: Diaminochlorotriazine (DACT) was the most frequently detected analyte (58%>limit of detection [LOD]) followed by desethyl atrazine (6%), desethyl atrazine mercapturate (3%), atrazine mercapturate (1%), hydroxyl atrazine (1%), atrazine (1%) and desisopropyl atrazine (0.5%). Because of low detection of other analytes, only DACT was included in the exposure-outcome analyses. The adjusted odds of early menarche for girls with DACT exposures>/=median was 1.13 (95% Confidence Interval [95% CI]:0.82, 1.55) and exposure<median was 1.01 (95% CI: 0.73, 1.42) compared to girls with exposure<LOD (reference). In the subset that excluded girls with missing data, the adjusted odds of early menarche for girls with DACT exposures>/=median was 1.86 (95% CI: 1.03, 3.38) and exposure<median was 1.26 (95% CI: 0.65, 2.24) compared to the reference. CONCLUSIONS: This study is the first to examine the association between timing of menarche and atrazine analytes. We found a weak, non-significant association between in-utero exposure to atrazine metabolite DACT and early menarche, though the association was significant in the subset of girls with complete confounder information. Further exploration of the role of these exposures in female reproduction in other cohorts is needed.

    • Epidemiology and Surveillance RSS Word feed

      1. Hot spots, cluster detection and spatial outlier analysis of teen birth rates in the U.S., 2003-2012
        Khan D, Rossen LM, Hamilton BE, He Y, Wei R, Dienes E.
        Spat Spatiotemporal Epidemiol. 2017 ;21:67-75.
        Teen birth rates have evidenced a significant decline in the United States over the past few decades. Most of the states in the US have mirrored this national decline, though some reports have illustrated substantial variation in the magnitude of these decreases across the U.S. Importantly, geographic variation at the county level has largely not been explored. We used National Vital Statistics Births data and Hierarchical Bayesian space-time interaction models to produce smoothed estimates of teen birth rates at the county level from 2003-2012. Results indicate that teen birth rates show evidence of clustering, where hot and cold spots occur, and identify spatial outliers. Findings from this analysis may help inform efforts targeting the prevention efforts by illustrating how geographic patterns of teen birth rates have changed over the past decade and where clusters of high or low teen birth rates are evident.

      2. Overview of Asian American data collection, release, and analysis: National Health and Nutrition Examination Survey 2011-2018
        Paulose-Ram R, Burt V, Broitman L, Ahluwalia N.
        Am J Public Health. 2017 Apr 20:e1-e6.
        The National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, is a cross-sectional survey on the health and nutritional status of US adults and children. Data Collection/Processing. A complex, multistage probability design is used to select a sample representative of the US civilian, noninstitutionalized population. NHANES includes in-home interviews, physical examinations, and biospecimen collection. About 5000 persons are examined annually. Since 2011, NHANES has been oversampling Asian Americans in addition to traditionally oversampled groups, including Hispanics and non-Hispanic Blacks. Data Analysis/Dissemination. Data are publicly released online in 2-year cycles. Some data, because of disclosure risk, are only available through the Research Data Center. Data users should read documentation, examine sample sizes and response rates, and account for the complex survey design. With publicly released data, analyses of Asians as a single group is only possible; some Asian subgroup analyses may be conducted through the Research Data Center. Public Health Implications. Oversampling Asians in NHANES 2011-2018 allows national estimates to be computed on health conditions, nutrition, and risk factors of public health importance on this growing subpopulation of Asian Americans.

      3. Multiple imputation to evaluate the impact of an assay change in national surveys
        Sternberg M.
        Stat Med. 2017 Apr 16.
        National health surveys, such as the National Health and Nutrition Examination Survey, are used to monitor trends of nutritional biomarkers. These surveys try to maintain the same biomarker assay over time, but there are a variety of reasons why the assay may change. In these cases, it is important to evaluate the potential impact of a change so that any observed fluctuations in concentrations over time are not confounded by changes in the assay. To this end, a subset of stored specimens previously analyzed with the old assay is retested using the new assay. These paired data are used to estimate an adjustment equation, which is then used to ‘adjust’ all the old assay results and convert them into ‘equivalent’ units of the new assay. In this paper, we present a new way of approaching this problem using modern statistical methods designed for missing data. Using simulations, we compare the proposed multiple imputation approach with the adjustment equation approach currently in use. We also compare these approaches using real National Health and Nutrition Examination Survey data for 25-hydroxyvitamin D.

    • Food Safety RSS Word feed
      1. Incidence and trends of infections with pathogens transmitted commonly through food and the effect of increasing use of culture-independent diagnostic tests on surveillance – Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2013-2016
        Marder EP, Cieslak PR, Cronquist AB, Dunn J, Lathrop S, Rabatsky-Ehr T, Ryan P, Smith K, Tobin-D’Angelo M, Vugia DJ, Zansky S, Holt KG, Wolpert BJ, Lynch M, Tauxe R, Geissler AL.
        MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):397-403.
        Foodborne diseases represent a substantial public health concern in the United States. CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) monitors cases reported from 10 U.S. sites* of laboratory-diagnosed infections caused by nine enteric pathogens commonly transmitted through food. This report describes preliminary surveillance data for 2016 on the nine pathogens and changes in incidences compared with 2013-2015. In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths caused by these pathogens. The use of culture-independent diagnostic tests (CIDTs) by clinical laboratories to detect enteric pathogens has been steadily increasing since FoodNet began surveying clinical laboratories in 2010 (1). CIDTs complicate the interpretation of FoodNet surveillance data because pathogen detection could be affected by changes in health care provider behaviors or laboratory testing practices (2). Health care providers might be more likely to order CIDTs because these tests are quicker and easier to use than traditional culture methods, a circumstance that could increase pathogen detection (3). Similarly, pathogen detection could also be increasing as clinical laboratories adopt DNA-based syndromic panels, which include pathogens not often included in routine stool culture (4,5). In addition, CIDTs do not yield isolates, which public health officials rely on to distinguish pathogen subtypes, determine antimicrobial resistance, monitor trends, and detect outbreaks. To obtain isolates for infections identified by CIDTs, laboratories must perform reflex culturedagger; if clinical laboratories do not, the burden of culturing falls to state public health laboratories, which might not be able to absorb that burden as the adoption of these tests increases (2). Strategies are needed to preserve access to bacterial isolates for further characterization and to determine the effect of changing trends in testing practices on surveillance.

    • Genetics and Genomics RSS Word feed
      1. U50: A new metric for measuring assembly output based on non-overlapping, target-specific contigs
        Castro CJ, Ng TF.
        J Comput Biol. 2017 Apr 18.
        Advances in next-generation sequencing technologies enable routine genome sequencing, generating millions of short reads. A crucial step for full genome analysis is the de novo assembly, and currently, performance of different assembly methods is measured by a metric called N50. However, the N50 value can produce skewed, inaccurate results when complex data are analyzed, especially for viral and microbial datasets. To provide a better assessment of assembly output, we developed a new metric called U50. The U50 identifies unique, target-specific contigs by using a reference genome as baseline, aiming at circumventing some limitations that are inherent to the N50 metric. Specifically, the U50 program removes overlapping sequence of multiple contigs by utilizing a mask array, so the performance of the assembly is only measured by unique contigs. We compared simulated and real datasets by using U50 and N50, and our results demonstrated that U50 has the following advantages over N50: (1) reducing erroneously large N50 values due to a poor assembly, (2) eliminating overinflated N50 values caused by large measurements from overlapping contigs, (3) eliminating diminished N50 values caused by an abundance of small contigs, and (4) allowing comparisons across different platforms or samples based on the new percentage-based metric UG50%. The use of the U50 metric allows for a more accurate measure of assembly performance by analyzing only the unique, non-overlapping contigs. In addition, most viral and microbial sequencing have high background noise (i.e., host and other non-targets), which contributes to having a skewed, misrepresented N50 value-this is corrected by U50. Also, the UG50% can be used to compare assembly results from different samples or studies, the cross-comparisons of which cannot be performed with N50.

      2. Comprehensive bioinformatics analysis of Mycoplasma pneumoniae genomes to investigate underlying population structure and type-specific determinants
        Diaz MH, Desai HP, Morrison SS, Benitez AJ, Wolff BJ, Caravas J, Read TD, Dean D, Winchell JM.
        PLoS One. 2017 ;12(4):e0174701.
        Mycoplasma pneumoniae is a significant cause of respiratory illness worldwide. Despite a minimal and highly conserved genome, genetic diversity within the species may impact disease. We performed whole genome sequencing (WGS) analysis of 107 M. pneumoniae isolates, including 67 newly sequenced using the Pacific BioSciences RS II and/or Illumina MiSeq sequencing platforms. Comparative genomic analysis of 107 genomes revealed >3,000 single nucleotide polymorphisms (SNPs) in total, including 520 type-specific SNPs. Population structure analysis supported the existence of six distinct subgroups, three within each type. We developed a predictive model to classify an isolate based on whole genome SNPs called against the reference genome into the identified subtypes, obviating the need for genome assembly. This study is the most comprehensive WGS analysis for M. pneumoniae to date, underscoring the power of combining complementary sequencing technologies to overcome difficult-to-sequence regions and highlighting potential differential genomic signatures in M. pneumoniae.

      3. Complete genome sequence of human norovirus GII.Pe-GII.4 Sydney from the United States
        Yang Z, Vinje J, Kulka M.
        Genome Announc. 2017 Apr 13;5(15).
        We report here the first near-complete genome sequence (7,551 nucleotides) of a human norovirus GII.Pe-GII.4 Sydney variant, detected in a stool sample from an outbreak on a cruise ship in 2013.

    • Healthcare Associated Infections RSS Word feed
      1. Investigation of a cluster of Clostridium difficile infections in a pediatric oncology setting
        Dantes R, Epson EE, Dominguez SR, Dolan S, Wang F, Hurst A, Parker SK, Johnston H, West K, Anderson L, Rasheed JK, Moulton-Meissner H, Noble-Wang J, Limbago B, Dowell E, Hilden JM, Guh A, Pollack LA, Gould CV.
        Am J Infect Control. 2016 Feb;44(2):138-45.
        BACKGROUND: We investigated an increase in Clostridium difficile infection (CDI) among pediatric oncology patients. METHODS: CDI cases were defined as first C difficile positive stool tests between December 1, 2010, and September 6, 2012, in pediatric oncology patients receiving inpatient or outpatient care at a single hospital. A case-control study was performed to identify CDI risk factors, infection prevention and antimicrobial prescribing practices were assessed, and environmental sampling was conducted. Available isolates were strain-typed by pulsed-field gel electrophoresis. RESULTS: An increase in hospital-onset CDI cases was observed from June-August 2012. Independent risk factors for CDI included hospitalization in the bone marrow transplant ward and exposure to computerized tomography scanning or cefepime in the prior 12 weeks. Cefepime use increased beginning in late 2011, reflecting a practice change for patients with neutropenic fever. There were 13 distinct strain types among 22 available isolates. Hospital-onset CDI rates decreased to near-baseline levels with enhanced infection prevention measures, including environmental cleaning and prolonged contact isolation. CONCLUSION: C difficile strain diversity associated with a cluster of CDI among pediatric oncology patients suggests a need for greater understanding of modes and sources of transmission and strategies to reduce patient susceptibility to CDI. Further research is needed on the risk of CDI with cefepime and its use as primary empirical treatment for neutropenic fever.

      2. High clinical suspicion of donor-derived disease leads to timely recognition and early intervention to treat solid organ transplant-transmitted lymphocytic choriomeningitis virus
        Mathur G, Yadav K, Ford B, Schafer IJ, Basavaraju SV, Knust B, Shieh WJ, Hill S, Locke GD, Quinlisk P, Brown S, Gibbons A, Cannon D, Kuehnert M, Nichol ST, Rollin PE, Stroher U, Miller R.
        Transpl Infect Dis. 2017 Apr 19.
        Despite careful donor screening, unexpected donor-derived infections continue to occur in organ transplant recipients (OTRs). Lymphocytic choriomeningitis virus (LCMV) is one such transplant-transmitted infection that in previous reports has resulted in a high mortality among the affected OTRs. We report a LCMV case cluster that occurred 3 weeks post-transplant in three OTRs who received allografts from a common organ donor in March 2013. Following confirmation of LCMV infection at Centers for Disease Control and Prevention, immunosuppression was promptly reduced and ribavirin and/or intravenous immunoglobulin therapy were initiated in OTRs. The liver recipient died, but right kidney recipients survived without significant sequelae and left kidney recipient survived acute LCMV infection with residual mental status deficit. Our series highlights how early recognition led to prompt therapeutic intervention, which may have contributed to more favorable outcome in the kidney transplant recipients. This article is protected by copyright. All rights reserved.

      3. Improving patient safety through antibiotic stewardship: The Veterans Health Administration leads the way, again
        Srinivasan A, Davidson LE.
        Infect Control Hosp Epidemiol. 2017 May;38(5):521-523.
        [No abstract]

    • Injury and Violence RSS Word feed
      1. Running the numbers: Understanding the prevalence of eye and ear injuries in North Carolina
        Geary SM, Cox ME, Proescholdbell SK.
        N C Med J. 2017 Mar-Apr;78(2):134-137.
        [No abstract]

      2. Unpacking the impact of adverse childhood experiences on adult mental health
        Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, Grogan-Kaylor A.
        Child Abuse Negl. 2017 Apr 15;69:10-19.
        Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.



      3. Adverse childhood experiences and life opportunities: Shifting the narrative
        Metzler M, Merrick MT, Klevens J, Ports KA, Ford DC.
        Child Youth Serv Rev. 2017 Jan;72:141-149.
        Substantial research shows that early adversity, including child abuse and neglect, is associated with diminished health across the life course and across generations. Less well understood is the relationship between early adversity and adult socioeconomic status, including education, employment, and income. Collectively, these outcomes provide an indication of overall life opportunity. We analyzed data from 10 states and the District of Columbia that used the adverse childhood experiences (ACE) module in the 2010 Behavioral Risk Factor Surveillance System to examine the association between ACEs and adult education, employment, and income. Compared to participants with no ACEs, those with higher ACE scores were more likely to report high school non-completion, unemployment, and living in a household below the federal poverty level. This evidence suggests that preventing early adversity may impact health and life opportunities that reverberate across generations. Current efforts to prevent early adversity might be more successful if they broaden public and professional understanding (i.e., the narrative) of the links between early adversity and poverty. We discuss our findings within the context of structural policies and processes that may further contribute to the intergenerational continuity of child abuse and neglect and poverty.

    • Laboratory Sciences RSS Word feed
      1. Altered ion transport in normal human bronchial epithelial cells following exposure to chemically distinct metal welding fume particles
        Fedan JS, Thompson JA, Meighan TG, Erdely PC, Antonini JM.
        Toxicol Appl Pharmacol. 2017 Apr 11.
        Welding fume inhalation causes pulmonary toxicity, including susceptibility to infection. We hypothesized that airway epithelial ion transport is a target of fume toxicity, and investigated the effects of fume particulates from manual metal arc-stainless steel (MMA-SS) and gas metal arc-mild steel (GMA-MS) on ion transport in normal human bronchial epithelium (NHBE) cultured in air-interface. MMA-SS particles, more soluble than GMA-MS particles, contain Cr, Ni, Fe and Mn; GMA-MS particles contain Fe and Mn. MMA-SS or GMA-MS particles (0.0167-166.7mug/cm2) were applied apically to NHBEs. After 18h transepithelial potential difference (Vt), resistance (Rt), and short circuit current (Isc) were measured. Particle effects on Na+ and Cl channels and the Na+,K+,2Cl -cotransporter were evaluated using amiloride (apical), 5-nitro-2-[(3-phenylpropyl)amino]benzoic acid (NPPB, apical), and bumetanide (basolateral), respectively. MMA-SS (0.0167-16.7mug/cm2) increased basal Vt. Only 16.7mug/cm2 GMA-MS increased basal Vt significantly. MMA-SS or GMA-MS exposure potentiated Isc responses (decreases) to amiloride and bumetanide, while not affecting those to NPPB, GMA-MS to a lesser degree than MMA-SS. Variable effects on Rt were observed in response to amiloride, and bumetanide. Generally, MMA-SS was more potent in altering responses to amiloride and bumetanide than GMA-MS. Hyperpolarization occurred in the absence of LDH release, but decreases in Vt, Rt, and Isc at higher fume particulate doses accompanied lactate dehydrogenase release, to a greater extent for MMA-SS. Thus, Na+ transport and Na+,K+,2Cl -cotransport are affected by fume exposure; MMA-MS is more potent than GMA-MS. Enhanced Na+ absorption and decreased airway surface liquid could compromise defenses against infection.

      2. One-step quantitative RT-PCR assays for detecting, genotyping and differentiating wild-type group A rotaviruses and vaccine (Rotarix(R) and RotaTeq(R)) strains in stool samples
        Gautam R, Bowen MD.
        J Vaccines Vaccin. 2016 Sep 26;7(5).
        [No abstract]

      3. Liquid chromatography-tandem mass spectrometry assay of leukocyte acid alpha-glucosidase for post-newborn screening evaluation of Pompe disease
        Lin N, Huang J, Violante S, Orsini JJ, Caggana M, Hughes EE, Stevens C, DiAntonio L, Chieh Liao H, Hong X, Ghomashchi F, Babu Kumar A, Zhou H, Kornreich R, Wasserstein M, Gelb MH, Yu C.
        Clin Chem. 2017 Apr;63(4):842-851.
        BACKGROUND: Pompe disease (PD) is the first lysosomal storage disorder to be added to the Recommended Uniform Screening Panel for newborn screening. This condition has a broad phenotypic spectrum, ranging from an infantile form (IOPD), with severe morbidity and mortality in infancy, to a late-onset form (LOPD) with variable onset and progressive weakness and respiratory failure. Because the prognosis and treatment options are different for IOPD and LOPD, it is important to accurately determine an individual’s phenotype. To date, no enzyme assay of acid alpha-glucosidase (GAA) has been described that can differentiate IOPD vs LOPD using blood samples. METHODS: We incubated 10 muL leukocyte lysate and 25 muL GAA substrate and internal standard (IS) assay cocktail for 1 h. The reaction was purified by a liquid-liquid extraction. The extracts were evaporated and reconstituted in 200 muL methanol and analyzed by LC-MS/MS for GAA activity. RESULTS: A 700-fold higher analytical range was observed with the LC-MS/MS assay compared to the fluorometric method. When GAA-null and GAA-containing fibroblast lysates were mixed, GAA activity could be measured accurately even in the range of 0%-1% of normal. The leukocyte GAA activity in IOPD (n = 4) and LOPD (n = 19) was 0.44-1.75 nmol . h-1 . mg-1 and 2.0-6.5 nmol . h-1 . mg-1, respectively, with no overlap. The GAA activity of pseudodeficiency patients ranged from 3.0-28.1 nmol . h-1 . mg-1, showing substantial but incomplete separation from the LOPD group. CONCLUSIONS: This assay allows determination of low residual GAA activity in leukocytes. IOPD, LOPD, and pseudodeficiency patients can be partially differentiated by measuring GAA using blood samples.


      4. Morphological and genetic variability in small island populations of the striped field mouse Apodemus agrarius Pallas, 1771
        Sheremetyeva IN, Kartavtseva IV, Pavlenko MV, Kostenko VA, Sheremetyev IS, Katin IO, Kosoy ME.
        Biology Bulletin. 2017 ;44(2):159-171.
        Morphological (craniometrical characteristics and variations of cusp t3 on the second upper molar (M2)) and genetic (polymorphism of chromosomes and blood proteins) variability was analyzed in small island populations of the striped field mouse Apodemus agrarius Pallas, 1771 from the Peter the Great Bay (Sea of Japan). It was found that the absence of t3 on M2 is not a specific trait for A. agrarius. It was demonstrated that the population of field mice on the Bolshoy Pelis Island significantly differs from the populations from other islands and from the mainland according to the craniometrical parameters, teeth phenes, and variants of blood transferrin. The possible age of establishment of the island populations of the striped field mouse is discussed.

      5. Effects of preanalytical factors on hemoglobin measurement: A comparison of two HemoCue(R) point-of-care analyzers
        Whitehead RD, Zhang M, Sternberg MR, Schleicher RL, Drammeh B, Mapango C, Pfeiffer CM.
        Clin Biochem. 2017 Apr 12.
        BACKGROUND: In field studies, hemoglobin (Hb) is often measured using a battery-operated, portable HemoCue(R) hemoglobinometer. METHODS: We compared the performance of 2 HemoCue(R) models (Hb-201+ and Hb-301) and investigated effects of preanalytical factors on Hb results by simulating unfavorable field conditions. RESULTS: The Hb-301 produced 2.6% higher results compared to the Hb-201+. Hb had to be measured within 1min of filling the Hb-301 cuvette to avoid artificially elevated concentrations (1.3% per min). The Hb-301 cuvettes withstood elevated temperature (37 degrees C) and humidity (72%) for 3weeks, while the Hb-201+ cuvettes degraded within 10min under those conditions. Both cuvette types withstood elevated temperature for 3weeks. Properly-collected venous and capillary blood produced comparable results. Pooled capillary blood produced comparable results to the second and third but not the fourth drop of blood (3.3% lower). Blood could be stored for </=4days at 10-30 degrees C before Hb-201+ measurement, but only for 1day at 10-23 degrees C before Hb-301 measurement (</=1% change in Hb). CONCLUSIONS: Higher Hb results obtained with the Hb-301 may influence the interpretation of anemia prevalence in health surveys. While the Hb-301 performed better in high humidity conditions, the Hb-201+ provided more user flexibility regarding delayed Hb reading.

    • Maternal and Child Health RSS Word feed
      1. Predictors of breastfeeding initiation and maintenance in an integrated healthcare setting
        Henninger ML, Irving SA, Kauffman TL, Kurosky SK, Rompala K, Thompson MG, Sokolow LZ, Avalos LA, Ball SW, Shifflett P, Naleway AL.
        J Hum Lact. 2017 May;33(2):256-266.
        BACKGROUND: The American Academy of Pediatrics recommends exclusive breastfeeding to age 6 months. Although breastfeeding rates in the United States have been increasing over time, further improvements are needed to meet Healthy People 2020 targets. Research aim: This study examined predictors of breastfeeding initiation and maintenance among a population of insured pregnant women. METHODS: Participants were 1,149 pregnant women enrolled in the Pregnancy and Influenza Project in two Kaiser Permanente regions in 2010-2011. Data were collected through interviews at enrollment and 1 month and 6 months postpartum and through participants’ electronic medical records. RESULTS: Nearly all (99%) women reported initiating breastfeeding. Rates of exclusive breastfeeding were 70% and 54% at 1 month and 6 months, respectively; an additional 22% and 23% of women reported supplementing breastfeeding with formula. Of the women who supplemented, the mean ( SD) infant age at formula introduction was 53 (62) days. Of those who had stopped breastfeeding, the mean ( SD) infant age at cessation was 85 (59) days. Higher maternal education level, better maternal self-rated health, prenatal folic acid use, absence of chronic medical conditions, and infant full-term birth were significantly associated with breastfeeding maintenance. CONCLUSION: Although rates of breastfeeding in this population were higher than national rates, a significant number of women stopped breastfeeding or introduced formula earlier than recommended. Two to 3 months postpartum may be a critical period warranting additional encouragement or intervention by healthcare providers. Mothers’ education attainment, maternal health factors, and gestational age at delivery may predict likelihood of breastfeeding maintenance.

      2. Keeping an eye on chlamydia and gonorrhea conjunctivitis in infants in the United States, 2010-2015
        Kreisel K, Weston E, Braxton J, Llata E, Torrone E.
        Sex Transm Dis. 2017 .
        Perinatal transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) can result in conjunctivitis in infants. We examined national rates of reported CT/GC conjunctivitis among infants. Surveillance of these infections is heavily affected by the completeness of reported data on specimen source and age. Alternative data sources should be evaluated.

    • Nutritional Sciences RSS Word feed
      1. Engaging parents to promote children’s nutrition and health
        Dev DA, Byrd-Williams C, Ramsay S, McBride B, Srivastava D, Murriel A, Arcan C, Adachi-Mejia AM.
        Am J Health Promot. 2017 Mar;31(2):153-162.
        PURPOSE: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health. DESIGN: Qualitative. SETTING: State-licensed center-based childcare programs. PARTICIPANTS: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. METHODS: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. RESULTS: Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included-(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included-(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. CONCLUSION: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health.

      2. Sodium, sugar, and fat content of complementary infant and toddler foods sold in the United States, 2015
        Maalouf J, Cogswell ME, Bates M, Yuan K, Scanlon KS, Pehrsson P, Gunn JP, Merritt RK.
        Am J Clin Nutr. 2017 Apr 19.
        Background: As part of a healthy diet, limiting intakes of excess sodium, added sugars, saturated fat, and trans fat has been recommended. The American Heart Association recommends that children aged <2 y should avoid added sugars.Objective: We sought to determine commercial complementary infant-toddler food categories that were of potential concern because of the sodium, added sugar, saturated fat, or trans fat content.Design: Nutrition label information (e.g., serving size, sodium, saturated fat, trans fat) for 1032 infant and toddler foods was collected from manufacturers’ websites and stores from May to July 2015 for 24 brands, which accounted for >95% of infant-toddler food sales. The presence of added sugars was determined from the ingredient list. Reference amount customarily consumed (RACC) categories were used to group foods and standardize serving sizes. A high sodium content was evaluated on the basis of the Upper Intake Level for children aged 1-3 y and the number of potential servings per day ([i.e., 1500 mg/7 servings (>210 mg/RACC)], a sodium amount >200 mg/100 g, or a mean sodium density >1000 mg/1000 kcal.Results: In 2015, most commercial infant-only vegetables, fruit, dinners, and cereals were low in sodium, contained no saturated fat, and did not contain added sugars. On average, toddler meals contained 2233 mg Na/1000 kcal, and 84% of the meals had >210 mg Na/RACC (170 g), whereas 69% of infant-toddler savory snacks had >200 mg Na/100 g. More than 70% of toddler’s meals, cereal bars and breakfast pastries, and infant-toddler grain- or dairy-based desserts contained >/=1 sources of added sugar. Approximately 70% of toddler meals contained saturated fat (mean: 1.9 g/RACC), and no commercial infant-toddler foods contained trans fats.Conclusion: Most commercial toddler meals, cereal bars and breakfast pastries, and infant-toddler snacks and desserts have high sodium contents or contain added sugars, suggesting a need for continued public health efforts to support parents in choosing complementary foods for their infants and toddlers.

      3. Restaurant food allergy practices – six selected sites, United States, 2014
        Radke TJ, Brown LG, Faw B, Hedeen N, Matis B, Perez P, Viveiros B, Ripley D.
        MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):404-407.
        Food allergies affect an estimated 15 million persons in the United States (1), and are responsible for approximately 30,000 emergency department visits and 150-200 deaths each year (2). Nearly half of reported fatal food allergy reactions over a 13-year period were caused by food from a restaurant or other food service establishment (3). To ascertain the prevalence of food allergy training, training topics, and practices related to food allergies, CDC’s Environmental Health Specialists Network (EHS-Net), a collaborative forum of federal agencies and state and local health departments with six sites, interviewed personnel at 278 restaurants. Fewer than half of the 277 restaurant managers (44.4%), 211 food workers (40.8%), and 156 servers (33.3%) interviewed reported receiving food allergy training. Among those who reported receiving training, topics commonly included the major food allergens and what to do if a customer has a food allergy. Although most restaurants had ingredient lists for at least some menu items, few had separate equipment or areas designated for the preparation of allergen-free food. Restaurants can reduce the risk for allergic reactions among patrons by providing food allergy training for personnel and ingredient lists for all menu items and by dedicating equipment and areas specifically for preparing allergen-free food.

      4. Evaluating community measures of healthy food access
        Santorelli ML, Okeke JO.
        J Community Health. 2017 Apr 17.
        Several community level measures of healthy food access exist, but evaluation efforts have been limited leaving uncertainty about how to prioritize communities for intervention. This study aimed to assess several existing measures to inform statewide public health planning efforts in New Jersey, USA. We assessed agreement between community measures of healthy food access and then evaluated the predictive validity of each measure by describing its association with complete fruit and vegetable cash-value voucher redemption (proportion redeemed >/=70, >/=80, >/=90%) among 30,078 low-income households participating in the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2013-2014. The United States Department of Agriculture’s (USDA) food desert measure agreed with the Centers for Disease Control and Prevention’s (CDC) no healthier food retailers (NHFR) measure for 76.5% of New Jersey census tracts, but the Kappa statistic was only 0.10. For urban households, the NHFR measure was negatively associated with complete redemption after adjusting for demographic factors and Supplemental Nutrition Assistance Program participation (>/=70% odds ratio (OR) 0.68, 95% confidence interval (CI) 0.61-0.75; >/=80% OR 0.67, 95% CI 0.62-0.73; >/=90% OR 0.72, 95% CI 0.66-0.77). For rural households, a negative association was observed for the USDA’s low-income/low-vehicle access measure (>/=70% OR 0.48, 95% CI 0.26-0.90). The CDC’s NHFR measure is more appropriate for prioritizing urban areas while the USDA’s low-income/low-vehicle access measure may be better for rural areas.

      5. Facilitating fresh: State laws supporting school gardens are associated with use of garden-grown produce in school nutrition services programs
        Turner L, Leider J, Piekarz E, Schermbeck RM, Merlo C, Brener N, Chriqui JF.
        J Nutr Educ Behav. 2017 Apr 15.
        OBJECTIVE: To examine whether state laws are associated with the presence of school gardens and the use of garden-grown produce in school nutrition services programs. DESIGN: Nationally representative data from the School Health Policies and Practices Study 2014 were combined with objectively coded state law data regarding school gardens. MAIN OUTCOME MEASURES: Outcomes were: (1) the presence of a school garden at each school (n = 419 schools), and (2) the use of garden-grown items in the school nutrition services program. ANALYSIS: Multivariate logistic regression was used to examine each outcome. Contextual covariates included school level, size, locale, US Census region, student race/ethnic composition, and percentage of students eligible for free and reduced-priced meals. RESULTS: State law was not significantly associated with whether schools had a garden, but it was associated with whether schools used garden-grown items in nutrition services programs (odds ratio, 4.21; P < .05). Adjusted prevalence of using garden-grown items in nutrition services programs was 15.4% among schools in states with a supportive law, vs 4.4% among schools in states with no law. CONCLUSIONS AND IMPLICATIONS: State laws that support school gardens may facilitate the use of garden-grown items in school nutrition service programs. Additional research is needed regarding the types of messaging that might be most effective for motivating school administrators to appreciate the value of school gardens. In addition, another area for further research pertains to scaling garden programs for broader reach.

    • Occupational Safety and Health RSS Word feed
      1. Prevalence of cardiovascular health by occupation: A cross-sectional analysis among U.S. workers aged >/=45 years
        MacDonald LA, Bertke S, Hein MJ, Judd S, Baron S, Merritt R, Howard VJ.
        Am J Prev Med. 2017 Apr 05.
        INTRODUCTION: Identification of groups with poor cardiovascular health (CVH) can inform where and how to target public health efforts. National prevalence estimates of CVH were derived for clinical (blood glucose, total cholesterol, blood pressure) and behavioral (BMI, diet quality, physical activity, smoking) factors among U.S. workers aged >/=45 years. METHODS: This cross-sectional analysis included 6,282 employed black and white men and women aged >/=45 years enrolled in the national population-based REasons for Geographic And Racial Differences in Stroke study from 2003 to 2007. Each CVH factor was scored as ideal (2); intermediate (1); or poor (0) according to American Heart Association criteria, and summed to define optimal composite scores: CVH (sum, 10-14); clinical (sum, 5-6); and behavioral (sum, 6-8) health. Occupational data were collected 2011-2013. Analyses were conducted in 2016. RESULTS: Only 14% met ideal criteria for all three clinical health factors, and none met ideal criteria for all four behavioral health factors. Sales and low status office workers had a low prevalence of optimal CVH. Service workers in protective services and the food preparation and serving occupations had a low prevalence of optimal clinical health; computer and healthcare support workers had a low prevalence of optimal behavioral health. CONCLUSIONS: The prevalence of optimal CVH among middle-aged and older workers in the U.S. is low, but considerable differences exist by occupation. Targeted public health interventions may improve the CVH of at-risk older workers with different clinical and behavioral risk factor profiles employed in diverse occupational settings.

      2. Advancing well-being through Total Worker Health(R)
        Schill AL.
        Workplace Health Saf. 2017 Apr;65(4):158-163.
        Total Worker Health(R) (TWH) is a paradigm-shifting approach to safety, health, and well-being in the workplace. It is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The most current TWH concepts are presented, including a description of issues relevant to TWH and introduction of a hierarchy of controls applied to TWH. Total Worker Health advocates for a foundation of safety and health through which work can contribute to higher levels of well-being.

    • Occupational Safety and Health – Mining RSS Word feed
      1. Radiographic disease progression in contemporary US coal miners with progressive massive fibrosis
        Laney AS, Blackley DJ, Halldin CN.
        Occup Environ Med. 2017 Apr 13.
        INTRODUCTION: Among contemporary US coal miners, there has been an increase in the prevalence and severity of pneumoconiosis, including its advanced form progressive massive fibrosis (PMF). We examine radiographic progression in Coal Workers’ Health Surveillance Program (CWHSP) participants. METHODS: CWHSP participants with a final determination of PMF during 1 January 2000-1 October 2016 with at least one prior radiograph in the system were included. We characterised demographics, participation and progression patterns. RESULTS: A total of 192 miners with a PMF determination contributed at least one additional radiograph (total count: 2-10). Mean age at first radiograph was 28.8 years, 162 (84%) worked in Kentucky, Virginia or West Virginia and 169 (88%) worked exclusively underground. A total of 163 (85%) miners had a normal initial radiograph. Mean time from most recent normal radiograph to one with a PMF determination was 20.7 years (range: 1-43) and 27 (17%) progressed to PMF in less than 10 years. DISCUSSION: Dust exposure is the sole cause of this disease, and a substantial number of these miners progressed from normal to PMF in less than a decade. Participation in CWHSP is voluntary, and these findings are influenced by participation patterns, so for many miners it remains unclear how rapidly their disease progressed. The National Institute for Occupational Safety and Health recommends all working miners to participate in radiographic surveillance at 5-year intervals. Improved participation could allow more precise characterisation of the burden and characteristics of pneumoconiosis in US coal miners and provide an important early detection tool to prevent cases of severe disease.

    • Substance Use and Abuse RSS Word feed
      1. Quit methods used by US adult cigarette smokers, 2014-2016
        Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA.
        Prev Chronic Dis. 2017 Apr 13;14:E32.
        To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014-2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. Further research into the effectiveness of e-cigarettes as a cessation aid is warranted.

    • Zoonotic and Vectorborne Diseases RSS Word feed
      1. Zika virus: Common questions and answers
        Igbinosa , Rabe IB, Oduyebo T, Rasmussen SA.
        Am Fam Physician. 2017 Apr 15;95(8):507-513.
        Since local mosquito-borne transmission of Zika virus was first reported in Brazil in early 2015, the virus has spread rapidly, with active transmission reported in at least 61 countries and territories worldwide, including the United States. Zika virus infection during pregnancy is a cause of microcephaly and other severe brain anomalies. The virus is transmitted primarily through the bite of an infected Aedes mosquito, but other routes of transmission include sexual, mother-to-fetus during pregnancy, mother-to-infant at delivery, laboratory exposure, and, possibly, transfusion of blood products. Most persons with Zika virus infection are asymptomatic or have only mild symptoms; hospitalizations and deaths are rare. When symptoms are present, maculopapular rash, fever, arthralgia, and conjunctivitis are most common. Zika virus testing is recommended for persons with possible exposure (those who have traveled to or live in an area with active transmission, or persons who had sex without a condom with a person with possible exposure) if they have symptoms consistent with Zika virus disease. Testing is also recommended for pregnant women with possible exposure, regardless of whether symptoms are present. Treatment is supportive, and no vaccine is currently available. The primary methods of prevention include avoiding bites of infected Aedes mosquitoes and reducing the risk of sexual transmission. Pregnant women should not travel to areas with active Zika virus transmission, and men and women who are planning to conceive in the near future should consider avoiding nonessential travel to these areas. Condoms can reduce the risk of sexual transmission.

      2. Enhanced epilepsy surveillance and awareness in the age of Zika
        Pastula DM, Yeargin-Allsopp M, Kobau R.
        JAMA Neurol. 2017 Apr 17.
        [No abstract]

      3. A decade of arboviral activity-Lessons learned from the trenches
        Powers AM, Waterman SH.
        PLoS Negl Trop Dis. 2017 Apr;11(4):e0005421.
        [No abstract]


      4. Incidence and clinical characteristics of Guillain-Barre syndrome before the introduction of Zika virus in Puerto Rico
        Salinas JL, Major CG, Pastula DM, Dirlikov E, Styczynski A, Luciano CA, Wojna V, Sharp TM, Sejvar JJ, Rivera-Garcia B.
        J Neurol Sci. 2017 ;377:102-106.
        Background Zika virus has been associated with increases in Guillain-Barre syndrome (GBS) incidence. A GBS incidence estimation and clinical description was performed to assess baseline GBS epidemiology before the introduction of Zika virus in Puerto Rico. Methods Hospitalization administrative data from an island-wide insurance claims database and U.S. Census Bureau population estimates provided a crude GBS incidence for 2013. This estimate was adjusted using the proportion of GBS cases meeting Brighton criteria for confirmed GBS from nine reference hospitals. Characteristics of confirmed GBS cases in the same nine hospitals during 2012-2015 are described. Results A total of 136 GBS hospitalization claims were filed in 2013 (crude GBS incidence was 3.8 per 100,000 population). The adjusted GBS incidence was 1.7 per 100,000 population. Of 67 confirmed GBS cases during 2012-2015, 66% had an antecedent illness. Median time from antecedent illness to GBS onset was 7 days. Most cases (67%) occurred during July-September. Conclusions Puerto Rico’s GBS incidence for 2013 was estimated using a combination of administrative data and medical records review; this method could be employed in other regions to monitor GBS incidence before and after the introduction of GBS infectious triggers.

      5. Notes from the Field: Powassan virus disease in an infant – Connecticut, 2016
        Tutolo JW, Staples JE, Sosa L, Bennett N.
        MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):408-409.
        [No abstract]

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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article's inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.

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