Volume 8: No. 4, July 2011

ORIGINAL RESEARCH
Effect of School District Policy Change on Consumption of Sugar-Sweetened Beverages Among High School Students, Boston, Massachusetts, 2004-2006

Angie L. Cradock, ScD; Anne McHugh, MS; Helen Mont-Ferguson, MBA, RD; Linda Grant, MD; Jessica L. Barrett, MPH; Y. Claire Wang, MD, ScD; Steven L. Gortmaker, PhD

Suggested citation for this article: Cradock AL, McHugh A, Mont-Ferguson H, Grant L, Barrett JL, Wang C, et al. Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006. Prev Chronic Dis 2011;8(4):A74. http://www.cdc.gov/pcd/issues/2011/jul/10_0149.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Consumption of sugar-sweetened beverages has increased among youth in recent decades, accounting for approximately 13% of total calories consumed. The Boston Public Schools passed a policy restricting sale of sugar-sweetened beverages in Boston schools in June 2004. The objective of this study was to determine whether high school students’ consumption of sugar-sweetened beverages declined after this new policy was implemented.

Methods
We conducted a quasi-experimental evaluation by using data on consumption of sugar-sweetened beverages by public high school students who participated in the Boston Youth Survey during February through April 2004 and February through April 2006 (N = 2,033). We compared the observed change with national trends by using data from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Regression methods were adjusted for student demographics.

Results
On average, Boston’s public high school students reported daily consumption of 1.71 servings of sugar-sweetened beverages in 2004 and 1.38 servings in 2006. Regression analyses showed significant declines in consumption of soda (−0.16 servings), other sugar-sweetened beverages (−0.14 servings), and total sugar-sweetened beverages (−0.30 servings) between 2004 and 2006 (P < .001 for all). NHANES indicated no significant nationwide change in adolescents’ consumption of sugar-sweetened beverages between 2003-2004 and 2005-2006.

Discussion
Data from Boston youth indicated significant reductions in consumption of sugar-sweetened beverages, which coincided with a policy change restricting sale of sugar-sweetened beverages in schools. Nationally, no evidence was found for change in consumption of sugar-sweetened beverages among same-aged youth, indicating that implementing policies that restrict the sale of sugar-sweetened beverages in schools may be a promising strategy to reduce adolescents’ intake of unnecessary calories.

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Volume 8: No. 4, July 2011

ORIGINAL RESEARCH
Playground Renovations and Quality at Public Parks in Boston, Massachusetts, 1996-2007

Jessica L. Barrett, MPH; Cynthia Hannon, MSW; Linda Keefe; Steven L. Gortmaker, PhD; Angie L. Cradock, ScD

Suggested citation for this article: Barrett JL, Hannon C, Keefe L, Gortmaker SL, Cradock AL. Playground renovations and quality at public parks in Boston, Massachusetts, 1996-2007. Prev Chronic Dis 2011;8(4). http://www.cdc.gov/pcd/issues/2011/jul/10_0118.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Recreational and transportation infrastructure can promote physical activity among children and adolescents. The Play Across Boston community-based research project sought to estimate and compare playground renovation rates across Boston areas before and after a playground quality assessment, to describe changes in playground quality among a subset of parks, and to document features of local transportation infrastructure around parks.

Methods
We used an observational pretest-posttest design to estimate playground renovation rates among 103 city-operated parks. Renovation rates were calculated on the basis of annual city Parks Department capital budgets from fiscal years 1996 through 2007. We used the same design to describe changes between a 2000 to 2001 baseline assessment of playground quality and a 2007 follow-up measured via observation of a subsample of 18 low-scoring parks in disadvantaged areas. We used χ² analysis to compare percentages of playgrounds renovated across city areas before and after baseline assessment, logistic regression analysis to calculate odds ratios comparing renovation rates after baseline by city area, and paired t tests to compare playground quality at baseline and follow-up.

Results
Overall playground renovation rates before (29%) and after (34%) baseline assessment were similar. Parks scoring low on playground quality at baseline were renovated after baseline at a higher rate than high-scoring playgrounds. After accounting for baseline playground quality, parks in disadvantaged areas were renovated at a rate similar to those in other areas. Playground quality scores improved between baseline (mean, 38.3; 95% confidence interval, 35.3-41.3) and 2007 in a subsample of previously low-scoring parks in disadvantaged areas.

Conclusion
The findings of the 2007 follow-up assessment indicate an equitable rate of playground renovation across city areas according to need.

Volume 8: No. 3, May 2011

ORIGINAL RESEARCH

Rashid Njai, PhD, MPH; Paul Z. Siegel, MD, MPH; Jacqueline W. Miller, MD; Youlian Liao, MD

Suggested citation for this article: Njai R, Siegel PZ, Miller JW, Liao Y. Misclassification of survey responses and black-white disparity in mammography use, Behavioral Risk Factor Surveillance System, 1995-2006. Prev Chronic Dis 2011;8(3). http://www.cdc.gov/pcd/issues/2011/may/10_0109.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
The validity of self-reported data for mammography differ by race. We assessed the effect of racial differences in the validity of age-adjusted, self-reported mammography use estimates from the Behavioral Risk Factor Surveillance System (BRFSS) from 1995 through 2006 to determine whether misclassification (inaccurate survey question response) may have obscured actual racial disparities.

Methods
We adjusted BRFSS mammography use data for age by using 2000 census estimates and for misclassification by using the following formula: (estimated prevalence − 1 + specificity) / (sensitivity + specificity − 1). We used values reported in the literature for the formula (sensitivity = 0.97 for both black and white women, specificity = 0.49 and 0.62, respectively, for black and white women).

Results
After adjustment for misclassification, the percentage of women aged 40 years or older in 1995 who reported receiving a mammogram during the previous 2 years was 54% among white women and 41% among black women, compared with 70% among both white and black women after adjustment for age only. In 2006, the percentage after adjustment for misclassification was 65% among white women and 59% among black women compared with 77% among white women and 78% among black women after adjustment for age only.

Conclusion
Self-reported data overestimate mammography use — more so for black women than for white women. After adjustment for respondent misclassification, neither white women nor black women had attained the Healthy People 2010 objective (≥70%) by 2006, and a disparity between white and black women emerged.

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Volume 8: No. 3, May 2011

TOOLS AND TECHNIQUES

Susan D. Newman, PhD, RN, CRRN; Jeannette O. Andrews, PhD, APRN-BC, FNP; Gayenell S. Magwood, PhD, RN; Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, LD, FAAN; Melissa J. Cox, MPH; Deborah C. Williamson, DHA, MSN, CNM

Suggested citation for this article: Newman SD, Andrews JO, Magwood GS, Jenkins C, Cox MJ, Williamson DC. Community advisory boards in community-based participatory research: a synthesis of best processes. Prev Chronic Dis 2011;8(3). http://www.cdc.gov/pcd/issues/2011/may/10_0045.htm. Accessed [date].

PEER REVIEWED

Abstract

Community-based participatory research (CBPR) is a paradigm to study and reduce disparities in health outcomes related to chronic disease. Community advisory boards (CABs) commonly formalize the academic–community partnerships that guide CBPR by providing a mechanism for community members to have representation in research activities. Researchers and funding agencies increasingly recognize the value of the community’s contribution to research and acknowledge that community advisory boards are a key component of successful CBPR projects. In this article, we describe the best processes for forming, operating, and maintaining CABs for CBPR. We synthesize the literature and offer our professional experiences to guide formation, operation, and maintenance of CABs.

Volume 8: No. 3, May 2011

ORIGINAL RESEARCH

Olivia D. Carter-Pokras, PhD; Tammie M. Johnson, DrPH; Lisa A. Bethune; Cong Ye, MS; Jacquelyn L. Fried, RDH, MS; Lu Chen, MA; Robert Fiedler, JD

Suggested citation for this article: Carter-Pokras OD, Johnson TM, Bethune LA, Ye C, Fried JL, Chen L, et al. Lost opportunities for smoking cessation among adults with diabetes in Florida (2007) and Maryland (2006). Prev Chronic Dis 2011;8(3). http://www.cdc.gov/pcd/issues/2011/may/10_0111.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Diabetes organizations recommend that people with diabetes should not smoke because of increased risk of diabetes complications. We describe smoking rates and health care service use among adults with diabetes in Florida and Maryland and identify the role of dentists in offering smoking cessation advice and services.

Methods
We analyzed data from 3 state telephone surveys: the 2007 Florida Behavioral Risk Factor Surveillance Survey (n = 39,549), the 2007 Florida Tobacco Callback Survey (n = 3,560), and the 2006 Maryland Adult Tobacco Survey (n = 21,799).

Results
Findings indicated that 15.7% of adults with diabetes in Florida and 11.6% of adults with diabetes in Maryland currently smoke. Current smoking among people with diabetes was associated with age, education, income, and race/ethnicity. Almost all respondents with diabetes who were current smokers in Florida (92.9%) and Maryland (97.7%) had visited a doctor or health care professional in the past year, and less than half had visited a dentist (40.7% and 44.8%, respectively). Both in Florida and Maryland, approximately two-thirds of adults with diabetes who were smokers and had visited a dentist in the past year had not received advice to quit (63.8% and 63.9%, respectively). In contrast, most adults with diabetes who were smokers and had visited a doctor or health care professional had received advice to quit smoking (95.3% and 84.9%, respectively).

Conclusion
Dentists are in a unique position to identify and demonstrate the oral effects of smoking in patients with diabetes. These data support continued smoking cessation training and education of oral health professionals.

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Volume 8: No. 3, May 2011

ORIGINAL RESEARCH

Antonia J. Spadaro, EdD, RN; Jo Anne Grunbaum, EdD; Nicola U. Dawkins, PhD, MPH; Demia S. Wright, MPH; Stephanie K. Rubel, MPH; Diane C. Green, PhD, MPH; Eduardo J. Simoes, MD, MPH

Suggested citation for this article: Spadaro AJ, Grunbaum JA, Dawkins NU, Wright DS, Rubel SK, Green DC, et al. Training and technical assistance to enhance capacity building between Prevention Research Centers and their partners. Prev Chronic Dis 2011;8(3). http://www.cdc.gov/pcd/issues/2011/may/10_0093.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
The Centers for Disease Control and Prevention has administered the Prevention Research Centers Program since 1986. We quantified the number and reach of training programs across all centers, determined whether the centers’ outcomes varied by characteristics of the academic institution, and explored potential benefits of training and technical assistance for academic researchers and community partners. We characterized how these activities enhanced capacity building within Prevention Research Centers and the community.

Methods
The program office collected quantitative information on training across all 33 centers via its Internet-based system from April through December 2007. Qualitative data were collected from April through May 2007. We selected 9 centers each for 2 separate, semistructured, telephone interviews, 1 on training and 1 on technical assistance.

Results
Across 24 centers, 4,777 people were trained in 99 training programs in fiscal year 2007 (October 1, 2006-September 30, 2007). Nearly 30% of people trained were community members or agency representatives. Training and technical assistance activities provided opportunities to enhance community partners’ capacity in areas such as conducting needs assessments and writing grants and to improve the centers’ capacity for cultural competency.

Conclusion
Both qualitative and quantitative data demonstrated that training and technical assistance activities can foster capacity building and provide a reciprocal venue to support researchers’ and the community’s research interests. Future evaluation could assess community and public health partners’ perception of centers’ training programs and technical assistance.

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Volume 8: No. 2, March 2011

SPECIAL TOPIC
Deaf Sign Language Users, Health Inequities, and Public Health: Opportunity for Social Justice

Steven Barnett, MD; Michael McKee, MD, MPH; Scott R. Smith, MD, MPH; Thomas A. Pearson, MD, PhD, MPH

Suggested citation for this article: Barnett S, McKee M, Smith SR, Pearson TA. Deaf sign language users, health inequities, and public health: opportunity for social justice. Prev Chronic Dis 2011;8(2). http://www.cdc.gov/pcd/issues/2011/mar/10_0065.htm. Accessed [date].

PEER REVIEWED

Introduction

Inequities in health and health care have increasingly become an area for concern and action for public health professionals, clinicians, policy makers, and communities. Research has documented inequities in the prevalence of chronic diseases of subpopulations defined by education, income, race and ethnicity, and English proficiency. Justice, a cornerstone of medical ethics, calls for corrective actions (1).

We contend that all communities contain a minority group whose health needs are understudied and underserved. This group is the sign language–using deaf population. Most sign language users have been deaf since birth or early childhood (2-7). Sign language is not global nor is it based on a local spoken language. For example, British Sign Language (BSL) and American Sign Language (ASL) are distinct languages with little in common with the English language or each other. In the United States, an estimated 100,000 to 1 million people use ASL as their primary language. We describe 4 issues that underlie health inequities experienced by deaf sign language users and propose 6 public health approaches to address these health and health care inequities to promote health and prevent chronic diseases.

Volume 8: No. 2, March 2011

ORIGINAL RESEARCH
Barriers to Colorectal Cancer Screening: Physician and General Population Perspectives, New Mexico, 2006

Richard M. Hoffman, MD, MPH; Robert L. Rhyne, MD, MPH; Deborah L. Helitzer, ScD; S. Noell Stone, MPH; Andrew L. Sussman, PhD, MCRP; Elizabeth E. Bruggeman, PhD, MA; Robyn Viera; Teddy D. Warner, PhD

Suggested citation for this article: Hoffman RM, Rhyne RL, Helitzer DL, Stone SN, Sussman AL, Bruggeman EE, et al. Barriers to colorectal cancer screening: physician and general population perspectives, New Mexico, 2006. Prev Chronic Dis 2011;8(2). http://www.cdc.gov/pcd/issues/2011/mar/10_0081.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Colorectal cancer (CRC) screening rates are low in New Mexico. We used statewide surveys of primary care physicians and the general population to characterize CRC screening practices and compare perceptions about screening barriers.

Methods
In 2006, we surveyed 714 primary care physicians in New Mexico about their CRC screening practices, beliefs, and perceptions of patient, provider, and system barriers. A 2004 state-specific CRC screening module for the Behavioral Risk Factor Surveillance System (BRFSS) survey asked 3,355 participants aged 50 years or older why they had not ever or had not recently completed a fecal occult blood test (FOBT) or lower endoscopy.

Results
The 216 physicians (30% response rate) reported offering screening to a median 80% of their average-risk patients in the past year and estimated that a median 50% were current with screening. They attributed low screening proportions mainly to patient factors (embarrassment, fear of pain, lack of insurance). However, just 51% of physician respondents used health maintenance flow sheets, and only 13% used electronic medical records to identify patients due for CRC screening. The BRFSS respondents most often reported that lack of physician discussion was responsible for not being current with screening (45% FOBT, 34% endoscopy); being asymptomatic was also often cited as an explanation for lack of screening (22% FOBT, 36% endoscopy).

Conclusion
Physicians and adults in the general population had markedly different perspectives on barriers to CRC screening. Increasing screening may require system supports to help physicians readily identify patients due for CRC testing and interventions to educate patients about the rationale for screening

Volume 8: No. 2, March 2011

COMMUNITY CASE STUDY
Development of a Community-Based Participatory Colorectal Cancer Screening Intervention to Address Disparities, Arkansas, 2008-2009

Karen Yeary, PhD; Eric Flowers, MPH; Gemessia Ford, MPH; Desiree Burroughs; Jackie Burton; Delores Woods; Chara Stewart, MPH; Paulette Mehta, MD; Paul Greene, PhD; Ronda Henry-Tillman, MD

Suggested citation for this article: Yeary K, Flowers E, Ford G, Burroughs D, Burton J, Woods D, et al. Development of a community-based participatory colorectal cancer screening intervention to address disparities, Arkansas, 2008-2009. Prev Chronic Dis 2011;8(2). http://www.cdc.gov/pcd/issues/2011/mar/10_0103.htm. Accessed [date].

PEER REVIEWED

Abstract

Background
The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population.

Community Context
The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas.

Methods
Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument.

Outcome
Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention’s efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system.

Interpretation
Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.

Volume 8: No. 2, March 2011

ORIGINAL RESEARCH
Facilitators and Barriers to Implementing a Local Policy to Reduce Sodium Consumption in the County of Los Angeles Government, California, 2009

Lauren N. Gase, MPH; Tony Kuo, MD, MSHS; Diane O. Dunet, PhD; Paul A. Simon, MD, MPH

Suggested citation for this article: Gase LN, Kuo T, Dunet DO, Simon PA. Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009. Prev Chronic Dis 2011;8(2). http://www.cdc.gov/pcd/issues/2011/mar/10_0060.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content.

Methods
We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County.

Results
Study participants reported 3 key facilitators: their organization’s authority to impose nutrition standards, their organization’s desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8 ) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium.

Conclusion
Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions.