Home testing for SARS-CoV-2 and impact on surveillance in New York State.

PURPOSE: To determine the distribution of diagnosed SARS-CoV-2 infections by testing modality (at-home rapid antigen [home tests] versus laboratory-based tests in clinical settings [clinical tests]), assess factors associated with clinical testing, and estimate the true total number of diagnosed infections in New York State (NYS). METHODS: We conducted an online survey among NYS residents and analyzed data from 1012 adults and 246 children with diagnosed infection July 13-December 7, 2022. Weighted descriptive and logistic regression model analyses were conducted. Weighted percentages and prevalence ratios by testing modality were generated. The percent of infections diagnosed by clinical tests via survey data were synthesized with daily lab-reported results to estimate the total number of diagnosed SARS-CoV-2 infections in NYS July 1-December 31, 2022. RESULTS: Over 70% of SARS-CoV-2 infections in NYS during the study period were diagnosed exclusively with home tests. Diagnosis with a clinical test was associated with age, race/ethnicity, and region among adults, and sex, age, and education among children. We estimate 4.1 million NYS residents had diagnosed SARS-CoV-2 infection July 1-December 31, 2022, compared to 1.1 million infections reported over the same period. CONCLUSIONS: Most SARS-CoV-2 infections in NYS were diagnosed exclusively with home tests. Surveillance metrics using laboratory-based reporting data underestimate diagnosed infections.

Outcomes of Population Surveillance Data Collection Pilots and the Behavioral Risk Factor Surveillance System: What Happens in Texas.

Declining response rates and rising costs have prompted the search for alternatives to traditional random-digit dialing (RDD) interviews. In 2021, three Behavioral Risk Factor Surveillance System (BRFSS) pilots were conducted in Texas: data collection using an RDD short message service (RDD SMS) text-messaging push-to-web pilot, an address-based push-to-web pilot, and an internet panel pilot. We used data from the three pilots and from the concurrent Texas BRFSS Computer Assisted Telephone Interview (CATI). We compared unweighted data from these four sources to demographic information from the American Community Survey (ACS) for Texas, comparing respondents' health information across the protocols as well as cost and response rates. Non-Hispanic White adults and college graduates disproportionately responded in all survey protocols. Comparing costs across protocols was difficult due to the differences in methods and overhead, but some cost comparisons could be made. The cost per complete for BRFSS/CATI ranged from $75 to $100, compared with costs per complete for address-based sampling ($31 to $39), RDD SMS ($12 to $20), and internet panel (approximately $25). There were notable differences among survey protocols and the ACS in age, race/ethnicity, education, and marital status. We found minimal differences in respondents' answers to heart disease-related questions; however, responses to flu vaccination questions differed by protocol. Comparable responses were encouraging. Properly weighted web-based data collection may help use data collected by new protocols as a supplement to future BRFSS efforts.

Assessing quality-adjusted years of life lost associated with exclusive cigarette smoking and smokeless tobacco use.

The main purpose of this analysis is to quantify quality adjusted life years (QALYs) lost associated with lifetime exclusive cigarette or smokeless tobacco use among U.S. adults. Multiple waves of National Health Interview Survey (NHIS) data linked to death certificate records were used to define current exclusive cigarette and smokeless tobacco use and associated mortality risks. NHIS data were used to assess health-related quality of life (HRQOL). Regression and Cox proportional hazard modeling were used to adjust HRQOL and mortality risk associated with tobacco use for age, sex, race/ethnicity, body mass index, education, and household poverty level. QALYs were estimated based on adjusted HRQOL and mortality risks. All analyses were initiated in 2019 and completed in 2020. Male current exclusive cigarette smokers, aged 25 to 29 years would lose 8.1 QALYs (SE = 0.09), and male current exclusive smokeless tobacco users aged 25 to 34 would lose 4.1 QALYs (SE = 0.22), compared to never users of tobacco. Current exclusive cigarette or smokeless tobacco use is associated with QALY loss. QALYs lost can be lessened through preventing the initiation of tobacco product use or helping tobacco product users quit as early in life as possible.

Evidence of the Impact of the Tips From Former Smokers Campaign: Results From the Behavioral Risk Factor Surveillance System.

The Tips From Former Smokers campaign (Tips) has demonstrated significant impact as a population-based intervention for smoking cessation in the United States. Since 2012, evaluations of Tips have relied on web-panel data to attribute the campaign to smoking cessation outcomes. We re-examined the relationship between market-level doses of the campaign and quit attempts by using Behavioral Risk Factor Surveillance System (BRFSS) data to triangulate prior findings. We found that Tips was associated with increased quit attempts among smokers, which validates prior evaluation research on the impact of Tips. These results suggest that continued investments in Tips may help sustain its impact on cessation-related outcomes.

The Feeding Infants and Toddlers Study (FITS) 2016: Study Design and Methods.

Background: Diet and feeding patterns during the infant, toddler, and preschool years affect nutrient adequacy or excess during critical developmental periods. Understanding food consumption, feeding practices, and nutrient adequacy or excess during these periods is essential to establishing appropriate recommendations aimed at instilling healthy eating behaviors in children. Objective: The objective of the 2016 Feeding Infants and Toddlers Study (FITS 2016) was to update our knowledge on the diets and feeding patterns of young children and to provide new data in related areas such as feeding behaviors, sleep, physical activity, and screen use. This article describes the study design, data collection methods, 24-h dietary recall (24-h recall) protocol, and sample characteristics of FITS 2016. Methods: FITS 2016 is a cross-sectional study of caregivers of children aged <4 y living in the 50 states and Washington, DC. Data collection occurred between June 2015 and May 2016. A recruitment interview (respondent and child characteristics, feeding practices, physical activity, screen use, and sleep habits) was completed by telephone or online. This was followed by a feeding practices questionnaire and the 24-h recall conducted by telephone. A second 24-h recall was collected for a random subsample of 25% of the total sampled population. Results: Among the 4830 recruited households with an age-eligible child, 3248 (67%) completed the 24-h recall. The respondents were more likely to be white, less likely to be Hispanic, and more highly educated than the US population of adults in households with a child <4 y of age. The sample was subsequently calibrated and weighted, and the distribution of respondents was compared with known population distributions. Conclusions: FITS 2016 provides data based on sound methods that can inform researchers, policymakers, and practitioners about the food and nutrient intakes of young children. New findings may also be compared with previous FITS studies.

New insights in regulation of calcium homeostasis.

PURPOSE OF REVIEW: Regulation of calcium homeostasis during a lifetime is a complex process reflecting a balance among intestinal calcium absorption, bone calcium influx and efflux, and renal calcium excretion. Perturbations can result in hypocalcemia or hypercalcemia and adaptations in calcium handling must occur during growth and aging. RECENT FINDINGS: Study of the calcium sensing receptor in the thick ascending limb of Henle and TRPV5 in the distal tubule continues to provide insights into regulation of renal calcium excretion. Hypercalcemia-induced secretion of calcitonin via activation of the calcium-sensing receptor may protect against the development of hypercalcemia. A calcilytic was shown to increase serum calcium by decreasing renal calcium excretion. Ezrin, a cross-linking protein important for renal phosphate handling, is also involved in the regulation of intestinal calcium absorption. Increased 1,25-hydroxyvitamin D (1,25D) values were shown to protect against the development of hypocalcemia by increasing calcium efflux and decreasing calcium influx in bone. Finally, fibroblast growth factor 23 stimulation, which should result in suppression of 1,25D, was shown to be prevented in a model of vitamin D deficiency in which maintenance of 1,25D is important in minimizing hypocalcemia. SUMMARY: Recent information has provided new insights on how intestinal, bone and renal mechanisms are regulated to maintain calcium homeostasis.

The role of subway travel in an influenza epidemic: a New York City simulation.

The interactions of people using public transportation in large metropolitan areas may help spread an influenza epidemic. An agent-based model computer simulation of New York City's (NYC's) five boroughs was developed that incorporated subway ridership into a Susceptible-Exposed-Infected-Recovered disease model framework. The model contains a total of 7,847,465 virtual people. Each person resides in one of the five boroughs of NYC and has a set of socio-demographic characteristics and daily behaviors that include age, sex, employment status, income, occupation, and household location and membership. The model simulates the interactions of subway riders with their workplaces, schools, households, and community activities. It was calibrated using historical data from the 1957-1958 influenza pandemics and from NYC travel surveys. The surveys were necessary to enable inclusion of subway riders into the model. The model results estimate that if influenza did occur in NYC with the characteristics of the 1957-1958 pandemic, 4% of transmissions would occur on the subway. This suggests that interventions targeted at subway riders would be relatively ineffective in containing the epidemic. A number of hypothetical examples demonstrate this feature. This information could prove useful to public health officials planning responses to epidemics.

Intercenter differences in bronchopulmonary dysplasia or death among very low birth weight infants.

OBJECTIVES: To determine (1) the magnitude of clustering of bronchopulmonary dysplasia (36 weeks) or death (the outcome) across centers of the Eunice Kennedy Shriver National Institute of Child and Human Development National Research Network, (2) the infant-level variables associated with the outcome and estimate their clustering, and (3) the center-specific practices associated with the differences and build predictive models. METHODS: Data on neonates with a birth weight of <1250 g from the cluster-randomized benchmarking trial were used to determine the magnitude of clustering of the outcome according to alternating logistic regression by using pairwise odds ratio and predictive modeling. Clinical variables associated with the outcome were identified by using multivariate analysis. The magnitude of clustering was then evaluated after correction for infant-level variables. Predictive models were developed by using center-specific and infant-level variables for data from 2001 2004 and projected to 2006. RESULTS: In 2001-2004, clustering of bronchopulmonary dysplasia/death was significant (pairwise odds ratio: 1.3; P < .001) and increased in 2006 (pairwise odds ratio: 1.6; overall incidence: 52%; range across centers: 32%-74%); center rates were relatively stable over time. Variables that varied according to center and were associated with increased risk of outcome included lower body temperature at NICU admission, use of prophylactic indomethacin, specific drug therapy on day 1, and lack of endotracheal intubation. Center differences remained significant even after correction for clustered variables. CONCLUSION: Bronchopulmonary dysplasia/death rates demonstrated moderate clustering according to center. Clinical variables associated with the outcome were also clustered. Center differences after correction of clustered variables indicate presence of as-yet unmeasured center variables.

Mass commuting and influenza vaccination prevalence in new york city: protection in a mixing environment.

OBJECTIVE: Assess influenza vaccination among commuters using mass transit in New York City (NYC). METHODS: We used the 2006 NYC Community Health Survey (CHS) to analyze the prevalence of influenza immunization by commuting behaviors and to understand what socioeconomic and geographic factors may explain any differences found. RESULTS: Vaccination prevalence is significantly lower for New Yorkers who commute on public transportation compared to other New Yorkers. This difference is largely attenuated after adjusting for socio-demographic characteristics and neighborhood of residence. CONCLUSIONS: The analysis identified a low prevalence of immunization among commuters, and given the transmissibility in that setting, targeting commuters for vaccination campaigns may impede influenza spread.

Gender differences in the impact of social support on crack use among African Americans.

This article examines the influence of social support on crack use in a sample of 435 African American out-of-treatment crack users recruited through street outreach in Raleigh, North Carolina, between 2000 and 2002. Multivariate regression models indicated that social support was not a strong influence on crack use. For women, no social support variables predicted crack use, whereas for men, having a non-using partner was negatively associated with crack use. Findings indicate that existing social support is not strongly linked to drug use among African Americans, but African American men may be positively influenced by non-using sexual partners. Limitations of the sample and data are discussed. Further research is needed on the influence of social support for African American drug-using populations.