Influential Periods in Longitudinal Clinical Cardiovascular Health Scores.

The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Proportion of Orofacial Clefts Attributable to Recognized Risk Factors.

OBJECTIVE: Estimate the population attributable fraction (PAF) for a set of recognized risk factors for orofacial clefts. DESIGN: We used data from the National Birth Defects Prevention Study. For recognized risk factors for which data were available, we estimated crude population attributable fractions (cPAFs) to account for potential confounding, average-adjusted population attributable fractions (aaPAFs). We assessed 11 modifiable and 3 nonmodifiable parental/maternal risk factors. The aaPAF for individual risk factors and the total aaPAF for the set of risk factors were calculated using a method described by Eide and Geffler. SETTING: Population-based case-control study in 10 US states. PARTICIPANTS: Two thousand seven hundred seventy-nine cases with isolated cleft lip with or without cleft palate (CL±P), 1310 cases with isolated cleft palate (CP), and 11 692 controls with estimated dates of delivery between October 1, 1997, and December 31, 2011. MAIN OUTCOME MEASURES: Crude population attributable fraction and aaPAF. RESULTS: The proportion of CL±P and CP cases attributable to the full set of examined risk factors was 50% and 43%, respectively. The modifiable factor with the largest aaPAF was smoking during the month before pregnancy or the first month of pregnancy (4.0% for CL±P and 3.4% for CP). Among nonmodifiable factors, the factor with the largest aaPAF for CL±P was male sex (27%) and for CP it was female sex (16%). CONCLUSIONS: Our results may inform research and prevention efforts. A large proportion of orofacial cleft risk is attributable to nonmodifiable factors; it is important to better understand the mechanisms involved for these factors.

An examination of the benefits of health promotion programs for the national fire service.

BACKGROUND: Firefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies. METHODS: Using the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms). RESULTS: Firefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers' Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking. CONCLUSIONS: Firefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.

A Single, Multimodal Exercise Tolerance Test Can Assess Combat Readiness in Army-ROTC Cadets: A Brief Report.

The Army Combat Fitness Test (ACFT) is a multi-event assessment battery designed to determine the combat readiness of U.S. Army personnel. However, for Reserve Officers' Training Corps (ROTC) programs the logistical demands of collegiate life make repeated administration of the ACFT challenging. The present study sought to design and evaluate a single, multimodal exercise tolerance test (METT) capable of serving as a time-efficient proxy measure of combat readiness. METHODS: Using a formal instrument design process, we constructed the METT to mimic the demands of the ACFT and assessed its reliability, validity, and responsiveness. RESULTS: The METT demonstrates minimal measurement error (i.e., a 2% coefficient of variation), concurrent validity with the ACFT (R2 = 0.327, F = 10.67, p < 0.001), the ability to classify cadets who may be at-risk for failing the ACFT (X2 = 8.16, p = 0.017, sensitivity = 0.878, specificity = 0.667), and appropriate change following a training intervention (5.69 ± 8.9%). CONCLUSIONS: The METT has the potential to provide a means to monitor progress, identify areas for improvement, and guide informed decision-making regarding individualization of cadet combat training plans.

Long-term physical activity outcomes of home-based lifestyle interventions among breast and prostate cancer survivors.

PURPOSE: Few studies have investigated long-term effects of physical activity (PA) interventions. The goal of this study was to evaluate whether or not increased levels of moderate to vigorous physical activity (MVPA) were maintained by cancer survivors 1 year after receipt of two home-based interventions. METHODS: The FRESH START trial randomized 543 breast and prostate cancer survivors to 1-of-2 mailed print diet and exercise interventions: sequentially-tailored vs. standardized (attention control). Each arm received eight mailings over a 1-year period, with follow-up at 1 and 2 years. This analysis focuses solely on the 400 participants who had suboptimal levels of MVPA at baseline (measured by the 7-Day Physical Activity Recall) and who completed the 2-year study. RESULTS: Median minutes of MVPA at baseline, 1-year and 2-year follow-up in the tailored intervention arm were as follows: 0, 90, and 60 min/week, respectively. The corresponding values in the attention control group were 0, 30, and 30 min/week. Significant improvements in MVPA from baseline to 2-year follow-up were observed in both study arms (p < 0.01). While significant between-arm differences were observed at 1-year follow-up (p < 0.01), there was only the suggestion of a trend (p = 0.08) at 2-year follow-up. CONCLUSIONS: This study provides evidence that mailed-print exercise interventions result in significant and sustainable improvements in MVPA among newly diagnosed cancer survivors that are observed well after the intervention is complete. While tailored interventions, as compared to standardized materials, appear to produce superior improvements in MVPA initially, these differences diminish over time.

Implications of the WHO Child Growth Standards in rural Honduras.

OBJECTIVE: The present study analysed the impact of using the 2006 WHO Child Growth Standards ('the WHO standards') compared with the 1977 National Center for Health Statistics (NCHS) international growth reference ('the NCHS reference') on the calculated prevalence of chronic malnutrition in children aged 6·0-59·9 months. DESIGN: Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland-Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories. SETTING: The study was conducted in thirteen rural villages within Honduras's department of Intibucá. SUBJECTS: Children aged 6·0-59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study. RESULTS: The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0-35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender. CONCLUSIONS: The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

A review of body size and breast cancer risk in Hispanic and African American women.

Obesity is an epidemic in the United States, especially among Hispanics and African Americans. Studies of obesity and breast cancer risk have been conducted primarily in non-Hispanic whites. There have been few studies of the association between body mass index (BMI) or weight gain and the risk of breast cancer in minorities, and the results have been inconsistent. Because most studies are conducted primarily in non-Hispanic whites, the etiology of breast cancer in minorities is not well understood. The authors of the current report reviewed the literature on the association between obesity, weight, and weight gain and breast cancer in minorities using a combination of the Medical Subject Heading (MeSH) terms "obesity," "body mass index," "weight," "weight gain," "Hispanic," and "African American." Only publications in English and with both risk estimates and 95% confidence intervals were considered. Forty-five studies of body size and breast cancer risk in non-Hispanic whites were identified. After an exhaustive search of the literature, only 3 studies of body size and breast cancer were conducted in Hispanic women were identified, and only 8 such studies in African American women were identified. The results were inconsistent in both race/ethnicity groups, with studies reporting positive, inverse, and null results. Thus, as obesity rates among Hispanics and African Americans continue to rise, there is an urgent need to identify the roles that both obesity and adult weight gain play in the development of breast cancer in these minorities. Additional studies are needed to provide more understanding of the etiology of this disease and to explain some of the disparities in incidence and mortality.

Antioxidant genes, diabetes and dietary antioxidants in association with risk of pancreatic cancer.

To test the hypothesis that polymorphic variants of antioxidant genes modify the risk of pancreatic cancer, we examined seven single-nucleotide polymorphisms (SNPs) of genes coding for superoxide dismutase (SOD) 2, glutathione S-transferase alpha 4 (GSTA4), catalase and glutathione peroxidase in 575 patients with pancreatic adenocarcinoma and 648 healthy controls in a case-control study. Information on risk factors was collected by personal interview and dietary information was collected by a self-administered food frequency questionnaire. Genotypes were determined using the Taqman method. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were estimated by unconditional logistic regression. No significant main effect of genotype was observed. A borderline significant interaction between diabetes and SOD2 Ex2+24T>C CT/TT genotype was observed (P(interaction) = 0.051); the AORs (95% CI) were 0.98 (0.73-1.32) for non-diabetics carrying the CT/TT genotype, 1.73 (0.94-3.18) for diabetics carrying the CC genotype and 3.49 (2.22-5.49) for diabetics carrying the CT/TT genotype compared with non-diabetics carrying the CC genotype. Moreover, the SOD2 -1221G>A AA genotype carriers had a significantly increased risk for pancreatic cancer among those with a low dietary vitamin E intake but decreased risk among those with a high vitamin E intake (P(interaction) = 0.002). There was a non-significant interaction between diabetes and GSTA4 Ex5-64G>A genotypes (P(interaction) = 0.078). No significant interaction between genotype with cigarette smoking or vitamin C intake was observed. These data suggest that genetic variations in antioxidant defenses modify the risk of pancreatic cancer in diabetics or individuals with a low dietary vitamin E intake.

Cardiovascular Health Trajectories From Childhood Through Middle Age and Their Association With Subclinical Atherosclerosis.

Importance: Cross-sectional measures of cardiovascular health (CVH) have been associated with cardiovascular disease in older age, but little is known about longitudinal trajectories in CVH and their association with subclinical atherosclerosis in middle age. Objectives: To model long-term patterns in CVH starting in childhood and to assess their association with subclinical atherosclerosis in middle age. Design, Setting, and Participants: This cohort study used data from 5 prospective cardiovascular cohort studies from the United States and Finland from 1973 to 2015. A total of 9388 participants aged 8 to 55 years had at least 3 examinations and were eligible for this study. Statistical analysis was performed from December 1, 2015, to June 1, 2019. Exposures: Clinical CVH factors (body mass index, total cholesterol level, blood pressure, and glucose level) were classified as ideal, intermediate, or poor, and were summed as a clinical CVH score. Group-based latent class modeling identified trajectories in this score over time. Main Outcomes and Measures: Carotid intima-media thickness (cIMT) was measured for participants in 3 cohorts, and high cIMT was defined as a value at or above the 90th percentile. The association between CVH trajectory and cIMT was modeled using both linear and logistic regression adjusted for demographics, baseline health behaviors, and baseline (or proximal) CVH score. Results: Among 9388 participants (5146 [55%] female; 6228 [66%] white; baseline mean [SD] age, 17.5 [7.5] years), 5 distinct trajectory groups were identified: high-late decline (1518 participants [16%]), high-moderate decline (2403 [26%]), high-early decline (3066 [32%]), intermediate-late decline (1475 [16%]), and intermediate-early decline (926 [10%]). The high-late decline group had significantly lower adjusted cIMT vs other trajectory groups (high-late decline: 0.64 mm [95% CI, 0.63-0.65 mm] vs intermediate-early decline: 0.72 mm [95% CI, 0.69-0.75 mm] when adjusted for demographics and baseline smoking, diet, and physical activity; P < .01). The intermediate-early declining group had higher odds of high cIMT (odds ratio, 2.4; 95% CI, 1.3-4.5) compared with the high-late decline group, even after adjustment for baseline or proximal CVH score. Conclusions and Relevance: In this study, CVH declined from childhood into adulthood. Promoting and preserving ideal CVH from early life onward may be associated with reduced CVD risk later in life.

Antibiotics taken for other illnesses and spontaneous clearance of Helicobacter pylori infection in children.

PURPOSE: Factors that determine persistence of untreated Helicobacter pylori (H. pylori) infection in childhood are not well understood. We estimated risk differences for the effect of incidental antibiotic exposure on the probability of a detected clearance at the next test after an initial detected H. pylori infection. METHODS: The Pasitos Cohort Study (1998-2005) investigated predictors of H. pylori infection in children from El Paso, Texas, and Juarez, Mexico. Children were screened for infection at 6-month target intervals from 6 to 84 months of age, using the 13C-urea breath test corrected for body-size-dependent variation in CO2 production. Exposure was defined as courses of any systemic antibiotic (systemic) or those with anti-H. pylori action (HP-effective) reported for the interval between initial detected infection and next test. Binomial regression models included country of residence, mother's education, adequacy of prenatal care, age at infection, and interval between tests. RESULTS: Of 205 children with a test result and antibiotic data following a detected infection, the number of children who took > or =1 course in the interval between tests was 74 for systemic and 33 for HP-effective. The proportion testing negative at the next test was 66% for 0 courses, 72% for > or =1 systemic course, and 79% for > or =1 HP-effective course. Adjusted risk differences (95%CI) for apparent clearance, comparing > or =1 to 0 courses were 10% (1-20%) for systemic and 11% (0-21%) for HP-effective. CONCLUSIONS: Incidental antibiotic exposure appears to influence the duration of childhood H. pylori infection but seems to explain only a small portion of spontaneous clearance.

Body mass index and risk, age of onset, and survival in patients with pancreatic cancer.

CONTEXT: Obesity has been implicated as a risk factor for pancreatic cancer. OBJECTIVE: To demonstrate the association of excess body weight across an age cohort and the risk, age of onset, and overall survival of patients with pancreatic cancer. DESIGN, SETTING, AND PARTICIPANTS: A case-control study of 841 patients with pancreatic adenocarcinoma and 754 healthy individuals frequency matched by age, race, and sex. The study was conducted at a university cancer center in the United States from 2004 to 2008. Height and body weight histories were collected by personal interview starting at ages 14 to 19 years and over 10-year intervals progressing to the year prior to recruitment in the study. MAIN OUTCOME MEASURES: The associations between patients' body mass index (BMI) and risk of pancreatic cancer, age at onset, and overall survival were examined by unconditional logistic regression, linear regression, and Cox proportional hazard regression models, respectively. RESULTS: Individuals who were overweight (a BMI of 25-29.9) from the ages of 14 to 39 years (highest odds ratio [OR], 1.67; 95% confidence interval [CI], 1.20-2.34) or obese (a BMI > or = 30) from the ages of 20 to 49 years (highest OR, 2.58; 95% CI, 1.70-3.90) had an associated increased risk of pancreatic cancer, independent of diabetes status. The association was stronger in men (adjusted OR, 1.80; 95% CI, 1.45-2.23) by mean BMI from the ages of 14 to 59 years than in women (adjusted OR, 1.32; 95% CI, 1.02-1.70) and in ever smokers (adjusted OR, 1.75; 95% CI, 1.37-2.22) than in never smokers (adjusted OR, 1.46; 95% CI, 1.16-1.84). The population-attributable risk percentage of pancreatic cancer based on the mean BMI from the ages of 14 to 59 years was 10.3% for never smokers and 21.3% for ever smokers. Individuals who were overweight or obese from the ages of 20 to 49 years had an earlier onset of pancreatic cancer by 2 to 6 years (median age of onset was 64 years for patients with normal weight, 61 years for overweight patients [P = .02], and 59 years for obese patients [P < .001]). Compared with those with normal body weight and after adjusting for all clinical factors, individuals who were overweight or obese from the ages of 30 to 79 years or in the year prior to recruitment had reduced overall survival of pancreatic cancer regardless of disease stage and tumor resection status (overweight patients: hazard ratio, 1.26 [95% CI, 0.94-1.69], P = .04; obese patients: hazard ratio, 1.86 [95% CI, 1.35-2.56], P < .001). CONCLUSIONS: Overweight or obesity during early adulthood was associated with a greater risk of pancreatic cancer and a younger age of disease onset. Obesity at an older age was associated with a lower overall survival in patients with pancreatic cancer.

Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome.

OBJECTIVE: The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. METHODS: The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. RESULTS: An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. CONCLUSIONS: TF20 supports firefighters' weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.

Personality as a predictor of dietary quality in spouses during midlife.

The authors evaluated the NEO Personality Inventory-Revised (NEO-PI-R) as a predictor of dietary quality in 850 married couples, focusing on associations among each participant's personality as a predictor of their own dietary quality and their spouses' dietary quality. Diet was based on a modified version of the US Department of Agriculture Healthy Eating Index. Openness was associated with self-ratings of dietary quality for wives (r = .28) and husbands (r = .27). Wives' levels of the characteristic openness were also related to their spouses' ratings of dietary quality (r = .22). The primary facets of openness accounting for the domain-level findings were O2-aesthetics and O4-actions. The remaining personality domains (neuroticism, extraversion, agreeableness, and conscientiousness) were not associated with self or spousal ratings of dietary quality (rs = .08-.09). Openness was associated with healthy eating habits--findings that may affect disease prevention during, midlife.

Relationship between Homocysteine and Muscle Strength Decline: The Baltimore Longitudinal Study of Aging.

Background: Decreased muscle strength is strongly associated with future mobility limitations in older adults. Homocysteine is a risk factor for vascular disease and may exacerbate muscle strength decline. The present study aimed to examine the association between homocysteine levels and muscle strength in adults aged 50 years or older. Methods: Data were from 1,101 participants of The Baltimore Longitudinal Study of Aging between December 2004 and March 2015. Muscle strength was measured using grip strength. Mixed effects linear regression was used to estimate the association between homocysteine and muscle strength in men and women, separately. Results: Total mean follow-up time was 4.7 ± 3.1 years, range from 0 to 10.1 years. Baseline mean grip strength was 39.9 kg for men and 25.5 kg for women. Grip strength declined over the follow-up time for both men and women. Among women, there was a significant inverse relationship between homocysteine and grip strength, where grip strength declined as a function of increasing homocysteine over time (ß = -0.05, p = .031). Among men, an increase of 1 µmol/L in homocysteine was associated with -0.10 kg decrease in grip strength, though not significantly. Conclusions: In this study of healthy older adults aged 50 years or older, higher homocysteine was related to lower muscle strength in women. This is the first study to characterize the relationship over a long follow-up period. Future research should focus on assessing homocysteine as a marker of physical function decline and translating the relationship into clinical and public health practice.

Adenovirus 36 antibody detection: Improving the standard serum neutralization assay.

Adenovirus 36 (AdV36) causes weight gain in animal models, including non-human primates. In humans, AdV36-neutralizing antibodies are associated with adiposity; however, longitudinal studies in large populations are needed to clarify AdV36's contribution. The current gold standard for detection of AdV36-specific antibody is the serum neutralization assay (SNA), which requires long incubation times and highly trained personnel. The standard SNA was modified using an immunocytochemical (ICC) approach, which allows for a more rapid and objective assessment of AdV36 antibodies. Using the ICC assay, virus-infected cells were detected as early as day 1 (D1) and by D5 were detected in 100% of microtiter wells versus 20.3% of wells detected by observing the cytopathic effect. Further, human sera tested with the ICC assay at D5 had a sensitivity and specificity of 80.0% and 95.7%, respectively, when compared to the standard SNA read at D11. Thus, the ICC assay decreased assay incubation time, provided a more objective and easily interpreted assessment, and had a high degree of sensitivity and specificity in determining serological status. The more rapid and objective ICC method will make large population studies feasible, improve comparability among laboratories, and contribute to understanding the role of AdV36 in obesity.

Dynamics of Helicobacter pylori infection in a US-Mexico cohort during the first two years of life.

BACKGROUND: The Pasitos Cohort Study has followed children in El Paso, Texas and Ciudad Juarez, Mexico since 1998 to identify determinants of Helicobacter pylori infection. This paper describes patterns of acquisition and elimination of H. pylori infection in 468 children from birth to 24 months. METHODS: Mothers were recruited during pregnancy at maternal-child clinics; children were targeted for follow-up examinations every 6 months after birth. H. pylori infection was detected using the 13C-urea breath test, corrected for age-dependent variation in CO2 production. RESULTS: Test results were available for 359, 341, 269, and 215 children around target ages of 6, 12, 18, and 24 months, respectively. The person-time at risk of a first detectable infection was 7742 person-months; 128 first infections were detected, thus the incidence rate was 1.7% per month (95% confidence interval 1.4-2.0%). Rates were similar in boys and girls and on both sides of the border; evidence suggests, however, that this similarity could be due to selection bias. Among children with follow-up after a positive test, 77% tested negative at a later visit. CONCLUSIONS: The initial acquisition of detectable H. pylori infection occurred at a rate of 20% per year among Pasitos Cohort children from birth to 24 months of age. A key finding, with implications for clinical, community health, and research settings, is that most of these infections did not persist. The transient nature of early H. pylori infection should be considered when designing research or contemplating therapeutic intervention for this age group.

Heritage retention and bean intake correlates to dietary fiber intakes in Hispanic mothers--Qué Sabrosa Vida.

OBJECTIVE: To determine the correlation between fruit/vegetable and bean stage of change and heritage retention with fiber intake in Hispanic mothers. DESIGN: Cross-sectional study design used baseline survey data from the Qué Sabrosa Vida nutrition intervention developed by the University of Texas School of Public Health, Human Nutrition Center (Houston, TX). Participants were recruited and data gathered from telephone surveys using random digit dial methodology ensuring proportional representation of demographic subgroups. SUBJECTS: Hispanic mothers (N=293) responded to the baseline survey in El Paso, TX. ANALYSES: Using SPSS version 11.0 (SPSS Inc, Chicago, IL), descriptive statistics, chi2 , correlations, and analyses of variance were used to determine the relationship of variables to fiber intake. Potential confounding variables included were grain stage of change, age, education level, and marital status. RESULTS: Mean fiber intake for mothers was 21.9 g/day and mean age was 35.8 years. Chi2 of fruit/vegetable stage was P =.784. Chi 2 of bean stage, heritage retention score, age, and education to fiber intake were significant, P =.008, P =.004, P =.005, and P =.001, respectively. Bean stage, heritage retention score, age, and education level were significantly correlated. One-way analysis of variance of bean stage, heritage retention score, age, and education level by fiber intake were significant, P =.006, P =.001, P =.004, and P =.002, respectively. CONCLUSIONS: Older Hispanic mothers in the action/maintenance bean stage with strong heritage retention score had greater fiber intakes than younger mothers in pre-action bean stage with weak heritage retention score. As education level increased fiber intake decreased. Encouragement of bean consumption and heritage retention may increase fiber intake in this Hispanic mother population.

Prevalence and correlates of cell phone use among Texas drivers.

INTRODUCTION: Cell phone use while driving restricts peripheral awareness and impairs reaction time. This study assessed the 3-year prevalence of cell phone use (CPU) of drivers and characteristics associated with its use in six cities across Texas, 2011-2013. METHODS: CPU and driver characteristics were observed among motor vehicles (n = 1280) stopped at major intersections in medical and academic campuses. A multivariable logistic regression model described the association between driver characteristics and CPU. RESULTS: The overall prevalence of any CPU was 18.7%. Any type of CPU and talking tended to decline, while texting seemed to increase from 2011 to 2013. CPU was more likely among female drivers (OR = 1.63; 95% CI = 1.21, 2.20), drivers < 25 years of age (OR = 4.12; 95% CI = 2.29, 7.39), and drivers without passengers (OR = 4.40; 95% CI = 2.82, 6.88). CONCLUSION: Despite its dangers, CPU remains popular among Texas drivers. CPU and texting bans should target public health campaigns towards female and younger drivers.

Alcohol use and caloric intake from alcohol in a national cohort of U.S. career firefighters.

OBJECTIVE: Both media reports and preliminary research suggest that problem drinking is a concern in the U.S. fire service. However, no national epidemiological research has been conducted. This study presents the first national data on alcohol consumption patterns among firefighters. METHOD: Data are from 954 male firefighters at 20 career fire departments. The departments covered 14 U.S. states, commonwealths, and/or territories and each of the four major U.S. Census Bureau Regions. Alcohol use was assessed through both surveys and, in a subsample, 24-hour dietary recall interviews from an off-duty day. RESULTS: More than 85% of participants consumed alcohol, nearly half reported excessive drinking, and approximately one third reported episodic heavy use when off duty. Firefighters (in comparison with officers or chiefs) and those with fewer years of service had particularly high levels of alcohol intake. Among firefighters who drank, the energy derived from alcohol averaged 539 kcals, or nearly 18% of total energy. Twenty five percent of firefighters consumed more than 770 kcals from alcohol in a single day. CONCLUSIONS: Given the high prevalence of excessive and episodic heavy drinking and the impact of alcohol on energy intake in this population, national surveillance programs and targeted prevention interventions for problem drinking in the U.S. fire service are critically needed.

Weight Advice Associated With Male Firefighter Weight Perception and Behavior.

INTRODUCTION: The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters. METHODS: A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011-2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity. RESULTS: Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders. CONCLUSIONS: Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters.