Estimating quality-adjusted life expectancy (QALE) for local authorities in Great Britain and its association with indicators of the inclusive economy: a cross-sectional study.

OBJECTIVES: Quantifying area-level inequalities in population health can help to inform policy responses. We describe an approach for estimating quality-adjusted life expectancy (QALE), a comprehensive health expectancy measure, for local authorities (LAs) in Great Britain (GB). To identify potential factors accounting for LA-level QALE inequalities, we examined the association between inclusive economy indicators and QALE. SETTING: 361/363 LAs in GB (lower tier/district level) within the period 2018-2020. DATA AND METHODS: We estimated life tables for LAs using official statistics and utility scores from an area-level linkage of the Understanding Society survey. Using the Sullivan method, we estimated QALE at birth in years with corresponding 80% CIs. To examine the association between inclusive economy indicators and QALE, we used an open access data set operationalising the inclusive economy, created by the System Science in Public Health and Health Economics Research consortium. RESULTS: Population-weighted QALE estimates across LAs in GB were lowest in Scotland (females/males: 65.1 years/64.9 years) and Wales (65.0 years/65.2 years), while they were highest in England (67.5 years/67.6 years). The range across LAs for females was from 56.3 years (80% CI 45.6 to 67.1) in Mansfield to 77.7 years (80% CI 65.11 to 90.2) in Runnymede. QALE for males ranged from 57.5 years (80% CI 40.2 to 74.7) in Merthyr Tydfil to 77.2 years (80% CI 65.4 to 89.1) in Runnymede. Indicators of the inclusive economy accounted for more than half of the variation in QALE at the LA level (adjusted R2 females/males: 50%/57%). Although more inclusivity was generally associated with higher levels of QALE at the LA level, this association was not consistent across all 13 inclusive economy indicators. CONCLUSIONS: QALE can be estimated for LAs in GB, enabling further research into area-level health inequalities. The associations we identified between inclusive economy indicators and QALE highlight potential policy priorities for improving population health and reducing health inequalities.

Impact of built environment change on all-cause and cause-specific mortality: a novel longitudinal method and study.

BACKGROUND: Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better population health and whether BE change can help narrow health inequalities. This knowledge gap is partly due to a lack of suitable longitudinal BE data in most countries. We devised a method to quantify BE change longitudinally and explored associations with mortality. The method is replicable in any nation that captures BE vector map data. METHODS: Ordnance Survey data were used to categorise small areas as having no change, loss or gain, in buildings, roads, and woodland between 2015 and 2019. We examined individual mortality records for 2012-2015 and 2016-2019, using negative binomial regression to explore associations between BE change and all-cause and cause-specific mortality, adjusting for income deprivation. RESULTS: BE change varied significantly by deprivation and urbanicity. Change in the BE and change in mortality were not related, however, areas that went on to experience BE change had different baseline mortality rates compared with those that did not. For example, areas that gained infrastructure already had lower mortality rates. CONCLUSION: We provide new methodology to quantify BE change over time across a nation. Findings provide insight into the health of areas that do/do not experience change, prompting critical perspectives on cross-sectional studies of associations between BE and health. Methods and findings applied internationally could explore the context of BE change and its potential to improve health in areas most in need beyond the UK.

Physical health of care-experienced young children in high-income countries: a scoping review protocol.

INTRODUCTION: Care-experienced children have poorer health, developmental, and quality of life outcomes across the lifespan compared to children who are not in care. These inequities begin to manifest in the early years. The purpose of the proposed scoping review is to collate and synthesise studies of the physical health of young care-experienced children. The results of the review will help map the distribution of health outcomes, identify potential targets for intervention, and assess gaps in the literature relating to this group. METHODS AND ANALYSIS: We will carry out a scoping review of the literature to identify studies of physical health outcomes in care-experienced children. Systematic literature searches will be carried out on the MEDLINE, CINAHL and Web of Science Core Collection databases for items indexed on or before 31 August 2022. Studies will be included where the participants are aged 3 months or greater and less than 6 years. Data elements extracted from included studies will include study objectives, health outcomes, participant demographics, care setting characteristics and bibliographic information. The results of the review will be synthesised and reported using a critical narrative approach. Comparisons between care and non-care populations will be reported if sufficient studies are identified. ETHICS AND DISSEMINATION: Data will be extracted from publicly available sources, so no additional ethical approval is required. Results will be published in a peer-reviewed journal article. Furthermore, they will be shared in summary reports and presented to local authorities, care organisations and other relevant stakeholders that can influence healthcare policy and procedure relating to young children in care.

Differences in ill health and in socioeconomic inequalities in health by ethnic groups: a cross-sectional study using 2011 Scottish census.

Objectives: We compare rates of ill health and socioeconomic inequalities in health by ethnic groups in Scotland by age. We focus on ethnic differences in socioeconomic inequalities in health. There is little evidence of how socioeconomic inequalities in health vary by ethnicity, especially in Scotland, where health inequalities are high compared to other European countries.Design: A cross-sectional study using the 2011 Scottish Census (population 5.3 million) was conducted. Directly standardized rates were calculated for two self-rated health outcomes (poor general health and limiting long-term illness) separately by ethnicity, age and small-area deprivation. Slope and relative indices of inequality were calculated to measure socioeconomic inequalities in health.Results: The results show that the White Scottish population tend to have worse health and higher socioeconomic inequalities in health than many other ethnic groups, while White Polish and Chinese people tend to have better health and low socioeconomic inequalities in health. These results are more salient for ages 30-44. The Pakistani population has high rates of poor health similar to the White Scottish for ages 15-44, but at ages 45 and above Pakistani people have the highest rates of poor self-rated health. Compared to other ethnicities, Pakistani people are also more likely to experience poor health in the least deprived areas, particularly at ages 45 and above.Conclusions: There are statistically significant and substantial differences in poor self-rated health and in socioeconomic inequalities in health between ethnicities. Rates of ill health vary between ethnic groups at any age. The better health of the younger minority population should not be taken as evidence of better health outcomes in later life. Since socioeconomic gradients in health vary by ethnicity, policy interventions for health improvement in Scotland that focus only on deprived areas may inadvertently exclude minority populations.

Cohort profile: The 'Children's Health in Care in Scotland' (CHiCS) study-a longitudinal dataset to compare health outcomes for care experienced children and general population children.

PURPOSE: The Children's Health in Care in Scotland Cohorts were set up to provide first population-wide evidence on the health outcomes of care experienced children (CEC) compared with children in the general population (CGP). To date, there are no data on how objective health outcomes, mortality and pregnancies for CEC are different from CGP in Scotland. PARTICIPANTS: The CEC cohort includes school-aged children who were on the 2009/2010 Scottish Government's Children Looked After Statistics (CLAS) return and on the 2009 Pupil Census (PC). The children in the general population cohort includes those who were on the 2009 PC and not on any of the CLAS returns between 1 April 2007 and 31 July 2016. FINDINGS TO DATE: Data on a variety of health outcomes, including mortality, prescriptions, hospitalisations, pregnancies, and Accident & Emergency attendances, were obtained for the period 1 August 2009 to 31 July 2016 for both cohorts. Data on socioeconomic status (SES) for both cohorts were available from the Birth Registrations and a small area deprivation measure was available from the PC. CEC have, on average, lower SES at birth and live in areas of higher deprivation compared with CGP. A higher proportion of CEC have recorded events across all health data sets, and they experienced higher average rates of mortality, prescriptions and hospitalisations during the study period. The reasons for contacting health services vary between cohorts. FUTURE PLANS: Age-standardised rates for the two cohorts by sex and area deprivation will be calculated to provide evidence on population-wide prevalence of main causes of death, reasons for hospitalisation and types of prescription. Event history analysis will be used on matched cohorts to investigate the impact of placement histories and socioeconomic factors on health.

Cancer mortality 1981-2016 and contribution of specific cancers to current socioeconomic inequalities in all cancer mortality: A population-based study.

BACKGROUND: In many high-income countries cancer mortality rates have declined, however, socioeconomic inequalities in cancer mortality have widened over time with those in the most deprived areas bearing the greatest burden. Less is known about the contribution of specific cancers to inequalities in total cancer mortality. METHODS: Using high-quality routinely collected population and mortality records we examine long-term trends in cancer mortality rates in Scotland by age group, sex, and area deprivation. We use the decomposed slope and relative indices of inequality to identify the specific cancers that contribute most to absolute and relative inequalities, respectively, in total cancer mortality. RESULTS: Cancer mortality rates fell by 24 % for males and 10 % for females over the last 35 years; declining across all age groups except females aged 75+ where rates rose by 14 %. Lung cancer remains the most common cause of cancer death. Mortality rates of lung cancer have more than halved for males since 1981, while rates among females have almost doubled over the same period. CONCLUSION: Current relative inequalities in total cancer mortality are dominated by inequalities in lung cancer mortality, but with contributions from other cancer sites including liver, and head and neck (males); and breast (females), stomach and cervical (younger females). An understanding of which cancer sites contribute most to inequalities in total cancer mortality is crucial for improving cancer health and care, and for reducing preventable cancer deaths.

Deaths of despair: cause-specific mortality and socioeconomic inequalities in cause-specific mortality among young men in Scotland.

BACKGROUND: Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as "deaths of despair", they are seen to stem from unprecedented economic pressures and a breakdown in social support structures. METHODS: We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15-44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RIIL) for the years 2001-2018. RESULTS: Since 1980 there have been only small reductions in mortality among men aged 15-44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7-1.4) to 44.9 (95% CI 42.5-47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5-70.9) in 2001-2003 to SII = 120.0 (95% CI 113.3-126.8) in 2016-2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality. CONCLUSIONS: Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.

All-cause and cause-specific mortality in Scotland 1981-2011 by age, sex and deprivation: a population-based study.

BACKGROUND: Average life expectancy has stopped increasing for many countries. This has been attributed to causes such as influenza, austerity policies and deaths of despair (drugs, alcohol and suicide). Less is known on the inequality of life expectancy over time using reliable, whole population, data. This work examines all-cause and cause-specific mortality rates in Scotland to assess the patterning of relative and absolute inequalities across three decades. METHODS: Using routinely collected Scottish mortality and population records we calculate directly age-standardized mortality rates by age group, sex and deprivation fifths for all-cause and cause-specific deaths around each census 1981-2011. RESULTS: All-cause mortality rates in the most deprived areas in 2011 (472 per 100 000 population) remained higher than in the least deprived in 1981 (422 per 100 000 population). For those aged 0-64, deaths from circulatory causes more than halved between 1981 and 2011 and cancer mortality decreased by a third (with greater relative declines in the least deprived areas). Over the same period, alcohol- and drug-related causes and male suicide increased (with greater absolute and relative increases in more deprived areas). There was also a significant increase in deaths from dementia and Alzheimer's disease for those aged 75+. CONCLUSIONS: Despite reductions in mortality, relative (but not absolute) inequalities widened between 1981 and 2011 for all-cause mortality and for several causes of death. Reducing relative inequalities in Scotland requires faster mortality declines in deprived areas while countering increases in mortality from causes such as drug- and alcohol-related harm and male suicide.

Small-area deprivation measure datasets for Scotland, 2001 and 2011.

These data present a new small-area deprivation measure, but also include a variety of other indicators, such as the Scottish Index of Multiple Deprivation (SIMD) and the Carstairs score. The data are for Scottish 2001 Datazones and for the years 2001 and 2011. In addition the data provide standardised self-reported measures of general health and limiting long-term illness. The theoretical background for developing the new deprivation measure, and the implications of using different measures to study health inequalities are discussed in "Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland" (Allik et al., 2016) [1].

Developing a new small-area measure of deprivation using 2001 and 2011 census data from Scotland.

Material deprivation contributes to inequalities in health; areas of high deprivation have higher rates of ill-health. How deprivation is measured has a great impact on its explanatory power with respect to health. We compare previous deprivation measures used in Scotland and proposes a new deprivation measure using the 2001 and 2011 Scottish census data. We calculate the relative index of inequality (RII) for self-reported health and mortality. While across all age groups different deprivation measures provide similar results, the assessment of health inequalities among those aged 20-29 differs markedly according to the deprivation measure. In 2011 the RII for long-term health problem for men aged 20-24 was only 0.71 (95% CI 0.60-0.83) using the Carstairs score, but 1.10 (0.99-1.21) for the new score and 1.13 (1.03-1.24) for the income domain of Scottish Index of Multiple Deprivation (SIMD). The RII for mortality in that age group was 1.25 (0.89-1.58) for the Carstairs score, 1.69 (1.35-2.02) for the new measure and 1.76 (1.43-2.08) for SIMD. The results suggest that researchers and policy makers should consider the suitability of deprivation measures for different social groups.

Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate.

BACKGROUND AND OBJECTIVE: Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. DESIGN: Retrospective multicohort comparative study. PATIENTS AND METHODS: Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. RESULTS: Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). CONCLUSIONS: Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.

3D assessment of lip scarring and residual dysmorphology following surgical repair of cleft lip and palate: a preliminary study.

OBJECTIVE: To evaluate lip scarring and the three-dimensional (3D) lip morphology following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous noncleft data. DESIGN: Retrospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, University of Glasgow, U.K. PATIENTS AND PARTICIPANTS: Three groups of 10-year-old children: 51 with UCLP, 43 UCL (unilateral cleft lip), and 68 controls. METHODS: Three-dimensional images of the face were recorded using stereo cameras on a two-pod capture station, and 3D coordinates of anthropometric landmarks were extracted from the facial images. A novel method was applied to quantify residual scarring and the associated lip dysmorphologies. The relationships among outcome measures were investigated. RESULTS: Residual lip dysmorphologies were more pronounced in UCLP cases. The width of the Cupid's bow was increased due to lateral displacement of the christa philteri left (cphL) in both UCL and UCLP patients. In the upper part of the lip, the nostril base was significantly wider in UCLP cases when compared with UCL cases and controls. Scar redness was more pronounced in UCL than in UCLP cases. No relationship could be identified between lip scarring and other measurements of lip dysmorphology. CONCLUSIONS: Stereophotogrammetry, together with associated image analysis, allow early detection of residual dysmorphology following cleft repair.

Measurement of damage in systemic vasculitis: a comparison of the Vasculitis Damage Index with the Combined Damage Assessment Index.

OBJECTIVES: To compare the Vasculitis Damage Index (VDI) with the Combined Damage Assessment Index (CDA) as measures of damage from vasculitis. METHODS: A total of 283 patients with vasculitis from 11 European centres were evaluated in a cross-sectional study using the VDI and CDA. RESULTS: Wegener's granulomatosis (58.4%) and microscopic polyangiitis (11.0%) were the most common diagnoses. Agreement between VDI and CDA scores (Spearman's correlation) was 0.90 (95% CI 0.87 to 0.92). There was good correlation between individual comparably evaluated organ systems (Spearman's correlation 0.70-0.94). Interobserver reliability (assessed by intraclass correlation coefficient (ICC)) was 0.94 (95% CI 0.89 to 0.98) for VDI and 0.78 (95% CI 0.63 to 0.93) for CDA. Intraobserver reliability was 0.92 (95% CI 0.83 to 1.00) for VDI and 0.87 (95% CI 0.75 to 1.00) for CDA. A total of 13 items were not used in the VDI compared to 23 in the CDA. Observers agreed that the CDA covered the full spectrum of damage attributable to vasculitis but was more time consuming and thus possibly less feasible for clinical and research purposes. CONCLUSIONS: The VDI and CDA capture reliable data on damage among patients with vasculitis. The CDA captures more detail but is more complex and less practical than the VDI. Further evolution of damage assessment in vasculitis is likely to include key elements from both instruments.

Scottish mortality rates 2000-2002 by deprivation and small area population mobility.

Despite recent increases in life expectancy, inequalities in mortality in Scotland have been widening. Previous research has suggested that one of the potential drivers of geographical inequalities in health is the process of selective migration. Although support for the effect of selective migration on widening geographic inequalities in health has been mixed, several studies have shown that people in good health move away from deprived areas while people in poor health move towards more deprived areas. In this paper, we examine mortality rates in Scotland by area deprivation and population mobility. Previous research in Scotland has shown that the relationship between population mobility and migration disappears once deprivation is accounted for. However, the authors measure population mobility over a longer time period than we do here and at a different geographical level. We consider small area population mobility on the basis of moves made in the year prior to the 2001 Scottish census. Areas were classified as one of four types: decreasing, increasing or stable (with high or low turnover). Mortality rates, calculated for the period 2000-2002, were found to be highest in deprived areas that had declined in population over the previous year. In the most deprived quintile, the causes of death contributing disproportionately to the excess mortality in decreasing areas were causes linked to alcohol and drug use, suicides and assault. Focussing on those individuals in the most deprived areas who live in areas that are declining in population could help to reduce widening inequalities for these causes of death. This work shows the extent to which population migration can influence small areas over a relatively short time period and gives some insight into potential factors, not measured by traditional indices of area level deprivation, which may lead to differences in the health status of areas.

Managing sales of beverages in schools to preserve profits and improve children's nutrition intake in 15 Mississippi schools.

School environments that provide consistent and reliable nutrition information promote the development of healthful eating in children. High-energy, nutrient-poor beverages offered for sale to children during the school day compete with healthful choices. The primary objective of this prospective, quasiexperimental study was to encourage children to choose more healthful beverages during the school day without adversely affecting the profits realized from vending sales. Fifteen of 18 schools completed voluntary changes to beverage sales practices during the school day between August 2005 and May 2006. Twelve of 15 schools reported increased profits from the previous year (2004-2005) while offering more healthful beverage choices at discounted prices. Units of carbonated soft drinks sold declined when sports drinks, 100% fruit juice, and water were made available in their place. Passive marketing in the form of vending machine fronts, attractive pricing with a nominal 10% to 25% discount, and changing the types and proportions of beverages offered encouraged children to make more healthful choices. Local school administrators were receptive to making changes to beverage sales when local needs were incorporated into the study design. Profit information from this study informed state legislators and the Mississippi State Board of Education in the development and adoption of statewide snack and beverage vending guidelines. Registered dietitians serve as advocates to foster these collaborative efforts, inform key decision makers, and work in their local communities to develop and promote healthful practices in K-12 school settings.

Population mobility, deprivation and self-reported limiting long-term illness in small areas across Scotland.

This study investigates population mobility and its relationship with area level deprivation and health. Based on UK movement in the year preceding the 2001 census, small areas in Scotland were classified as being one of the following population types; decreasing, increasing or stable (with high or low turnover). In the most deprived areas, illness rates for those under 65 were significantly lower in stable populations with low turnover than in other areas of comparable deprivation. Decreasing populations in deprived areas had significantly highest illness rates overall. Leaving those in poor health behind may lead to artifactual increases in area based health inequalities.

Theory of planned behavior and multivitamin supplement use in Caucasian college females.

The objective of this study was to identify predictors of the use of multivitamin supplements (MVS) among Caucasian college females utilizing the Theory of Planned Behavior (TPB). Variables of the TPB and the self-reported use of multivitamin supplements were measured by two separate surveys within 1 week with a convenience sample of 96 Caucasian college student females. Two attitudinal beliefs and one control belief significantly predicted behavioral intention to use multivitamin. A belief that taking multivitamin supplements helps to feel and look good was the most important predictor of the use of multivitamin supplements. EDITORS' STRATEGIC IMPLICATIONS: Findings from this study, although in need of replication, suggest that prevention campaigns would be more successful if messages used to reach these females were consistent with perceived beliefs regarding benefits of using MVS. More broadly, TPB appears to offer a useful framework for understanding or predicting behavior based on psychological constructs theorized to influence behavior.

Predictors of multivitamin supplement use among African-American female students: a prospective study utilizing the theory of planned behavior.

BACKGROUND: Public health officials recommend that women capable of becoming pregnant use folic acid-containing supplements (FAS) to prevent neural tube defects (NTD) in their newborn infants. However, the knowledge about NTD prevention and the prevalence of the use of FAS among women capable of becoming pregnant increased only modestly since the issuing of the recommendation in 1992. Since most commonly available multivitamin supplements (MVS) contain the recommended 400 gg of folic acid, finding out reasons why women take MVS and utilizing these factors in educational campaigns may contribute to increasing the use of FAS. METHODS: The Theory of Planned Behavior variables and the self-reported use of MVS were measured by two separate surveys within one week. A preliminary open-ended questionnaire was utilized to elicit beliefs about MVS. A convenience sample of 100 African-American female college students, mean age 20.99 (SD=1.7) years, participated in this study. RESULTS: Approximately 65% of variance in behavioral intention was explained by attitude, subjective norms, and perceived behavioral control (P<.001). Subjective norms had the greatest influence (3=0.348, P<.001), followed by PBC (3=0.336, P<.001), and attitude (1=0.228, P<.038). Behavioral intention significantly predicted the use of MVS accounting for =59.2% of variance. CONCLUSION: Consistent with the results of the present study, educational campaigns that target African-American female college students to encourage the use of MVS should focus on the impact of physicians, family, and peers.

Prevalence of food production systems in school foodservice.

OBJECTIVE: What is the prevalence of central kitchens that use either cook-chill or cook-freeze production systems in school foodservice settings? DESIGN: A descriptive study using a 5-minute telephone survey during normal working hours was conducted. Questions were designed to be easily answered with minimal need to reference other documentation. SUBJECTS: Five hundred forty school foodservice directors, managers, and supervisors working in school districts of all sizes across the United States were randomly sampled from a national commercial directory of school districts for the study. A total of 353 individuals completed the survey representing 49 of 50 states. MAIN OUTCOME MEASURES: Means, standard deviations, and percentages were evaluated for all data collected. STATISTICAL ANALYSES PERFORMED: Descriptive statistics of school district characteristics, prevalence of production systems, food transport systems, inventory methods and equipment used for reheating food are reported. RESULTS: The most frequently reported production system was on-site kitchens (45.3%) followed by combination production systems (40.5%) where a central kitchen delivered to a number of satellite locations in addition to schools with on-site food preparation. Central kitchens without additional on-site kitchens represented 14.2% of this study. Of those school districts using either central kitchens or combination production systems, 78% reported hot-food preparation using hot-food delivery to satellites. Cook-chill or cook-freeze production systems were reported by 22% of respondents. CONCLUSIONS: The high proportion of school districts that prepared and delivered foods hot to satellite sites supports continuing efforts to identify food safety practices and issues related to maintaining food quality in schools.