Evaluating school obesity-related policies using surveillance tools: lessons from the ScOPE study.

The evidence evaluating the association between school obestiy prevention policies and student weight is mixed. The lack of consistent findings may result, in part, from limited evaluation approaches. The goal of this article is to demonstrate the use of surveillance data to address methodological gaps and opportunities in the school policy evaluation literature using lessons from the School Obesity-Related Policy Evaluation (ScOPE) study. The ScOPE study uses a repeated, cross-sectional study design to evaluate the association between school food and activity policies in Minnesota and behavioral and weight status of youth attending those schools. Three surveillance tools are used to accomplish study goals: Minnesota School Health Profiles (2002-2012), Minnesota Student Survey (2001-2013), and National Center for Educational Statistics. The ScOPE study takes two broad steps. First, we assemble policy data across multiple years and monitor changes over time in school characteristics and the survey instrument(s), establish external validity, and describe trends and patterns in the distribution of policies. Second, we link policy data to student data on health behaviors and weight status, assess nonresponse bias, and identify cohorts of schools. To illustrate the potential for program evaluators, the process, challenges encountered, and solutions used in the ScOPE study are presented.

Improving dementia care in nursing homes: experiences with a palliative care symptom-assessment tool (MIDOS).

BACKGROUND: In the past decade, the palliative care approach has been used in the care of frail older people living with debilitating chronic conditions, including dementia. AIM: To describe health professionals' experiences of assessing the symptoms of people with dementia using a cancer-patient-oriented symptom-assessment tool from a palliative care context. METHOD: This was a qualitative study that used semi-structured interviews (n=13) with clinical staff in three nursing homes prior to and following the implementation of the Minimal Documentation system for Palliative care (MIDOS) tool for assessing symptoms over a period of 6 weeks. RESULTS: Baseline interviews showed specific concerns about symptom assessment, such as uncertainty about underlying symptoms in residents who appeared to be in distress. After the implementation of the MIDOS tool, participants reported that daily use of the tool was perceived as helpful in evaluating symptoms other than pain and improved internal communication between staff regarding clinical decision making. CONCLUSION: The MIDOS tool was perceived as a helpful and valuable complement to existing tools. Participants expressed some concerns regarding the subjective nature of perceiving symptoms and clinical decision making. The use of tools such as the MIDOS tool has the potential to enhance the quality of palliative care in dementia care.

Levels and determinants of exposure to vapours and aerosols of bitumen.

Bitumen (referred to as asphalt in the United States) is a widely used construction material, and emissions from hot bitumen applications have been a long-standing health concern. One objective of the Human Bitumen Study was to identify potential determinants of the exposure to bitumen. The study population analysed comprised 259 male mastic asphalt workers recruited between 2003 and 2008. Personal air sampling in the workers' breathing zone was carried out during the shift to measure exposure to vapours and aerosols of bitumen. The majority of workers were engaged in building construction, where exposure levels were lower than in tunnels but higher than at road construction sites. At building construction sites, exposure levels were influenced by the room size, the processing temperature of the mastic asphalt and the job task. The results show that protective measures should include a reduction in the processing temperature.

Characterizing and comparing young adult intermittent and daily smokers.

We interviewed 732 smokers (from five US upper Midwestern states) via telephone in 2006 to examine young adult smoking patterns. We first defined two groups of intermittent smokers-low (who smoked for 1-14 days in the past 30 days) and high (who smoked for 15-29 days in the past 30 days), and then analyzed differences between these two groups and daily smokers. Low intermittent smokers were much less likely to consider themselves smokers, feel addicted, or smoke with friends than high intermittent smokers. Daily smokers were more likely to feel addicted and have trouble quitting smoking than high intermittent smokers. Implications, limitations, and ideas for future studies will be discussed.

Biological monitoring as a useful tool for the detection of a coal-tar contamination in bitumen-exposed workers.

In our research project entitled "Chemical irritative and/or genotoxic effect of fumes of bitumen under high processing temperatures on the airways," 73 mastic asphalt workers exposed to fumes of bitumen and 49 construction nonexposed workers were analyzed and compared with respect to polycyclic aromatic hydrocarbons (PAHs) exposure and exposure-related health effects. In order to assess the internal exposure the monohydroxylated metabolites of pyrene, 1- hydroxypyrene (1-OHP), and phenanthrene, 1-, 2- and 9-, and 3- and 4-hydroxyphenanthrene (OHPH) were determined in pre- and post-shift urinary samples. Significantly higher concentrations 1-OHP and OHPH were detected in the post-shift urine samples of 7 mastic asphalt workers working on the same construction site compared to the reference workers and all other 66 mastic asphalt workers. The adjusted mean OHPH in the reference, 66 mastic worker, and 7 worker subgroups was 1022, 1544, and 12919 ng/g creatinine (crn) respectively, indicating a marked rise in the 7 worker subgroup. In addition, there was a more than 12-fold increase of PAH metabolites from pre- to post-shift in these 7 workers, whereas in the other mastic asphalt workers there was only a twofold rise in PAH-metabolite concentration between pre- and post-shift values. The analysis of a drilling core from the construction site of the seven workers led to the detection of the source for this marked PAH exposure during the working shift as being coal tar plates, which were, without knowledge of the workers and coordinators, the underground material of the mastic asphalt layer. The evaluation of the stationary workplace concentration showed enhanced levels of phenanthrene, pyrene, fluorene, anthracene, and acenaphthene during working shifts at the construction site of these seven workers. Our study shows that biological monitoring is also a useful tool for the detection of unrecognized sources with high PAH concentrations.

Increasing Inequality in Physical Activity Among Minnesota Secondary Schools, 2001-2010.

BACKGROUND: Two Healthy People 2020 goals are to increase physical activity (PA) and to reduce disparities in PA. We explored whether PA at the school level changed over time in Minnesota schools and whether differences existed by demographic and socioeconomic factors. METHODS: We examine self-reported PA (n = 276,089 students; N = 276 schools) for 2001-2010 from the Minnesota Student Survey linked to school demographic data from the National Center for Education Statistics and the Rural-Urban Commuting Area Codes. We conducted analyses at the school level using multivariable linear regression with cluster-robust recommendation errors. RESULTS: Overall, students who met PA recommendations increased from 59.8% in 2001 to 66.3% in 2010 (P < .001). Large gains in PA occurred at schools with fewer racial/ethnic minority students (0%-60.1% in 2001 to 67.5% in 2010, P < .001), whereas gains in PA were comparatively small at schools with a high proportion of racial/ethnic minority students in 2001 (30%-59.2% in 2001 to 62.7% in 2010). CONCLUSIONS: We found increasing inequalities in school-level PA by racial/ethnic characteristics of their schools and communities among secondary school students. Future research should monitor patterns of PA over time and explore mechanisms for patterns of inequality.

Secondhand Smoke Exposure 7 Years After an Indoor Smoke-Free Law.

PURPOSE: To examine locations of secondhand smoke (SHS) exposure among nonsmokers, 7 years after a statewide smoke-free policy. DESIGN: Data collected via statewide, random digit dial telephone survey. Response rates were 64.7% for landline and 73.5% for cell phone. SETTING: Minnesota, 2014. PARTICIPANTS: Representative sample of 7887 nonsmoking adults. MEASURES: Self-reported locations of SHS exposure and opinions on smoke-free restrictions. ANALYSIS: Descriptive statistics and logistic regression. RESULTS: A total of 35.5% of nonsmokers reported SHS exposure in the past 7 days. The greatest proportion of exposure occurred in community settings (31.7%) followed by cars (6.9%) and in the home (3.2%). Young adults were more likely to be exposed in a home or car than older adults. Nonsmokers living with a smoker were 39.6 (20.6-75.8) times more likely to be exposed to SHS in their home and 5.3 (4.1-6.8) times more likely to be exposed in a car, compared to those who did not live with a smoker. CONCLUSION: SHS exposure continues after comprehensive smoke-free policies restricted it from public places. Disparities in exposure rates exist for those who live with a smoker, are young, and have low incomes. Findings suggest the need for additional policies that will have the greatest public health benefit.

Tobacco Use among Minnesota Adults, 2014.

OBJECTIVES: The changing landscape of tobacco including the introduction of new products such as smokeless tobaccos and electronic delivery devices has highlighted the need for continued surveillance of tobacco use. METHODS: Minnesota has conducted an in-depth surveillance of adult tobacco use since 1999. For the fifth in the series, conducted in 2014, 9304 telephone interviews were completed. RESULTS: The 2014 prevalence of cigarette smoking (14.4%) continues a downward trend that remains lower than the national smoking prevalence (17.3%). Among all Minnesota adults, use prevalence of other tobacco products was as follows: e-cigarettes 5.9%, all smokeless tobaccos 3.6%, cigars 3.0%, water pipe 1.4%, and regular pipe 0.7%. Among individuals who have never smoked cigarettes, smokeless tobacco was the most common product used (2.0%), nearly twice the prevalence of e-cigarette use (1.2%). Former smokers were equally likely to use smokeless tobacco (4.9%) or e-cigarettes (4.8%). Among smokers, 27.3% reported current use of e-cigarettes. CONCLUSION: In the past 15 years, cigarette smoking prevalence in Minnesota has dropped by an average of 0.51 percentage points annually, and prevalence could drop to less than 5% by 2034.

Cessation outcomes among treatment-seeking menthol and nonmenthol smokers.

BACKGROUND: Menthol cigarettes account for 25% of the market in the U.S. The Food and Drug Administration currently is considering regulatory action on tobacco products, including a ban on menthol cigarettes. With 39% of menthol smokers reporting that they would quit smoking if menthol cigarettes were banned, there is a need to better understand whether existing cessation programs, such as quitlines, are serving menthol smokers. PURPOSE: This study compared baseline characteristics and cessation outcomes of menthol and nonmenthol smokers who were seeking treatment through a quitline. METHODS: Data were collected between September 2009 and July 2011 on 6257 participants. A random sample of eligible participants who registered for services between March 2010 and February 2011 was contacted for a follow-up survey 7 months post-registration (n=1147). Data were analyzed in 2011. RESULTS: Among participants, 18.7% of smokers reported using menthol cigarettes. Menthol smokers were more likely to be female, younger, African-American, and have less than a high school education. Menthol smokers who called the quitline were slightly less likely to enroll in services than nonmenthol smokers (92.2% vs 94.8%, p<0.001). However, for those that did enroll, there were no significant differences in self-reported intent-to-treat 30-day point prevalence abstinence rates between menthol and nonmenthol smokers (17.3% vs 13.8%, p=0.191). CONCLUSIONS: Quitlines appear to be adequately serving menthol smokers who call for help. Cessation outcomes for menthol smokers are comparable to nonmenthol smokers. However, if a menthol ban motivates many menthol smokers to quit, quitlines may have to increase their capacity to meet the increase in demand.

Cigarette use among young adults: comparisons between 2-year college students, 4-year college students, and those not in college.

OBJECTIVE: To examine cigarette smoking among young adults based on education status. PARTICIPANTS: Community-based sample of 2,694 young adults in the United States METHODS: The authors compared 3 groups--those not in college with no college degree, 2-year college students/graduates, 4-year college students/graduates--on various smoking measures: ever smoked, smoked in past month, smoked in past week, consider self a smoker, began smoking before age 15, smoked over 100 cigarettes in lifetime, ever tried to quit, and plan to quit in next year. RESULTS: The authors found that for nearly all the smoking measures, the 4-year college group was at lowest risk, the noncollege group was at highest risk, and the 2-year college group represented a midpoint. Differences between groups remain after adjusting for parents' education and other potential confounding factors. CONCLUSIONS: Smoking behaviors clearly differ between the 2-year, 4-year, and no college groups. Interventions should be tailored for each group.

Smokefree home rules adoption by smokers and nonsmokers: Minnesota, 1999-2010.

BACKGROUND: Smokefree workplace policies have successfully limited indoor exposure to secondhand smoke. However, exposure still exists in other indoor locations, most notably in the home. PURPOSE: This paper examines change in the public's awareness of secondhand smoke harm, exposure to secondhand smoke, and prevalence of smokefree home rules between 1999 and 2010 in Minnesota. METHODS: The Minnesota Adult Tobacco Survey is a statewide, cross-sectional, random-digit-dial telephone-based survey. The survey measures tobacco use, behaviors, attitudes, and beliefs among adults aged 18 and older in 1999, 2003, 2007, and 2010. Analysis was conducted in 2011. RESULTS: There was a significant decrease in self-reported exposure to secondhand smoke among all nonsmokers in Minnesota from 2003 (60.9%) to 2010 (37.7%) (p<0.05). The prevalence of smokefree home rules adoption among all Minnesotans increased significantly between each time point: 1999 (64.5%); 2003 (74.8%); 2007 (83.2%); 2010 (87.2%) (p<0.05). Although smokers tended to adopt smokefree home rules at rates lower than nonsmokers, the percentage of smokefree home rules among smokers nearly doubled between 1999 (31.4%) and 2010 (58.1%) (p<0.05). CONCLUSIONS: Over 10 years, Minnesotans reported a significant decline in exposure to secondhand smoke and a significant increase in voluntary smokefree home rules. Such a trend is notable as virtually all public tobacco control efforts were aimed at raising awareness and support for smokefree policies within workplaces. These findings demonstrate positive changes in social norms and suggest that behavior change in public settings might also be translated into practice in private settings.