Evaluating the Potential Health and Revenue Outcomes of a 100% Healthy Vending Machine Nutrition Policy at a Large Agency in Los Angeles County, 2013-2015.

CONTEXT: Healthy vending machine policies are viewed as a promising strategy for combating the growing obesity epidemic in the United States. Few studies have evaluated the short- and intermediate-term outcomes of healthy vending policies, especially for interventions that require 100% healthy products to be stocked. OBJECTIVE: To evaluate the potential impact of a 100% healthy vending machine nutrition policy. DESIGN: The vendor's quarterly revenue, product sales records, and nutritional information data from 359 unique vending machines were used to conduct a baseline and follow-up policy analysis. SETTING: County of Los Angeles facilities, 2013-2015. PARTICIPANTS: Vending machines in facilities located across Los Angeles County. INTERVENTION: A healthy vending machine policy executed in 2013 that required 100% of all products sold in contracted machines meet specified nutrition standards. OUTCOME MEASURES: Policy adherence; average number of calories, sugar, and sodium in food products sold; revenue change. RESULTS: Policy adherence increased for snacks and beverages sold by the vending machines by 89% and 98%, respectively. Average snack and beverage revenues decreased by 37% and 34%, respectively, during the sampled period. CONCLUSIONS: Although a 100% healthy vending policy represents a promising strategy for encouraging purchases of healthier foods, steps should be taken to counteract potential revenue changes when planning its implementation.

Does Sodium Knowledge Affect Dietary Choices and Health Behaviors? Results From a Survey of Los Angeles County Residents.

INTRODUCTION: In 2010, the Los Angeles County Department of Public Health launched a local sodium-reduction initiative to address the rising prevalence of high blood pressure (hypertension) and related cardiovascular conditions in the population. To inform this effort, we evaluated self-reported knowledge and health behaviors related to sodium intake among Los Angeles County residents. METHODS: We administered 3 cross-sectional Internet panel surveys on knowledge about dietary sodium to a sample of Los Angeles County adults, at intervals from December 2014 through August 2016. Multinomial and logistic regression models were constructed to describe associations between sodium knowledge and self-reported health behaviors. RESULTS: A total of 7,067 panel subjects clicked into the online survey, and 2,862 completed the survey (adjusted response rate = 40.5%). Only 102 respondents (3.6%) were able to accurately report the recommended milligrams of sodium that an average adult should consume daily (1,500 mg to 2300 mg). Knowing about daily sodium intake recommendations was associated with increased odds of using Nutrition Facts labels to make food purchase decisions (adjusted odds ratio [AOR], 3.48; 95% confidence interval [CI], 1.59-7.60) and with decreased odds of taking measures to prevent hypertension (AOR, 0.38; 95% CI, 0.19-0.74). CONCLUSIONS: Los Angeles County residents had a limited knowledge of recommended daily sodium intake. Efforts to increase understanding of these recommendations may encourage wider engagement in healthy behaviors. Health agencies should integrate sodium reduction messages in their diet and nutrition educational efforts.

The changing trends and profile of pneumocystosis mortality in the United States, 1999-2014.

Pneumocystosis (PCP) mortality in the U.S. has received less attention in recent years. This study describes recent trends in mortality and the estimated burden of PCP in the U.S., using the national multiple cause of death data during 1999-2014. PCP mortality rates were calculated for age, sex, race and year. Demographic differences were presented for decedents with and without a human immunodeficiency virus (HIV) co-diagnosis. Matched odds ratios (MOR) were generated to describe associations between non-HIV conditions and PCP mortality. In total, 11 512 PCP deaths occurred during 1999-2014. Annual age-adjusted PCP mortality decreased over this time period, from 0.479 to 0.154 per 100 000 population (1999 vs 2014 respectively). Over two-thirds of decedents were male and Blacks had the highest mortality as compared to Whites. HIV co-diagnosis accounted for 48% of all PCP deaths in 2014 vs 71% in 1999. Comorbid conditions such as connective tissue disorders (MOR=12.29; 95% confidence interval=[10.26, 14.71]) were associated with a PCP diagnosis. Productivity losses amounted to >$12 billion during the study period. Although widespread use of antiretroviral therapy and PCP prophylaxis for HIV infection likely contributed to the overall decline in PCP deaths during 1999-2014, a continual need exists to prevent and treat this fungal disease in immune-compromised populations that are not infected with HIV.

Legionnaires' disease and associated comorbid conditions as causes of death in the U.S., 2000-2010.

OBJECTIVE: Recent U.S. outbreaks of Legionnaires' disease (LD) underscore the virulent nature of this infectious pneumonia. To date, only a paucity of literature has described the mortality burden of LD. This study updates LD mortality using U.S. multiple-cause-of-death data from 2000-2010. METHODS: We calculated crude and age-adjusted rates for LD mortality for age, sex, race, state, Census region, and year. We conducted Poisson regression to assess seasonal and temporal trends. We generated matched odds ratios (MORs) to describe the association between LD-related deaths and other comorbid conditions listed on the death certificates. RESULTS: We identified a total of 1,171 LD-related deaths during 2000-2010. The age-adjusted mortality rate remained relatively static from 2000 (0.038 per 100,000 population, 95% confidence interval [CI] 0.031, 0.046) to 2010 (0.040 per 100,000 population, 95% CI 0.033, 0.047). The absolute number increased from 107 to 135 deaths during this period, with adults ≥45 years of age having the highest caseload. Overall, LD mortality rates were 2.2 times higher in men than in women. White people accounted for nearly 83.3% of all LD-related deaths, but the age-adjusted mortality rates for black and white people were similar. Comorbid conditions such as leukemia (MOR=4.8, 95% CI 3.5, 6.6) and rheumatoid arthritis (MOR=5.6, 95% CI 3.3, 9.4) were associated with LD diagnosis on death certificates. CONCLUSION: Comorbid conditions that could lead to an immunocompromised state were associated with fatal LD on U.S. death certificates. Characterization of LD mortality burden and related comorbidities has practice implications for clinical medicine and public health surveillance.