Kidney Cancer Incidence Among Non-Hispanic American Indian and Alaska Native Populations in the United States, 1999-2020.

Background Non-Hispanic American Indian and Alaska Native (NH-AI/AN) people experience a disproportionate incidence of kidney cancer. Nationally aggregated data does not allow for a comprehensive description of regional disparities in kidney cancer incidence among NH-AI/AN communities. This study describes kidney cancer incidence rates and trends among NH-AI/AN compared to non-Hispanic White (NHW) populations by geographic region. Methods Using the United States Cancer Statistics American Indian and Alaska Native (AI/AN) Incidence Analytic Database, we calculated age-adjusted incidence rates (per 100,000) of kidney cancers for NH-AI/AN and NHW people for the years 2011-2020 combined using SEER*stat software. Analyses were restricted to non-Hispanic persons living in purchased/referred care delivery area (PRCDA) counties. Average annual percent changes (AAPCs) and trends (1999-2019) were estimated using Joinpoint regression analyses. Results Rates of kidney cancer incidence were higher among NH-AI/AN compared to NHW persons in the U.S. overall and in 5 of 6 regions. Kidney cancer incidence rates also varied by region, sex, age, and stage of diagnosis. Between 1999 and 2019, trends in rates of kidney cancer significantly increased among NH-AI/AN males (AAPC = 2.7%) and females (AAPC = 2.4%). The largest increases in incidence were observed for NH-AI/AN males and females under age 50 and those diagnosed with localized stage disease. Conclusions Study findings highlight growing disparities in kidney cancer incidence rates between NH-AI/AN and NHW populations. Impact: Differences in geographic region, sex, and stage highlight opportunities to decrease prevalence of kidney cancer risk factors and improve access to preventive care.

Bibliometric and social network analysis of a Clinical and Translational Resource awardee: An Oklahoma experience 2014-2021.

Background: Social Network Analysis is a method of analyzing coauthorship networks or relationships through graph theory. Institutional Development Award (IDeA) Networks for Clinical and Translational Research (IDeA-CTR) was designed to expand the capability for clinical and translational research to enhance National Institutes of Health funding. Methods: All publications from a cohort of clinical and translational scientists in Oklahoma were collected through a PubMed search for 2014 through 2021 in October 2022. For this study's bibliometric portion, we pulled the citations from iCite in November of 2022. Results: There were 2,391 articles published in 1,019 journals. The number of papers published by year increased from 56 in 2014 to 448 in 2021. The network had an average of 6.4 authors per paper, with this increasing by year from 5.3 in 2014 to 6.9 in 2021. The average journal impact factor for the overall network was 7.19, with a range from 0.08 to 202.73. The Oklahoma Shared Clinical and Translational Resources (OSCTR) network is a small world network with relatively weak ties. Conclusions: This study provides an overview of coauthorship in an IDeA-CTR collaboration. We show the growth and structure of coauthorship in OSCTR, highlighting the importance of understanding and fostering collaboration within research networks.

Perception of Barriers to and Factors Associated with HPV Vaccination Among Parents of American Indian Adolescents in the Cherokee Nation.

The purpose of this study was to understand the perceptions of HPV vaccination barriers and factors among parents or guardians of American Indian adolescents in the Cherokee Nation. Fifty-four parents of American Indian adolescents in the Cherokee Nation participated in one of eleven focus group discussions from June to August 2019. Discussions were recorded, transcribed, coded, and analyzed for themes. Protection against cancer was the primary parent-reported reason for vaccinating their children against HPV. The lack of information and safety concerns about the HPV vaccine were the main reasons for non-vaccination. To increase HPV vaccine uptake, parents strongly supported offering vaccinations in school. Furthermore, increased healthcare provider-initiated discussion can ease parental concerns about HPV vaccine safety and improve coverage.

Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019.

Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.

Rural cancer disparities from Oklahoma cancer and vital records registries 2016-2020.

OBJECTIVES: Compared to Oklahoma, 33 states have higher all-cause cancer incidence rates, but only three states have higher all-cause cancer mortality rates. Given this troubling gap between Oklahoma's cancer incidence and mortality rankings, in-depth examination of cancer incidence, staging, and mortality rates among this state's high-risk populations is warranted. This study provides in-depth information on overall and cause-specific cancer incidence and mortality for the rural and urban Oklahoma populations classified by Rural-Urban Continuum Codes (RUCC). METHODS: Data were publicly available and de-identified, accessed through Oklahoma Statistics on Health Available for Everyone (OK2SHARE). Statistical analysis included calculating age-specific rates, age-adjusted rates, and percentages, as well as assessing temporal patterns using average annual percent change with 95 % confidence intervals determined by Joinpoint regression analysis. FINDINGS: Urban areas had a higher proportion of female breast cancer cases, while large and small rural areas had higher rates of lung and bronchus cancer. Urban residents were more likely to have private insurance and less likely to have Medicare compared to rural residents. Cancer incidence rates increased with age, and men had higher mortality rates than women. Lung and bronchus cancer was the leading cause of cancer death, with lower rates in urban areas compared to rural areas. CONCLUSIONS: Findings demonstrate the need to improve the early detection of cancer among the rural populations of Oklahoma. Additionally, the high mortality rates for most types of cancer experienced by the state's rural population underscores the need to improve cancer detection and treatment in these locations.

Exposure to persistent organic pollutants in newborn dried blood spots and childhood acute myeloid leukemia.

Acute myeloid leukemia (AML) is a rare malignancy representing 15-20% of all leukemia diagnoses among children. Maternal exposure to persistent organic pollutants is suggestive of increased risk for childhood AML based on existing evidence. We aimed to evaluate the relationship between persistent organic pollutants and childhood AML using newborn dried bloodspots (DBS) from the Michigan BioTrust for Health. We obtained data on AML cases diagnosed prior to 15 years of age (n = 130) and controls (n = 130) matched to cases on week of birth from the Michigan Department of Health and Human Services. We quantified levels of dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzene (HCB), and polybrominated diphenyl ether congener 47 (BDE-47) in newborn DBS. We also evaluated other organochlorine pesticides, polychlorinated biphenyls, polybrominated biphenyl congener 153, and polybrominated diphenyl ethers, though these were not further evaluated as >60% of observations were above the limit of detection for these chemicals. To evaluate the association between each chemical and AML, we used multivariable conditional logistic regression. In our multivariable model of HCB adjusted for month of birth, maternal age at delivery, and area poverty, we observed no association with AML (Odds Ratio [OR] per interquartile range increase: 1.17, 95% CI: 0.80, 1.69). For p,p'-DDE, ORs were significantly lower for those exposed to the highest tertile of p,'p-DDE (≥0.29 pg/mL, OR: 0.32, 95% CI: 0.11, 0.95) compared to the first tertile (<0.09 pg/mL). We observed no statistically significant associations between HCB and BDE-47 and AML. We observed a reduced odds of exposure to p,'p-DDE and an increased, though imprecise, odds of exposure to HCB among AML cases compared to controls. Future studies would benefit from a larger sample of AML patients and pooling newborn DBS across multiple states to allow for additional variability in exposures and evaluation of AML subtypes, which may have differing etiology.

Infant mortality and its determinants in Uganda 2016: Using a geographically weighted regression approach.

Infant mortality (IM) represents the overall health of a country or region as it relates to access to medicine, health care, and clean water in a population. IM remains understudied in many areas of Uganda, as many studies are from urban the capital (Kampala). The long-term goal of this research is the mitigation of IM and poor pregnancy outcomes in Uganda. Insights gained from geographic distribution of IM will allow adaptation of diagnosis, treatments, and interventions within the studied areas. Through using OLS and geographically weighted regression, this study has explored the significant factors and their heterogeneous and scaling effects in 2016 across Uganda. The empirical findings from this study include a significant association between IM and both being unmarried and preferring to speak Luganda when interviewed. Those unmarried may lack a social network to assist with income, childcare, and household chores representing decreased resources. Additionally, being interviewed in Luganda was associated over a large geographic area, which may represent not being comfortable in English, which is the language of education, commerce, and presumably health care, thus suggesting a disconnect with health care settings. These data suggest that strides can be made in Uganda by providing targeted resources to areas with high rates of unmarried mothers and those areas with high rates of Luganda as their language of choice.

Tobacco and marijuana use during the COVID-19 pandemic lockdown among American Indians residing in California and Oklahoma.

INTRODUCTION: American Indian (AI) people experience a disproportionate tobacco and marijuana burden which may have been exacerbated by the COVID-19 pandemic. Little is known about the tobacco and marijuana habits of American Indian individuals during the COVID-19 pandemic. The objective of this study is to examine tobacco and marijuana use as well as change in use during the COVID-19 pandemic among the American Indian community. METHODS: This cross-sectional study analyzes survey data from a convenience sample of American Indian individuals residing in California and Oklahoma and included adults with and without cancer that resided in both rural and urban areas (n=1068). RESULTS: During October 2020 - January 2021, 36.0% of participants reported current use of tobacco products, 9.9% reported current use of marijuana products, and 23.7% reported increased use of tobacco and/or marijuana in the past 30 days, with no difference between those with cancer and those without cancer. Tobacco use was associated with marital status, age, employment status, COVID-19 exposure, COVID-19 beliefs, and alcohol consumption. Marijuana use was associated with COVID-19 beliefs, alcohol consumption, and income level. Increased tobacco and/or marijuana use was associated with baseline use of those products. Nearly a quarter of participants reported increased use of tobacco and/or marijuana products during the COVID-19 pandemic. CONCLUSIONS: We observed high rates of tobacco use during the COVID-19 pandemic, consistent with other studies. Research is needed to examine whether tobacco and marijuana use will decrease to pre-pandemic levels post-pandemic or if these behaviors will persist post-pandemic. Given these findings, there is a pressing need to increase access to evidence-based tobacco and marijuana treatment services in the AI population post COVID-19 pandemic.

Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic.

Objectives: Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic. Methods: This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4. Results: During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9). Conclusion: This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.

The Relation Between Travel Distance and Overall Survival for HPV-Associated Cancers in a High-Burden State.

Purpose: To assess the association between travel distance to an academic health system and overall survival for patients with human papillomavirus (HPV)-associated cancers. Methods: Using hospital-based cancer registry data from 2005-2019, we calculated unidirectional travel distance from each patient's geocoded address to our academic health center through network analysis. We categorized distance as short (<25 miles), intermediate (25-74.9 miles), or long (≥75 miles). The primary outcome was time from the date of initial diagnosis to the date of death or last contact. We used multivariable Cox proportional hazards regression to evaluate the association between travel distance and overall survival. We also estimated the adjusted observed 5-year survival rate. Results: Patients with HPV-associated cancers traveling distances that were intermediate (hazard ratio [HR], 1.23; 95% CI, 1.06-1.43) and long (HR, 1.15; 95% CI, 1.01-1.32) had a higher hazard of death than the short-distance group. The adjusted 5-year observed survival rates for HPV-associated cancers were lowest in the intermediate-distance group (60.4%) compared with the long-(62.6%) and short-distance (66.2%) groups. Conclusions: Our findings indicate that travel distance to an academic health center was associated with overall survival for patients with HPV-associated cancers, reflecting the importance of considering travel burden in improving patient outcomes.

Investigation of Geographical Disparities: The Use of An Interpolation Method For Cancer Registry Data.

The American Cancer Society estimated 1.9 million diagnosed cancer cases and 608,570 cancer deaths in 2021 in the US; for Oklahoma, they estimated 22,820 cases and 8,610 deaths. This project aimed to demonstrate a method to systematically describe cancer in an accurate and visually attractive, yet simple to make, interpolated map using ZIP Code level registry data, as it is the smallest area unit with high accuracy using inverse distance weighting. We describe a process of creating smoothed maps with an appropriate, well-described, simple, replicable method. These smoothed maps display low (cold) or high (hot) areas of incidence rates of: (a) all cancer combined, (b) colorectal cancer and lung cancer rates by gender, (c) female breast cancer, and (d) prostate cancer, by ZIP Codes for Oklahoma from 2013-2017. The methods we present in this paper provide an effective visualization to pinpoint low (cold) or high (hot) areas of cancer incidence.

CATCH-UP vaccines: protocol for a randomized controlled trial using the multiphase optimization strategy (MOST) framework to evaluate education interventions to increase COVID-19 vaccine uptake in Oklahoma.

BACKGROUND: Oklahoma's cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma. METHODS: Our study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization). DISCUSSION: Because of Oklahoma's higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.

Cannabis use among cancer survivors in 22 states: Results from the Behavioral Risk Factor Surveillance System, 2020.

BACKGROUND: This study identified factors associated with recent cannabis use and cannabis use for medical purposes among cancer survivors relative to individuals without a history of cancer. METHODS: Data from the Behavioral Risk Factor Surveillance System were analyzed for the 22 states completing the optional cannabis module in 2020. Weighted multiple logistic regression was performed to explore variables associated with past 30-day cannabis use and cannabis use for medical purposes, stratified by history of cancer. Covariates included state-level cannabis policy, sociodemographic characteristics, health status indicators, and substance use. RESULTS: Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (7.57% vs. 10.83%). However, a higher proportion of cancer survivors reported use for medical purposes (82.23% vs. 62.58%). After adjusting for state-level policy, biological sex, age, educational attainment, self-reported race/ethnicity, home ownership, mental health status and physical health status, current smoking (odds ratio [OR], 5.14 vs. 3.74) and binge drinking (OR, 2.71 vs. 2.69) were associated with cannabis use in both groups. Characteristics associated with medical cannabis use varied for the two groups; however, daily use (20-30 days; OR, 1.72 vs. 2.43) was associated with cannabis use for medical purposes in both groups after adjusting for other variables in the model. CONCLUSIONS: A high proportion of individuals report cannabis use for medical purposes with higher rates among cancer survivors. Findings support the urgent need for ongoing cannabis research to better understand and inform its use for medical purposes, as well as the development of high-quality standardized education materials and clinical practice guidelines.

HPV vaccination coverage and factors among American Indians in Cherokee Nation.

PURPOSE: We estimated human papillomavirus (HPV) vaccine initiation coverage among American Indian adolescents and identified factors associated with HPV vaccination among parents of these adolescents. METHODS: We developed, tested, and disseminated a survey to a random sample of 2,000 parents of American Indian adolescents aged 9-17 years who had accessed Cherokee Nation Health Services from January 2019 to August 2020. We used log-binomial regression to estimate the unadjusted and adjusted weighted prevalence proportion ratios (PPR) and 95% confidence intervals (CI) for adolescent HPV vaccine initiation. RESULTS: HPV vaccine initiation coverage (≥ 1 dose) was 70.7% among adolescents aged 13-17 years. The prevalence of HPV vaccine initiation was higher among American Indian adolescents whose parents were aware of the HPV vaccine (adjusted weighted PPR 3.41; 95% CI 2.80, 4.15) and whose parents received a recommendation from their provider (adjusted weighted PPR 2.70; 95% CI 2.56, 2.84). The most common reasons reported by parents to vaccinate their children were to protect them against HPV-associated cancers (25.7%) and receiving a recommendation from a healthcare provider (25.0%). Parents cited vaccine safety concerns as the main reason for not getting their children vaccinated (33.2%). CONCLUSIONS: HPV vaccine initiation coverage among American Indian adolescents in Cherokee Nation was consistent with the national survey estimates. However, allaying parental concerns about vaccine safety and encouraging providers to recommend the HPV vaccine could improve coverage.

Measuring disparities in event-free survival among children with acute lymphoblastic leukemia in an academic institute in Oklahoma, 2005-2019.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. While there have been successes in the treatment of leukemia, less information is available on reasons for disparities in event-free survival (EFS) among underserved populations. METHODS: We partnered with a children's hospital at an academic institution to abstract data from the institution's cancer registry, the state cancer registry, and electronic medical records on cancer diagnosis, treatment, and outcomes for children with ALL (n = 275) diagnosed from 2005 to 2019 prior to age 20. We evaluated the relation between 1) race/ethnicity, 2) distance to the children's hospital, and 3) area deprivation with EFS, defined as time from diagnosis to relapse, death, or the end of the study period. We evaluated differences in EFS using Kaplan-Meier analysis with the log-rank test. We used the Cox Proportional Hazards Model for multivariable survival analyses. RESULTS: Most children were diagnosed with ALL under five years of age (45%) and with Pre-B ALL (87%). Twelve percent of children experienced a relapse and 5% died during induction or remission. EFS at 5 years was 82%. Non-Hispanic (NH) Black children had worse, though imprecise, EFS compared to NH White children (Adjusted Hazard Ratio: 2.07, 95% CI: 0.80, 5.38). Children residing in areas with higher deprivation had a higher adjusted hazard of poor outcomes compared to the least deprived areas, though estimates were imprecise (2nd quartile HR: 1.51, 3rd quartile: 1.85, 4th quartile: 1.62). We observed no association between distance to the children's hospital and EFS. CONCLUSION: We observed poorer EFS for NH Black children and children residing in areas with high deprivation, though the estimates were not statistically significant. Our next steps include further evaluating socioeconomic factors in both rural and urban children to identify disparities in outcomes for children with ALL and other childhood cancers.

Facilitators and Barriers to Implementation of Lung Cancer Screening: A Framework-Driven Systematic Review.

BACKGROUND: The purpose of this study is to undertake a comprehensive systematic review to describe multilevel factors (barriers and facilitators) that may influence the implementation of low-dose chest computed tomography for lung cancer screening in the United States. METHODS: Systematic literature searches were performed using 6 online databases and citation indexes for peer-reviewed studies, for articles published from 2013 to 2021. Studies were classified into 3 perspectives, based on the study's unit of analysis: system, health-care provider, and patient. Barriers and facilitators identified for each study included in our final review were then coded and categorized using the Consolidate Framework for Implementation Research domains. RESULTS: At the system level, the 2 most common constructs were external policy and incentives and executing the implementation process. At the provider level, the most common constructs were evidence strength and quality of the intervention characteristics, patient needs and resources, implementation climate, and an individual's knowledge and beliefs about the intervention. At the patient level, the most common constructs were patient needs and resources, individual's knowledge and beliefs about the intervention, and engaging in the implementation process. These constructs can act as facilitators or barriers to lung cancer screening implementation. CONCLUSIONS: Applying the Consolidate Framework for Implementation Research domains and constructs to understand and specify factors facilitating uptake of lung cancer screening as well as cataloging the lessons learned from previous efforts helps inform the development and implementation processes of lung cancer screening programs in the community setting. REGISTRATION: PROSPERO, CRD42021247677.

Relationships between proximity to grocery stores and Oklahoma Early Care and Education classroom nutrition practices.

The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs' (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a "low proximity" area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0 % were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p > 0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.

Inequalities in Tobacco Retailer Compliance Violations Across the State of Oklahoma, 2015-2019.

OBJECTIVE: To evaluate the relationship between compliance check violations, and characteristics of the tobacco retailer and neighborhood social vulnerability in Oklahoma. DESIGN: This cross-sectional study utilized the US Food and Drug Administration (FDA) Compliance Check Inspections of Tobacco Product Retailers database for 2015-2019. These data were combined with Neighborhood social vulnerability variables using the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index. SETTING: The setting of this study is the state of Oklahoma, USA. OUTCOME MEASURES: The outcome variable for this analysis was whether a sale was made to the youth during the compliance check (e.g., violation; yes/no) regardless of the outcome of the violation, and number of violations per a retailer. RESULTS: We observed a strong association between having a violation and retailer store type, after controlling for socioeconomic vulnerability and percentage of mobile homes. The proportion of a tobacco retailer's violations also varied by store type. CONCLUSIONS: More targeted enforcements and retailer education by store type may be necessary to increase compliance.

Home food access and children's heart healthy dietary intake at home and child care.

Background: About 12 million children under 5 years of age attend early care and education centers (ECEs). Child intake at home can be impacted by food insecurity, which is higher among low income, rural, and racially diverse families. Aim: Determine whether greater access to fruits, vegetables, and snacks at home was associated with heart-healthy diet score at home and at ECEs in preschool-age children, and to determine whether there is a difference in heart-healthy diet score between home and ECEs. Methods: Cross-sectional study involving children (3-to-5-year-old, n = 88) who attended 16 licensed ECEs across Oklahoma. Caregivers completed the Healthy Home Survey and 3-Dinner Dietary recall to report children's home food access and home dinner dietary intake, respectively. Researchers recorded children's ECE lunch consumption using the Dietary Observation for Child Care. Heart-healthy diet score was derived from composite scores for six variables: consumption of fish, fruits, vegetables, sodium, fiber, and sugary drinks. Results: Home access to total fruits and vegetables (16.2 ± 6.3) outnumbered snacks (5.5 ± 3.0). No difference in composite heart-healthy diet score between ECEs (1.50 ± 0.8) and home (1.27 ± 0.9, P = 0.0851). Children within neither environment met recommendations for most variables (vegetables [18-24%], fruit [6-10%], fish [5-10%], fiber [1%], sodium [22-39%]). No relationship between home food access variables and the heart-healthy diet scores at home or ECEs. Conclusion: Dietary intake of children at home and ECEs does not meet heart-healthy diet score recommendations. Interventions should support preschool aged children from families that are located rurally, low-income, racial minorities, and whose primary caregivers work outside the home.

Food Waste, Preference, and Cost: Perceived Barriers and Self-Reported Food Service Best Practices in Family Child Care Homes.

Background: Family Child Care Homes (FCCHs) are a setting where providers care for children at their own residence. FCCHs face unique challenges and children may not always receive optimal nutrition and have higher risk of obesity compared to other programs. The objective of this study was to determine differences in food service best practices scores between FCCHs who did/did not perceive barriers to serving healthy meals. Methods: FCCHs (n = 167) self-reported demographics, and perceived barriers to serving healthy foods. Nutrition and Physical Activity Self-Assessment for Child Care was used to assess food served with 1 (indicating poor practice) to 4 (indicating best practice). Means, standard deviations, and t-tests were conducted to determine differences in scores between FCCHs with and without perceived barriers. Adjusted alpha was 0.013. Results: FCCHs perceiving food waste as a barrier had significantly lower scores for total food and beverage (p = 0.006, 3.2 ± 0.3 vs. 3.4 ± 0.3); fruits and vegetables (p = 0.003, 3.1 ± 0.5 vs. 3.3 ± 0.5), whole fruits (p = 0.048, 3.1 ± 1.2 vs. 3.4 ± 0.9), and nonstarchy vegetables (p = 0.007, 2.8 ± 0.9 vs. 3.2 ± 0.9). Providers perceiving food preferences as a barrier had significantly lower scores compared to those who did not (p = 0.008, 2.9 ± 0.9 vs. 3.3 ± 0.9). No significant differences found in best practices among providers with vs. without perceived barrier of food costs. Conclusion: Food waste is an understudied barrier in FCCHs to serve healthy meals. Research is needed to explore these perceived barriers in FCCHs to improve best practices around meals.