Content of widely viewed YouTube videos about celiac disease.

OBJECTIVE: To describe the most widely viewed English language videos related to celiac disease on YouTube. STUDY DESIGN: This is a cross-sectional study. METHODS: Videos sorted by number of views yielded the 100 most widely viewed. Number of views, source (consumer, professional, or news agency), and inclusion of specific content were recorded. RESULTS: Collectively, the 100 videos were viewed nearly 7 million times. Between 2007 and 2010, 28% were uploaded, while more than 70% were uploaded after 2010. Professionals uploaded almost half (48%), consumers posted 32%, and news sources posted the remaining 20%. While gluten-containing foods/drinks were presented in 57% of the videos, these videos garnered almost 78% of cumulative views. Comparatively few videos provided substantive information related to age at diagnosis, who is at risk for the disease, hereditary nature, or that the disease can inhibit growth and development among children. Most videos (56%) did not cover how celiac disease is diagnosed, and only 14% mentioned family members of diagnosed individuals should be screened for the disease (garnering only 9% of cumulative views). CONCLUSION: Given the popularity and potential reach of YouTube, medical professionals have an opportunity to use this medium to reach a large audience in providing accurate and useful information to the public about celiac disease.

Sugar sweetened beverages on emerging outdoor advertising in New York City.

OBJECTIVES: As a replacement for traditional phone booths, LinkNYC kiosks provide the ability to make free calls, connect to WiFi, and to charge electronic devices. These structures, which are supported by advertising revenue, are found in growing numbers on the streets of New York City (NYC). The purpose of this study was to determine the prevalence of sugar-sweetened beverage advertisements on LinkNYC kiosks. STUDY DESIGN: Cross-sectional, observational. METHODS: A total of 100 kiosks from a sample of 507 kiosks were randomly selected and observed in Manhattan, NYC. RESULTS: A total of 2025 advertisements, including duplicates, were observed that included 347 (17.1%) viewed at 64 kiosks for non-alcoholic beverages. Over half (n = 206, 59.4%) featured beverages with added sugar. For the 206 beverages with sugar, the mean kilocalories and grams of sugar per serving were 149.90 (SD = 64.95, range = 90-300) and 35.04 (SD = 19.54, range = 17-81), respectively. Differences in the frequency of these 206 advertisements were examined by the median annual income quartile of the census tract where the kiosk was located, and no significant differences were observed, χ2 (3, N = 206) = 3.09, P = 0.38. CONCLUSIONS: As the NYC Department of Health and Mental Hygiene invests in efforts to reduce consumption of sugar-sweetened beverages, promoting these very products through new media controlled by the City does not seem well aligned with the goal of improving dietary intake of citizens.

Readability of online material related to skin cancer.

OBJECTIVES: The key to reducing mortality from skin cancer depends on early detection and treatment, which, in many cases, means a patient should be informed and possess the self-efficacy necessary to seek expert opinion. The purpose of this study was to determine the readability of skin cancer materials on the Internet using the commonly used readability tests. STUDY DESIGN: This is a cross-sectional study. METHODS: A search was conducted using the key words 'skin cancer.' The first 15 pages of websites that contained English language articles on skin cancer comprised the sample for this study. All English language articles appearing on these websites were analyzed using the Readable.io service to automate popular readability scores. For each article, it was determined if it was generated from a .org, .com, .gov, .net, .edu or other source. Five readability tests were conducted on the materials to determine the ease with which one can read each article. RESULTS: Of the 102 websites sampled, none received an acceptable score on all five assessments. In fact, more than 90% of the websites sampled received an unacceptable score on any one of the five assessments, and more than 78% of the websites sampled received an unacceptable level on all five assessments. All five readability assessments demonstrated statistically significant results; each P-value obtained from the t-tests was substantially below 0.01 and, hence, below the α = 0.05 threshold. These results indicate that it is unlikely that skin cancer websites are being written at the recommended level. Of the websites sampled, roughly 42% were .com, and slightly more than 36% were .org. Statistical evidence indicated that neither .com nor .org websites are likely to be written at the acceptable level. CONCLUSIONS: Both for-profit and non-profit agencies which aim to provide health information to consumers should be mindful of the readability levels of the materials they disperse.

What do popular YouTubeTM videos say about vaccines?

BACKGROUND: The unregulated social network YouTube TM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant. METHODS: Using the keywords 'vaccine safety' and 'vaccines and children', 87 of the most widely viewed YouTubeTM videos were identified and analyzed for content, author status and view count. RESULTS: The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTubeTM videos were consumers (27.6%), TV-based or Internet-based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines. CONCLUSION: Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

Variability and self-regulation of energy intake in young children in their everyday environment.

Recent data from small numbers of children studied under controlled protocols indicate that intraindividual variation in energy consumption over 24 hours is smaller than variation from eating occasion to eating occasion, implying that children self-regulate their energy consumption. This hypothesis was tested in children living in their everyday environment. Between 1986 and 1989, 24-hour recalls were administered on seven occasions (four times in 1986 through 1987 and three times in 1988 through 1989) to the mothers of 181 preschool children in New York City. Each 24-hour period was divided into six meals or snacks. The coefficient of variation (standard deviation divided by the mean) was calculated for each child for energy consumption at each eating occasion and for the day as a whole. Coefficients of variation for energy consumption at the six eating occasions ranged from 46.5% to 165.8%, compared with 30.3% for the whole day. This coefficient of variation for the observed whole-day energy consumption was significantly less (P < .001) than would be expected if no autoregulation of energy intake (no meal-to-meal correlation) occurred. These findings in children living in their everyday environment are consistent with observations under more controlled study conditions. These data suggest that children who eat less at one meal compensate at another, although the data do not address the issues of longer term energy self-regulation, overall energy balance, or diet quality.

Is there a relationship between dietary fat and stature or growth in children three to five years of age?

STUDY OBJECTIVE: To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children. DESIGN: Cohort study with mean of 25 months of follow-up. SETTING: Primary care pediatrics practice at a large urban medical center. SUBJECTS: A predominantly Hispanic group of 215 children aged 3 to 4 years at baseline. MEASUREMENTS AND MAIN RESULTS: The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C. CONCLUSIONS: These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.

The rate of increase in blood pressure in children 5 years of age is related to changes in aerobic fitness and body mass index.

OBJECTIVE: To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children. STUDY DESIGN: Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19.7 months. Aerobic fitness was assessed using a treadmill. All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study. SETTING: An inner-city medical center. OUTCOME MEASURES: Blood pressure was measured using an automated Dinamap device. RESULTS: Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02). CONCLUSION: Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.

Incentives and barriers to retinopathy screening among African-Americans with diabetes.

Diabetes-related ophthalmic complications are the leading cause of newly diagnosed blindness among adults. These eye complications are often asymptomatic in the early stages, yet the majority of diabetes patients are not screened yearly. To develop a health promotion intervention to increase the rate of screening for diabetic retinopathy by dilated fundus exam (DFE), we assessed the knowledge and health beliefs related to preventing diabetic eye complications among a sample of African-Americans with diabetes. The study design was cross-sectional, using a telephone interview to collect data. From a random sample of 104 African-Americans with diabetes, 67 (64%) were completed: 54 women; mean age of 58 years. The telephone interview schedule contained items grouped into subscales for Perceived Incentives, Perceived Barriers to getting a DFE, Causes of Eye Problems, Risk of Eye Problems, and Effective Treatments for Eye Problems. Descriptive statistics were used to analyze the quantitative data. Transcribed qualitative responses to the open-ended questions were analyzed for themes. The incentives "having eye problems" and "doctor said it was important to go" each had 91% responding it was an incentive to go for a DFE. Only about one-third agreed that any particular item was a barrier to receiving a DFE (e.g., economic factors). In the subscale for Risk of Eye Problems, "retinopathy" had the lowest level of perceived risk (30%). Only 21% of the sample reported there were effective treatments for retinopathy. Eighty-seven percent reported the faulty belief that "diabetic eye problems have symptoms." Only 36% of the sample said they had heard of retinopathy and of those, only 8% could describe it correctly. Among general response themes were: fear, spirituality (faith and hope), priorities, economic or logistical factors, and external/internal motivation. Perceived incentives for receiving a DFE were acknowledged at far greater rates than perceived barriers. Having a yearly DFE in the absence of symptoms must be emphasized in health promotion materials. There are effective, early treatments for diabetic eye problems, and this information should be used to counter the fear of a dreaded diagnosis with the hope of treatment and cure. Ways of coping with fear of having the exam should be included in health education. DFEs must become a routine yearly exam and not just a reaction to recognized problems. Health education must address the specific needs of high-risk minority populations.

A review of five major community-based cardiovascular disease prevention programs. Part II: Intervention strategies, evaluation methods, and results.

Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. The main hypothesis is that community intervention will reduce the prevalence of cardiovascular disease risk factors and consequently reduce cardiovascular disease incidence, morbidity, and mortality. Intervention strategies include community mobilization, social marketing, school-based health education, worksite health promotion, screening and referral of those at high risk, education of health professionals, direct education of adults, and modification of physical environments. Formative evaluation provides short-term feedback to program managers about immediate effects of intervention strategies. Outcome evaluation examines the effects of intervention on longitudinally sampled cohorts and compares cardiovascular risk status and morbidity and mortality in intervention and comparison communities. Results from North Karelia and the Stanford Three Community Study indicate that this model is efficacious and cost-effective. The National Heart, Lung, and Blood Institute biomedical research spectrum envisions research in knowledge transfer and innovation diffusion as the last link in the causal chain whereby research affects the health of the population, but research in this area remains undeveloped compared to other aspects of cardiovascular disease prevention. This is Part II of a two part article; Part I appeared in Volume 4, Number 3.

A review of five major community-based cardiovascular disease prevention programs. Part I: Rationale, design, and theoretical framework.

Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. These primary prevention programs aim to reduce cardiovascular disease incidence by reducing risk factors in whole communities. These risk factors are smoking, high blood cholesterol, diet high in cholesterol and saturated fat, hypertension, sedentary lifestyle, and obesity. This strategy may be contrasted with secondary prevention programs directed at patients who already have symptomatic cardiovascular disease and "high risk" primary prevention programs directed at individuals found through screening to have one or more risk factors. The design of the five major programs is similar in that intervention communities are matched for purposes of evaluation with nearby comparison communities. Underlying these programs are theories of community health education, social learning, communication, social marketing, and community activation, as well as more traditional biomedical and public health disciplines. This is Part I of a two-part article.

Correlates of internists' practices in caring for patients with elevated serum cholesterol.

Abstract This study examined the relationship between internists personal health practices, health beliefs, and demographic characteristics and their reported practices in caring for patients with elevated serum cholesterol. A questionnaire was mailed to 271 internists (181 respondents) on the medical staff of an urban university hospital. Perceived ability to provide dietary counseling was consistently associated with interventions offered by the internists themselves, including education, counseling, and use of lipid-lowering drugs and with defining elevation of serum cholesterol at a lower value. It was not associated with referral to the dietitian or the Lipid Clinic. There were only weak and inconsistent associations between physician personal health practices, including diet and having a personal cholesterol goal, and any of the physician-reported professional practices examined. These findings strengthen the hypothesis that there is a relationship between physicians' perceived competence and their use of diet counseling and lipid-lowering drugs.

Ophthalmic knowledge and beliefs among women with diabetes.

Many patients with diabetes do not obtain the recommended annual dilated eye exam that is necessary for early detection of diabetic retinopathy. In this study, 150 suburban, low-income women with diabetes were interviewed using a structured telephone questionnaire that included subscales of ophthalmic knowledge and beliefs regarding barriers, benefits, concerns, and self-efficacy related to receiving recommended ophthalmic screening. The data revealed significant gaps in knowledge about diabetes-related eye complications. More than half of the subjects did not know that eye complications may be asymptomatic and that there are ways to lower the risk of eye problems. Over three quarters did not mention having drops put in their eyes as part of an eye exam, one fifth did not know what type of health provider should perform an eye exam, and 17% did not know that annual eye exams were recommended. Subjects were concerned about eye complications associated with diabetes, were aware of the benefits of eye exams, and reported high levels of self-efficacy for receiving an annual eye exam.

Development and formative evaluation of a foot self-care program for African Americans with diabetes.

African Americans with diabetes have a higher rate of lower-extremity amputation due to diabetic foot complications than the general public. Education about proper foot care can help prevent serious diabetic foot complications and assist in early detection of problems. The purpose of this project was to develop, formatively evaluate, and pilot test a self-care, take-home program for the prevention of foot problems in African Americans with diabetes. The program included a brief, one-on-one orientation session and a take-home foot self-care packet. Through telephone follow-up subjects reported the following: good to excellent overall rating of the program, favorable reactions to the patient instruction booklet, an overwhelming positive response to the large hand mirror, and a positive effect on their daily foot-care practices. The Afrocentricity of the patient education materials was preferred by younger subjects; older subjects found this approach too restrictive.

Computer-assisted diabetes nutrition education increases knowledge and self-efficacy of medical students.

Medical students and physicians need to improve their understanding of the role of nutrition and the multidisciplinary team in diabetes care. To assist in this learning, an interactive computer program was developed that focused on prescribing diets for patients with diabetes. Parallel 10-item knowledge tests and an 8-item self-efficacy scale were used to evaluate the efficacy of the computer program among 41 third-year medical students. Mean knowledge scores increased significantly after using the computer program. Posttest knowledge scores for the medical students approached the level achieved by general practice dietitians with no diabetes specialty training. Mean self-efficacy scores increased significantly. The mean time spent on the educational component of the program was under 30 minutes. Computer-assisted diabetes nutrition education proved to be an efficient and effective method for teaching basic nutrition competencies to medical students. This program is available on the World Wide Web (http:/(/)medicine.aecom.yu.edu/diabetes/DEC.htm ) and may be a useful means for providing basic diabetes nutrition education to primary healthcare providers from a variety of disciplines as well as for medical students.

Diabetes care needs of Hispanic patients treated at inner-city neighborhood clinics in New York City.

The charts of 254 Hispanic patients were selected from a sample of 321 patients with diabetes in four urban clinics that received federal funding to provide medical care in underserved communities. A standardized chart-audit protocol was used to assess the process of healthcare delivery and the presence of diabetes-associated comorbidities and complications in patients. Inconsistent recognition of obesity (11% identified vs 59% present), hyperlipidemia (17% identified vs 69% present), and renal dysfunction (3.5% identified vs 16% present) was evident on chart review. We also found inadequate compliance with current recommendations for diabetes care with respect to routine health screenings for diabetes-related complications, recognition of comorbid diagnoses, and referral of patients for recommended specialty consultations. Issues specific to the varied Hispanic populations may need to be considered to improve the delivery of diabetes care for the growing Hispanic population with diabetes.

The telephone as a communication medium for health education.

The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.

Research on disseminating and implementing health education programs in schools.

Numerous school health education programs have been developed. No matter how effective a given program may be, however, its impact will be determined by the extent to which it actually is disseminated and maintained in classrooms. The dissemination of a program involves purposeful efforts by agencies usually outside the school to implement the program in many different schools, efforts by agencies usually outside the school to implement the program in many different schools, while program implementation involves efforts by those within a given school to effectively use the program in its classrooms. This paper has been prepared to review concepts, strategies, and methods used to study dissemination and implementation; to specify the functions of dissemination and implementation research; and to describe general approaches and specific procedures to evaluate the effectiveness of dissemination and implementation activities. As we develop more and better school health education interventions, the need for research that will allow us to efficiently transport these interventions to classrooms throughout the nation becomes increasingly important.

Preventing AIDS through education: concepts, strategies, and research priorities.

Concepts related to the design and implementation of AIDS education programs in schools are presented. For each concept, the rationale and implications for curricular planning are described and health education research priorities are outlined. Teachers can make a major contribution in preventing HIV transmission among youth, perhaps the single largest contribution of any professional group. To do so, however, may require letting go of familiar roles and assuming a redefined and expanded role. Improvements in the theory base for school health education provide guidelines that can be used by teachers to clarify and reinforce curriculum efforts and to adapt to this new role.

The validity of reliability assessments.

This paper focuses on reliability and evaluation of health education programs in school settings. Reliability is a concept that guides researchers in selecting or developing instruments, and is used as a standard, with validity and acceptability, for judging the credibility of research findings and inferences. Reliability is defined within the context of research design, and methods for estimating the reliability of cognitive measures are reviewed. Using data gathered in a school health education curriculum evaluation as an example, possible errors in hypotheses testing that may occur when estimating internal consistency of cognitive test scores obtained in quasi-experimental designs are examined. The appropriateness of internal consistency as a measure of reliability of cognitive measures is discussed and suggestions for reliability assessment and related issues such as power analysis are presented.