Using State Agency Reports to Augment Ohio's Agricultural Injury Surveillance Efforts.

BACKGROUND: Agriculture is a hazardous industry with undocumented injury events. Credible surveillance measures are critical for this industry, especially to guide injury prevention programs with targeted recommendations for specific commodity groups and populations. This multi-phase study explored the feasibility for two state agency databases, the Ohio Bureau of Workers' Compensation (BWC) Program and the Emergency Medical Services Incident Reporting System (EMSIRS), to augment the state's Bureau of Labor Statistics (BLS) annual reports. METHODS: BWC data described injury claims in agricultural workplaces from 1999 to 2008. State EMSIRS data described the types of medical emergencies for which EMS services were requested to Ohio farms in 2013-2014. Descriptive analyses were performed on each distinctive source. RESULTS: Over 14,000 BWC claims were analyzed, with primary nature of injury identified as sprains and strains of bodily extremities; falls were the most common cause of injury. The EMSIRS data provided 1,376 cases, where EMS services were requested to Ohio farms at injury onset. Some cases had possibility to be excluded in CFOI or employment claims data, with 24% patients 65 years and older and 6% children 13 years and younger. The primary cause of injury was falls, and the highest reported injury type was blunt trauma. CONCLUSIONS: Both BWC and EMSIRS databases showed the potential to enhance Ohio's agricultural surveillance data with viable information not found in previously used systems. Each agency database had its own merits to further clarify and quantify morbidity. When used together, these sources enrich surveillance statistics to describe Ohio's agricultural injury incidents.

Public Health Surveillance of Behavioral Health Emergencies through Emergency Medical Services Data.

Objective: To identify the demographic, clinical and EMS characteristics of events documented as behavioral health emergencies (BHE) by EMS. Methods: This was a cross-sectional study using the 2018 National Emergency Medical Services Information System (NEMSIS) Version 3 dataset. All events that had patient care provided with a documented impression (field diagnosis) of ICD-10 codes F01-F99 (i.e., mental, behavioral, and neurodevelopmental disorders) were labeled a BHE and included. Descriptive statistics were calculated. Results: A total of 1,594,821 (7.3%) EMS calls had a BHE impression. The most common was mental and behavioral disorders due to psychoactive substance use (42.3%). More males than females had BHEs (54.6% vs. 45.4%), and most patients were ages 18-34 (31.5%). Most BHE occurred in urban settings (89.6%). Almost half (47.9%) were dispatched with a complaint unrelated to behavioral health. Conclusion: BHEs were noted in 7.3% of NEMSIS events, and the majority were associated with substance use disorders. EMS professionals need comprehensive training on best practices for BHE. Stakeholders should have information on prevalence of BHEs to ensure proper educational standards, training practices, and resource allocation.

Manager Support for Wellness Champions: A Case Study for Consideration and Practice Implications.

BACKGROUND: Wellness champion networks are deemed an important component to workplace wellness programs. By encouraging colleagues to engage in healthy behaviors, champions can help improve employee health and well-being outcomes, while reducing healthcare costs and increasing productivity. However, little evidence exists regarding factors that impact the effectiveness of a wellness champion. This study examined the relationship between employee engagement in a workplace wellness champion program and the direct manager's support of the wellness champion role. METHODS: A descriptive study was conducted with a 15-item cross-sectional survey that was developed and disseminated to 470 wellness champions at a large academic institution. Survey questions addressed manager/supervisor support for the wellness champion, manager/supervisor support for faculty and staff direct reports participating in wellness activities, and demographic questions. FINDINGS: One hundred and ninety-nine (42%) wellness champions responded to the survey and responded to at least half of the questions. Wellness champions who reported a high level of manager support for their role were more likely to have high levels of engagement in communicating wellness initiatives (p = .0004), motivating and encouraging colleagues (p < .0001), and planning wellness activities (p = .04). CONCLUSION/APPLICATION TO PRACTICE: Findings suggested that support wellness champions received from direct managers was a key determinant to their level of engagement in efforts to improve their colleagues' health and well-being. As employers desire to impact the health and productivity of their employees and generate cost-savings, manager support of wellness champions is necessary to facilitate employee engagement in workplace wellness champion programs.

Access With Education Improves Fruit and Vegetable Intake in Preschool Children.

OBJECTIVE: To compare effects of interventions aimed at increasing fruit and vegetable (FV) intake in children. DESIGN: Pre-post comparison and intervention study with randomly grouped classrooms. SETTING: Head Start classrooms. PARTICIPANTS: Two hundred nine Head Start children. INTERVENTIONS: Treatment A (n = 61) and treatment B (n = 82) children received high-carotenoid FVs for 8 weeks. Treatment B children also received weekly FV education, and their caregivers received FV information and recipes. The comparison group (n = 66) received neither FVs nor education. MAIN OUTCOME MEASURE: Carotenoid values in Raman units. ANALYSIS: Multilevel mixed models, ANCOVA, and post hoc analysis were used. RESULTS: Multilevel mixed models with the group as fixed effect and classrooms within group as a random effect; ANCOVA showed that the only significant variable affecting the score was the group main effect. The intraclass correlation coefficient was 0.037; the Raman unit scores of treatment B were significantly higher than those of treatment A (P = .02) or comparison group (P < .001). However, there was no significant difference between treatment A and comparison (P = .10; Cohen D = .71). CONCLUSIONS AND IMPLICATIONS: The results suggested that providing education where FVs are offered may help increase consumption. Measurement of carotenoids in family members who received FVs plus education, as well as replication of this model in different locations and ages of children should be investigated in future research.

Statin users have an elevated risk of dysglycemia and new-onset-diabetes.

OBJECTIVE: Statins are one of the most widely prescribed medications in the United States; however, there is a concern that they are associated with new-onset-diabetes (NOD) development. We sought to understand the risk of dysglycemia and NOD for a cohort of individuals that reflect real-world physician prescribing patterns. METHODS: A retrospective cohort study was conducted among individuals with indications for statin use (n = 7064). To examine elevated glycosylated hemoglobin (>6.0%), logistic regression with inverse probability weighting was used to create balance between incident statin users and nonusers. To evaluate the risk of NOD development, Cox PH models with time varying statin use compared NOD diagnoses among statin users and nonusers. RESULTS: A higher prevalence of elevated HbA1c (PD = 0.065; 95% CI: 0.002, 0.129, P = 0.045) occurred among nondiabetic incident users of statins. Additionally, statin users had a higher risk of developing NOD (AHR = 2.20; 95% CI: 1.35, 3.58, P = 0.002). Those taking statins for 2 years or longer (AHR = 3.33; 95% CI: 1.84, 6.01, P < 0.001) were at the greatest risk of developing NOD; no differences were observed by statin class or intensity of dose. CONCLUSION: As lifestyle programs like the Diabetes Prevention Program are promoted in primary care settings, we hope physicians will integrate and insurers support healthy lifestyle strategies as part of the optimal management of individuals at risk for both NOD and cardiovascular disease. The relationships between statin use and glycemic control should be evaluated in large cohort studies, medical record databases, and mechanistic investigations to inform clinical judgment and treatment.

An Evaluation of Reach for a Work Site Implementation of the National Diabetes Prevention Program Focusing on Diet and Exercise.

PURPOSE: Our objective is to evaluate the "reach" component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program. DESIGN: A cross-sectional study design was used. SETTING: The setting was a large health system in the Midwest. PARTICIPANTS: Prediabetic health plan enrollees and spouses (N = 2158). MEASURES: An online health survey, annual voluntary biometric screenings delivered by a trained health-care professional using standardized protocols via point-of-care testing, and records from the DPP office were the sources of data for this study. ANALYSIS: Health behaviors and biometric screening results were simultaneously compared using multivariable logistic regression. RESULTS: The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (SD = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP, if they were female (adjusted odds ratio [AOR]: 2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; 95% CI: 1.43-3.47; P < .001), older in age (AOR: 1.08; 95% CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; 95% CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; 95% CI: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; 95% CI: 0.99-4.57; P = .05), after controlling for other covariates. CONCLUSION: Current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. These findings inform future engagement strategies, and we recommend that public health practitioners evaluate reach to ensure that health promotion programs are of high value.

Diet qualities: healthy and unhealthy aspects of diet quality in preschool children.

BACKGROUND: Diet quality indexes combine the healthy and unhealthy aspects of diet within a single construct, but few studies have evaluated their association. Emerging evidence suggests that predictors differ for the more and less healthy components of children's diets. OBJECTIVES: Our objectives were to determine whether preschool-aged children's frequency of eating healthy foods was inversely related to their intake of unhealthy foods and to determine whether this differed by household income, maternal education, or child race-ethnicity. DESIGN: We analyzed data from a representative sample of 8900 US children (mean age: 52.5 mo) who were born in 2001 and participated in the Early Childhood Longitudinal Study-Birth Cohort. Primary caregivers reported the frequency with which children consumed fruit, vegetables, milk, juice, sugar-sweetened beverages (SSBs), fast food, sweets, and salty snacks in the past week. Response options ranged from none to ≥4 times/d. We created healthy (fruit, vegetables, milk) and unhealthy (SSBs, fast food, sweets, salty snacks) diet scores. Healthy diet behaviors were defined as ≥2 daily servings of fruit, vegetables, and milk. RESULTS: The prevalence of consuming fruit, vegetables, and milk ≥2 times/d (i.e., having 3 healthy diet behaviors) was 18.5%, and a similar proportion (17.6%) of children had none of these healthy behaviors. Contrary to our hypotheses, children with more healthy diet behaviors did not have lower unhealthy diet scores. The intake of healthy foods was not inversely associated with unhealthy foods overall or within any subgroup. Overall, the Spearman rank correlation between healthy and unhealthy diet scores was positive (r = 0.09). From the lowest to the highest strata of household income, these correlations were 0.12, 0.14, 0.14, 0.05, and 0.00, respectively. CONCLUSIONS: No evidence was found in US preschool-aged children of an inverse association between eating healthy and unhealthy foods. The implications of combining healthy and unhealthy aspects of diet quality within an overall index should be considered by researchers.

Energy Contribution of Beverages in US Children by Age, Weight, and Consumer Status.

BACKGROUND: Messaging to reduce unhealthy beverage intake is often targeted to overweight and obese children; however, there is little evidence to show that healthy weight children have healthier beverage intake patterns. Further, data on consumers only may further elucidate beverage intake patterns. PURPOSE: The aim of this study was to update the current body of literature describing beverage intake in children by weight category, with the addition of consumer-only data. METHODS: Day one 24-hour recalls from the National Health and Nutrition Examination Survey 2005-2010 were analyzed to assess beverage intake of children 2-18 years old and differences by weight category. Beverages were coded as water, milk, 100% juice, coffee/tea, fruit drinks, soda, or low-calorie/diet drinks. RESULTS: On average, 18.7% of total daily calories for 2- to 18-year-old children came from beverages; 60% of total daily calories from added sugar came from beverages. Mean calories from beverages were 359, 358, and 386 kcal for normal weight, overweight, and obese children, respectively. Across all weight categories, there were clinically significant differences between overall means and means for consumers only. There were overlapping confidence intervals for intake of calories from soda and fruit drinks consumed by 2- to 5-year-olds and 12- to 18-year-olds, suggesting nonsignificant differences in intake across weight categories for these age groups. CONCLUSIONS: Messaging around beverage intake may be beneficial for children of all weights, particularly for those known to consume sugar-sweetened beverages. The per-consumer estimates may represent a better measure of intakes in future examinations of 24-hour recall data.

Interrelationships of More Healthful and Less Healthful Aspects of Diet Quality in a Low-Income Community Sample of Preschool-Aged Children.

OBJECTIVE: To investigate whether higher intake of "healthy" foods was associated with lower intake of "unhealthy" foods among a sample of low-income preschool-aged children, and if associations differed for younger (2-3 years) and older (4-5 years) children. METHODS: Between May 2012 and May 2013, we studied 298 parents/guardians of 357 preschool-aged children living in a low-income area of a large Midwestern city in the United States. Parents reported on children's past week frequency of intake of juice, fruits, vegetables, milk, sugar-sweetened beverages, fast food, sweets, and salty snacks with seven response options (coded 0-6) ranging from none to ≥4 times/day. We combined fruits, vegetables, and milk to create a healthy diet score, and denoted a healthy diet behavior if frequency of intake of these foods was ≥2 times/day. Sugar-sweetened beverages, fast food, sweets, and salty snacks were considered unhealthy aspects of children's diets. Juice was examined separately. RESULTS: The number of healthy diet behaviors was not related to the number of unhealthy diet behaviors or the unhealthy diet score. This was true overall and by age group (P trend values ranged from 0.26 to 0.90), and the pattern did not differ by age (P interaction >0.3). Correlations between healthy and unhealthy diet scores overall and for younger and older preschool-aged children were not statistically significant (Spearman correlation coefficients = 0.05, -0.01 and 0.11 respectively). CONCLUSIONS: Healthy and unhealthy aspects of children's diets may be independent of one another. Additional research in heterogeneous populations is needed.

Campus-based snack food vending consumption.

OBJECTIVE: To evaluate the purchases of university vending machine clientele and to understand what consumers purchase, purchase motivations, and purchase frequency after implementation of a vending policy designed to promote access to healthier snack options. METHODS: Cross-sectional data collection from consumers at 8 campus vending machines purposefully selected from a list of highest-grossing machines. Vending machines were stocked with 28.5% green (choose most often), 43% yellow (occasionally), and 28.5% red (least often) food items. RESULTS: Consumers were predominately students (86%) and persons aged 18-24 years (71%). Red vending choices were overwhelmingly selected over healthier vending options (59%). Vended snack food selections were most influenced by hunger (42%) and convenience (41%). Most consumers (51%) frequented vending machines at least 1 time per week. CONCLUSIONS AND IMPLICATIONS: Despite decreased access to less healthful red snack food choices, consumers chose these snacks more frequently than healthier options in campus vending machines.

An evaluation of the validity and reliability of a food behavior checklist modified for children.

OBJECTIVE: The objective of this study was to report the construct validity and internal consistency reliability of the Food Behavior Checklist modified for children (FBC-MC), with low-income, Youth Expanded Food and Nutrition Education Program (EFNEP)-eligible children. METHODS: Using a cross-sectional research design, construct validity was assessed using confirmatory factor analysis (weighted least squares method), and internal consistency reliability for 3 subscales was assessed using Cronbach alpha. RESULTS: Ninety-seven children from low-income families completed the FBC-MC. Indicator tests suggest adequate model fit (comparative fit index = 0.962; root mean square error of approximation = 0.064) and item factor loadings were significant for all subscales (P < .05). The instrument appeared to have adequate reliability for 1 subscale (fruit and vegetable consumption, alpha = 0.67), but not for the other 2 (milk consumption, alpha = 0.43; healthful eating behaviors, alpha = 0.56). CONCLUSIONS AND IMPLICATIONS: The FBC-MC may be a suitable instrument for evaluating dietary behaviors among Youth EFNEP-eligible children; however, more work is needed to establish internal reliability and criterion validity.

An Evaluation of Holiday Weight Gain Among Elementary-aged Children.

BACKGROUND: Previous studies suggest adults gain extra weight during the holiday season, however, few studies have been done with children during this time. The purpose of this study was to evaluate gains in growth among elementary children, and compare differences by gender and weight status. METHODS: Childrens (n = 90) height and weight were measured before and after their holiday break. Height, weight and body mass index (BMI) and body mass index-percentiles (BMI-%) were evaluated and compared by groups using repeated measures ANCOVAs. RESULTS: On average, children grew 0.82 cm (0.32 in), and gained 0.56 kg (1.2 lbs) and 0.28 BMI units, however the average BMI-% slightly decreased by 0.4%. Overweight and obese children gained significantly more weight, BMI units and BMI-% units compared with normal weight children. CONCLUSIONS: This study supports that the holiday period may be an important time to target children, especially those who are already overweight and obese. KEYWORDS: Holiday weight gain; Childhood obesity.

Improving patrons' meal selections through the use of point-of-selection nutrition labels.

OBJECTIVES: We examined changes in meal selection by patrons of university food-service operations when nutrition labels were provided at the point of selection. METHODS: We used a quasi-experimental, single-group, interrupted time-series design to examine daily sales before, during, and after provision of point-of-selection nutrition labels. Piecewise linear regression was employed to examine changes in the average energy content of entrées and a paired t test was used to detect differences in sales across the periods. RESULTS: The average energy content of entrées purchased by patrons dropped immediately when nutrition labels were made available at point of selection and increased gradually when nutrition information was removed. There was no significant change in number of entrées sold or in revenues between the 2 periods. CONCLUSIONS: Use of nutrition labels reduced the average energy content of entrées purchased without reducing overall sales. These results provide support for strengthening the nutrition labeling policy in food-service operations.