Sugar-Sweetened Beverage Intake Among Adults, by Residence in Metropolitan and Nonmetropolitan Counties in 12 States and the District of Columbia, 2017.

The objective of this study was to describe the prevalence of sugar-sweetened beverage (SSB) intake among US adults (n = 68,896) residing in metropolitan and nonmetropolitan counties, by state, using data from the Behavioral Risk Factor Surveillance System. We used multinomial logistic regression to calculate adjusted prevalence ratios for daily (≥1 time per day) SSB intake. Overall, 26.0% of respondents reported daily SSB intake, with significantly higher prevalence in nonmetropolitan counties (30.9%) than in metropolitan counties (24.8%) (adjusted prevalence ratio = 1.32, 95% confidence interval, 1.26-1.39). This same pattern was significant in 5 of 11 states with metropolitan and nonmetropolitan counties. These findings could inform efforts to reduce frequent SSB intake in nonmetropolitan areas.

Obesity Prevalence Among Adults Living in Metropolitan and Nonmetropolitan Counties - United States, 2016.

Approximately 46 million persons (14%) in the United States live in nonmetropolitan counties.* Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases such as diabetes (1), coronary heart disease (1), and arthritis (2). The 2005-2008 National Health and Nutrition Examination Survey (NHANES) found a significantly higher obesity prevalence among adults in nonmetropolitan (39.6%) than in metropolitan (33.4%) counties (3). However, this difference has not been examined by state. Therefore, CDC examined state-level 2016 Behavioral Risk Factor Surveillance System (BRFSS) data and found that the prevalence of obesity (body mass index [BMI] ≥30 kg/m2) was 34.2% among U.S. adults living in nonmetropolitan counties and 28.7% among those living in metropolitan counties (p<0.001). Obesity prevalence was significantly higher among nonmetropolitan county residents than among metropolitan county residents in all U.S. Census regions, with the largest absolute difference in the South (5.6 percentage points) and Northeast (5.4 percentage points). In 24 of 47 states, obesity prevalence was significantly higher among persons in nonmetropolitan counties than among those in metropolitan counties; only in Wyoming was obesity prevalence higher among metropolitan county residents than among nonmetropolitan county residents. Both metropolitan and nonmetropolitan counties can address obesity through a variety of policy and environmental strategies to increase access to healthier foods and opportunities for physical activity (4).

Fluoride effectiveness in high caries risk and medically complex Veterans.

BACKGROUND: The Global Burden of Disease Study showed there was a 34.5% increase in years lived with disability due to dental caries from 1990 to 2010. With the aging of 76 million baby boomers, dental caries will continue to pose a significant challenge for older adults. OBJECTIVE: Test the effectiveness of prescription or professionally applied fluoride in the prevention of new dental restorations in a clinical setting where patients are medically compromised and more dentally impaired than the general population. METHODS: A retrospective cohort study, using multiple electronic databases within the Department of Veterans Affairs. Propensity scores were used to adjust for confounding by indication and logistic regression modeled the outcome and included all expected covariates. RESULTS: The study sample included 140,114 high caries risk Veterans with a mean of 3.4 physical comorbidities, 1.2 mental comorbidities, and 11 medication groups per patient. Patients who received clinical fluoride treatments had 17-20% decreased odds of requiring a restoration during the follow-up period. CONCLUSIONS: Prescription self-applied or professionally applied fluoride provided either before or during an episode of care significantly reduced the likelihood of new restorations in high caries risk and medically compromised Veterans.

Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries.

BACKGROUND: Staff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past. METHODS: In a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM. RESULTS: In 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period. CONCLUSIONS: Fluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation. Practical Implications Fluoride use reduces the need for future restorations in adults at high risk of experiencing caries.

Behaviors related to physical activity and nutrition among U.S. high school students.

PURPOSE: National data related to physical activity (PA) and nutrition among adolescents are needed to help develop effective obesity prevention programs. The 2010 National Youth Physical Activity and Nutrition Study (NYPANS) was conducted to provide nationally representative data on behaviors and behavioral correlates related to healthy eating and PA. METHODS: NYPANS used a three-stage cluster sample design to obtain data representative of public- and private-school students in grades 9 through 12 in the United States (n = 11,429). Students completed an anonymous, self-administered questionnaire in their classrooms during a regular class period. Trained data collectors directly measured the students' height and weight at school using a standard protocol. RESULTS: Analyses revealed that 19.0% of students were obese and 17.8% were overweight. Students participated in a range of physical activities during the 12 months before the survey; prevalence ranged from 5.0% for ice hockey to 83.9% for walking. In addition, 52.5% of students enjoyed the physical education classes they took at school. During the 7 days before the survey, 74.8% of students ate at least one meal or snack from a fast food restaurant, with black students more likely than white and Hispanic students to have done so. Forty-one percent of students always or most of the time have a TV on while eating dinner at home. CONCLUSIONS: These and other NYPANS results can be used to develop obesity prevention programs that address specific behaviors and behavioral correlates, and target subgroups in which behaviors and behavioral correlates related to obesity are most prevalent.

Leading determinants of efficient dental care delivery.

OBJECTIVE: Identify structure and process variables that significantly contributed to dentist productivity across VA Dental Service clinics using multiple VA national datasets from fiscal year 2010. METHODS: A retrospective, longitudinal analysis with the primary outcome of care provided, as measured by relative value units per clinically mapped full-time employee equivalent dentist, per year. Predictor variables included physical plant variables, staffing variables, complexity of the patient population, workplace climate, and environment of care. Predictor variables were initially assessed in a bivariate analysis with the primary outcome and those significant at P < 0.2 were entered into an ordinary least squares regression model. RESULTS: Dentist productivity and several predictor variables were significantly different between sites with and without resident training programs; therefore, two explanatory models were constructed. In both models, increasing the assistant-to-dentist ratio was the most important driver for increasing productivity. Additional drivers include the resident-to-dentist ratio, use of technology, and connectedness and engagement with the medical center as demonstrated by participation in various committees and/or boards. Final models explained over 50 percent of the variance in productivity. CONCLUSIONS: In multiprovider settings, predictors of dentist clinical productivity differ for sites with and without residency training programs. Although the assistant-to-dentist ratio is the most explanatory for each type of setting, other variables such as the resident-to-dentist ratio, use of technology, and connectedness/engagement with the medical center are uniquely significant to the two types of service sites and should also be considered to maximize productivity.

Factors associated with the satisfaction of millennial generation dental residents.

Data from the 2010 Learners' Perceptions Survey (LPS) administered through the Office of Academic Affiliations, Department of Veterans Affairs (VA) were analyzed to identify factors associated with dental residents' satisfaction with the VA as a clinical training environment. Satisfaction scores were linked to clinic workloads, dental procedure complexity levels, staffing patterns, and facility infrastructure data to explore conditions that may improve residents' satisfaction. Findings supported the construct validity of the LPS survey data and underscored the importance of maintaining optimal ratios of attending dentists, dental assistants, and administrative staff to residents so that each trainee will have opportunities to perform an adequate level of dental workload. As programs strive to improve the quality of graduate dental education, findings from this study are vital for setting curriculum design guidelines and for providing infrastructure support for dental resident education.

The association between funding for statewide programs and enactment of obesity legislation.

OBJECTIVE: As part of a national effort to prevent and control obesity, the Centers for Disease Control and Prevention's (CDC's) Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (NPAO) provides funding to states to improve access to healthful food and increase opportunities for physical activity. The CDC also provides funding to states to build Coordinated School Health (CSH) programs across agencies and within schools to help reduce chronic disease risk factors. This paper investigates the possible role of these programs in state policy change. METHODS: Descriptive study of state legislation targeting obesity prevention passed in 2005. Units of analysis were 135 pieces of obesity-related state legislation identified within 4 legislative databases. Legislation was coded into programmatic setting and obesity-prevention strategy categories. RESULTS: On average, states receiving NPAO or CSH program funding passed twice as many bills as states not yet funded. CONCLUSIONS AND IMPLICATIONS: The statewide obesity prevention and school health programs may have contributed to states enacting more obesity-related legislation. Further research into the process by which state programs influence the enactment and effective implementation of policies could help build the evidence base for policy changes that help prevent obesity.

Impact of infrastructure on graduate dental education and dental clinic productivity.

Using all-inclusive data from 126 U.S. Department of Veterans Affairs health care facilities that provide dental services, this study identified the staffing infrastructure under which the Veterans Health Administration can provide graduate dental education without compromising dental clinic productivity. From regression analyses, we found that teaching residents has a negative impact on staff dentists' productivity; however, when the dental assistant to provider ratio is greater than or equal to 1.0, dental residents' workload contribution can offset the negative impact on overall clinic productivity. In the presence of dental residents, the dental assistant, front-desk personnel, and dental treatment room to provider ratios have a positive impact on productivity. The optimal ratios were calculated as 1.5 for dental assistants, 2.1 for dental treatment rooms, and 0.57 for front-desk personnel.