Exploring Risk Factors of Recall-Associated Foodborne Disease Outbreaks in the United States, 2009-2019.

Earlier identification and removal of contaminated food products is crucial in reducing economic burdens of foodborne outbreaks. Recalls are a safety measure that is deployed to prevent foodborne illnesses. However, few studies have examined temporal trends in recalls or compared risk factors between non-recall and recall outbreaks in the United States, due to disparate and often incomplete surveillance records in publicly reported data. We demonstrated the usability of the electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS) for describing temporal trends and outbreak risk factors of food recalls in 1998−2019. We examined monthly trends between surveillance systems by using segmented time-series analyses. We compared the risk factors (e.g., multistate outbreak, contamination supply chain stage, pathogen etiology, and food products) of recalls and non-recalls by using logistic regression models. Out of 22,972 outbreaks, 305 (1.3%) resulted in recalls and 9378 (41%) had missing recall information. However, outbreaks with missing recall information decreased at an accelerating rate of ~25%/month in 2004−2009 and at a decelerating rate of ~13%/month after the transition from eFORS to NORS in 2009−2019. Irrespective of the contaminant etiology, multistate outbreaks according to the residence of ill persons had odds 11.00−13.50 times (7.00, 21.60) that of single-state outbreaks resulting in a recall (p < 0.001) when controlling for all risk factors. Electronic reporting has improved the availability of food recall data, yet retrospective investigations of historical records are needed. The investigation of recalls enhances public health professionals' understanding of their annual financial burden and improves outbreak prediction analytics to reduce the likelihood and severity of recalls.

Gender Typicality, Pressure to Conform to Gender Norms, and Anti-Fat and Appearance Stereotypes in Girls.

This mixed-methods study investigated the relation among gender identity (i.e., self-perceived gender similarity to girls and boys; self-perceived parental and peer pressure to conform to gender norms) and stereotyping about weight (i.e., anti-fat stereotypes), weight change, and appearance in 83 girls ages 6-9 (Mage = 7.60 years, SD = .85; 65% White, 16% Mixed/Other, 11% Black, 8% Latina) in the U.S. Stereotypes about weight change were assessed with open-ended responses (i.e., qualitatively), and the rest of the constructs were assessed with closed-ended responses (i.e., quantitatively). There was a positive association between pressure from parents to conform to gender norms and appearance stereotypes, and between pressure from peers and negative stereotypes about the fat and thin figures. Girls who were more gender typical, or more similar to girls, were more likely to endorse appearance stereotypes. There was no significant relation among stereotypes about weight change and gender identity. Many girls deemed the fat figure as unattractive, physically restrained, unhealthy, and likely to be bullied and believed that the fat figure should change back to look like a thinner figure. Most girls were aware that exercising, eating healthy, and dietary restriction can lead to weight loss and that food consumption and lack of exercise can lead to weight gain. Findings suggest that certain aspects of weight (anti-fat) and appearance stereotypes are closely linked to gender identity in girls, whereas other aspects of weight stereotypes (e.g., stereotypes about weight change) are so pervasive that they are common in most girls, regardless of their gender identity.

Evaluating Completeness of Foodborne Outbreak Reporting in the United States, 1998-2019.

Public health agencies routinely collect time-referenced records to describe and compare foodborne outbreak characteristics. Few studies provide comprehensive metadata to inform researchers of data limitations prior to conducting statistical modeling. We described the completeness of 103 variables for 22,792 outbreaks publicly reported by the United States Centers for Disease Control and Prevention's (US CDC's) electronic Foodborne Outbreak Reporting System (eFORS) and National Outbreak Reporting System (NORS). We compared monthly trends of completeness during eFORS (1998−2008) and NORS (2009−2019) reporting periods using segmented time series analyses adjusted for seasonality. We quantified the overall, annual, and monthly completeness as the percentage of outbreaks with blank records per our study period, calendar year, and study month, respectively. We found that outbreaks of unknown genus (n = 7401), Norovirus (n = 6414), Salmonella (n = 2872), Clostridium (n = 944), and multiple genera (n = 779) accounted for 80.77% of all outbreaks. However, crude completeness ranged from 46.06% to 60.19% across the 103 variables assessed. Variables with the lowest crude completeness (ranging 3.32−6.98%) included pathogen, specimen etiological testing, and secondary transmission traceback information. Variables with low (<35%) average monthly completeness during eFORS increased by 0.33−0.40%/month after transitioning to NORS, most likely due to the expansion of surveillance capacity and coverage within the new reporting system. Examining completeness metrics in outbreak surveillance systems provides essential information on the availability of data for public reuse. These metadata offer important insights for public health statisticians and modelers to precisely monitor and track the geographic spread, event duration, and illness intensity of foodborne outbreaks.

Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station.

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation's whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City's (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city's overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital's opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

10 years after baby-friendly designation: breastfeeding rates continue to increase in a US neonatal intensive care unit.

BACKGROUND: Mothers of preterm and sick infants admitted to the neonatal intensive care unit (NICU) often encounter more difficulties with breastfeeding than mothers of healthy term newborns. The extent to which Baby-Friendly designation is associated with breastfeeding rates for NICU infants over time is unknown. OBJECTIVE: This study aimed to determine the rate of breastfeeding initiation and continuation in a US, inner-city, level 3 NICU 10 years after Baby-Friendly designation. METHODS: We compared the rate of breastfeeding initiation and continuation among breastfeeding-eligible mothers with infants admitted to the Boston Medical Center NICU in 1999 and 2009, using chi-square tests. RESULTS: Breastfeeding initiation increased from 74% in 1999 to 85% in 2009 (P = .04). Any breast milk at 2 weeks of age increased from 66% to 80% (P = .05), and exclusive breastfeeding at 2 weeks remained stable between 1999 and 2009. Breastfeeding initiation increased from 68% to 86% among black mothers from 1999 to 2009 (P = .01). CONCLUSION: Improvement in breastfeeding initiation and any breastfeeding at 2 weeks of age continued 10 years after Baby-Friendly designation among mothers with NICU infants in a US, inner-city, level 3 NICU.

Are you Baby-Friendly? Knowledge deficit among US maternity staff.

BACKGROUND: The Baby-Friendly Hospital Initiative began in 1991. In 2010, approximately 3% of United States (US) hospitals were Baby-Friendly certified. When collecting data for related studies, we noted that many maternity staff erroneously claimed their hospital was Baby-Friendly.™ OBJECTIVE: To determine whether maternity staff in US hospitals could accurately describe their institution's status with regard to Baby-Friendly certification. METHODS: In 2010-2011, we called all maternity hospitals in the US and asked to be connected to the maternity service. We then asked the person answering the maternity service phone: "Is your hospital a Baby-Friendly hospital?" and recorded the position of the respondent. RESULTS: We called 2974 hospitals, and received answers on Baby-Friendly status from 2851. According to the Baby-Friendly USA Website (http://www.babyfriendlyusa.org), 3% (75/2851) of these hospitals were Baby-Friendly. However, staff at 62% (1780/2851) stated their hospital was Baby-Friendly. Staff at 15% (424/2851) did not know what the caller meant by "Baby-Friendly hospital." Accuracy of knowledge varied dependent on the respondent's job title (P < .001). International Board Certified Lactation Consultants were most likely to be accurate, with 89% answering correctly. There was a strong positive correlation between the proportion of Baby-Friendly hospitals and the proportion of correct responses by state (r = 0.62, P < .001). CONCLUSION: Although the Baby-Friendly Hospital Initiative was established over 20 years ago, most US maternity staff responding to a telephone survey either incorrectly believed their hospital to be Baby-Friendly certified or were unaware of the meaning of "Baby-Friendly hospital."

Trends in US hospital distribution of industry-sponsored infant formula sample packs.

OBJECTIVE: To describe trends in the proportion of US hospitals that distribute industry-sponsored formula sample packs between 2007 and 2010. METHODS: This is a follow-up of a 2007 study. In 2007, we surveyed all 50 US states to determine the proportion of hospitals that distributed infant formula samples to new mothers. In 2010, we selected the 10 best-record and 10 worst-record states with regard to industry-sponsored formula sample-pack distribution in 2007. We called all hospitals in these 20 states and asked if the maternity service distributed a "formula company-sponsored diaper discharge bag" to new mothers. We also recorded the respondent's job title. RESULTS: We contacted 1239 hospitals in 20 states. In 2007, 14% of these hospitals were sample-pack-free. In 2010, 28% of the same hospitals were sample-pack-free; the proportion of sample-pack-free hospitals per state ranged from 0% (5 states) to 86% (Rhode Island). In the 10 best-record states, the weighted proportion of sample-pack-free hospitals increased by a mean difference of 18% between 2007 and 2010 (P < .0001). In the 10 worst-record states, the weighted proportion of sample-pack-free hospitals increased by a mean difference of 6% (P < .01). CONCLUSION: Most US hospitals continue to distribute industry-sponsored formula sample packs, but trends indicate a significant change in practice; increasing proportions of hospitals eliminate these packs. Change was more significant in states where higher proportions of hospitals had already eliminated packs in 2007.