Cross-Sector Monitoring and Evaluation Framework: Social, Economic, and Health Conditions Impacted During the COVID-19 Pandemic.

Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).

Menu labeling regulations and calories purchased at chain restaurants.

BACKGROUND: The federal menu labeling law will require chain restaurants to post caloric information on menus, but the impact of labeling is uncertain. PURPOSE: The goal of the current study was to examine the effect of menu labeling on calories purchased, and secondarily, to assess self-reported awareness and use of labels. DESIGN: Single-community pre-post-post cross-sectional study. Data were collected in 2008-2010 and analyzed in 2011-2012. SETTING/PARTICIPANTS: 50 sites from 10 chain restaurants in King County, Washington, selected through stratified, two-stage cluster random sampling. A total of 7325 customers participated. Eligibility criteria were: being an English speaker, aged ≥ 14 years, and having an itemized receipt. The study population was 59% male, 76% white non-Hispanic, and 53% aged<40 years. INTERVENTION: A regulation requiring chain restaurants to post calorie information on menus or menu boards was implemented. MAIN OUTCOME MEASURES: Mean number of calories purchased. RESULTS: No significant changes occurred between baseline and 4-6 months postregulation. Mean calories per purchase decreased from 908.5 to 870.4 at 18 months post-implementation (38 kcal, 95% CI=-76.9, 0.8, p=0.06) in food chains and from 154.3 to 132.1 (22 kcal, 95% CI=-35.8, -8.5, p=0.002) in coffee chains. Calories decreased in taco and coffee chains, but not in burger and sandwich establishments. They decreased more among women than men in coffee chains. Awareness of labels increased from 18.8% to 61.7% in food chains and from 4.4% to 30.0% in coffee chains (both p<0.001). Among customers seeing calorie information, the proportion using it (about one third) did not change substantially over time. After implementation, food chain customers using information purchased on average fewer calories compared to those seeing but not using (difference=143.2 kcal, p<0.001) and those not seeing (difference=135.5 kcal, p<0.001) such information. CONCLUSIONS: Mean calories per purchase decreased 18 months after implementation of menu labeling in some restaurant chains and among women but not men.

Nutrition-labeling regulation impacts on restaurant environments.

BACKGROUND: Recent attempts to improve the healthfulness of away-from-home eating include regulations requiring restaurants to post nutrition information. The impact of such regulations on restaurant environments is unknown. PURPOSE: To examine changes in restaurant environments from before to after nutrition-labeling regulation in a newly regulated county versus a nonregulated county. METHODS: Using the Nutrition Environment Measures Survey-Restaurant version audit, environments within the same quick-service chain restaurants were evaluated in King County (regulated) before and 6 and 18 months after regulation enforcement and in Multnomah County (nonregulated) restaurants over a 6-month period. Data were collected in 2008-2010 and analyses conducted in 2011. RESULTS: Overall availability of healthy options and facilitation of healthy eating did not increase differentially in King County versus Multnomah County restaurants aside from the substantial increase in onsite nutrition information posting in King County restaurants required by the new regulation. Barriers to healthful eating decreased in King County relative to Multnomah County restaurants, particularly in food-oriented establishments. King County restaurants demonstrated modest increases in signage that promotes healthy eating, although the frequency of such promotion remained low, and the availability of reduced portions decreased in these restaurants. The healthfulness of children's menus improved modestly over time, but not differentially by county. CONCLUSIONS: A restaurant nutrition-labeling regulation was accompanied by some, but not uniform, improvements in other aspects of restaurant environments in the regulated compared to the nonregulated county. Additional opportunities exist for improving the healthfulness of away-from-home eating beyond menu labeling.

Limited percentages of adults in Washington State meet the Dietary Guidelines for Americans recommended intakes of fruits and vegetables.

Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption.

The effect of age on transmission of 2009 pandemic influenza A (H1N1) in a camp and associated households.

BACKGROUND: A major portion of influenza disease burden during the 2009 pandemic was observed among young people. METHODS: We examined the effect of age on the transmission of influenza-like illness associated with the 2009 pandemic influenza A (H1N1) virus (pH1N1) for an April-May 2009 outbreak among youth-camp participants and household contacts in Washington State. RESULTS: An influenza-like illness attack rate of 51% was found among 96 camp participants. We observed a cabin secondary attack rate of 42% (95% confidence interval = 21%-66%) and a camp local reproductive number of 2.7 (1.7-4.1) for influenza-like illness among children (less than 18 years old). Among the 136 contacts in the 41 households with an influenza-like illness index case who attended the camp, the influenza-like illness secondary attack rate was 11% for children (5%-21%) and 4% for adults (2%-8%). The odds ratio for influenza-like illness among children versus adults was 3.1 (1.3-7.3). CONCLUSIONS: The strong age effect, combined with the low number of susceptible children per household (1.2), plausibly explains the lower-than-expected household secondary attack rate for influenza-like illness, illustrating the importance of other venues where children congregate for sustaining community transmission. Quantifying the effects of age on pH1N1 transmission is important for informing effective intervention strategies.

Area-based socioeconomic characteristics of industries at high risk for violence in the workplace.

This study examined socioeconomic factors associated with the presence of workplaces belonging to industries reported to be at high risk for worker homicide. The proportion of 2004 North Carolina workplaces in high-risk industries was computed following spatial linkage of individual workplaces to 2000 United States Census Block Groups (n = 3,925). Thirty census-derived socioeconomic variables (selected a priori as potentially predictive of violence) were summarized using exploratory factor analysis into poverty/deprivation, human/economic capital, and transience/instability. Multinomial logistic regression models indicate associations between higher proportion of workplaces belonging to high-risk industries and Block Groups with more poverty/deprivation or transience/instability and less human/economic capital. The relationship between human/economic capital and Block Groups proportion of high-risk industry workplaces was modified by levels of transience/instability. Community characteristics therefore contribute to the potential for workplace violence, and future research should continue to understand the relationship between social context and workplace violence risk.

Frequency and determinants of recommended workplace violence prevention measures.

PROBLEM: Limited information exists concerning adoption of workplace violence prevention measures by employers and the factors influencing their adoption. METHODS: A weighted sample of North Carolina workplaces (n=210) in operation January 1994 through March 1998 was used to estimate prevalence of 18 measures and identify community and workplace predictors of having >/=5 recommended measures. RESULTS: Location in a metropolitan area most strongly predicted presence of >/=5 administrative safety measures while a history of workplace violence and being in a high crime area were negatively associated. Belonging to an industry considered to be high-risk for workplace homicide was most strongly associated with having >/=5 environmental safety measures. DISCUSSION: Factors influencing high prevalence of violence prevention measures were related to business type, violence history, and location. Knowledge of factors influencing adoption of recommended workplace violence prevention measures can help tailor interventions to diverse industry settings. IMPACT ON INDUSTRY: An important contribution to the understanding and mitigation of workplace homicide is knowledge of the extent of implementation of recommended workplace violence prevention guidelines and factors influencing their adoption. Identifying factors that influence the prevalence and adoption of workplace violence safety interventions can help to tailor development of interventions to address the issue of workplace homicide across diverse industry settings.

Employer policies toward guns and the risk of homicide in the workplace.

This population-based case-control study of North Carolina workplaces evaluated the hypothesis that employers' policies allowing firearms in the workplace may increase workers' risk of homicide. Workplaces where guns were permitted were about 5 times as likely to experience a homicide as those where all weapons were prohibited (adjusted odds ratio=4.81; 95% confidence interval=1.70, 13.65). The association remained after adjustment for other risk factors. The findings suggest that policies allowing guns in the workplace might increase workers' risk of homicide.