Occupational fatalities among grounds maintenance workers in the United States (2016-2020).

BACKGROUND: In 2019, grounds maintenance work was ranked among the most dangerous jobs in the United States. The objective of this study was to provide a national profile of fatal injuries of grounds maintenance workers. METHODS: Data from the Census of Fatal Occupational Injuries and Current Population Survey were analyzed to determine grounds maintenance worker fatality rates and rate ratios during 2016-2020. RESULTS: During the 5-year study period, a total of 1064 deaths, or average fatality rate of 16.64 deaths per 100,000 full-time employees (FTEs) was identified in grounds maintenance workers compared to 3.52 deaths per 100,000 FTEs for all occupational worker deaths in the United States. The incidence rate ratio was 4.72 per 100,000 FTEs [95% CI: 4.44-5.02; p < 0.0001]. The primary events or exposures that led to work-related deaths were transportation incidents (28.0%), falls (27.3%), contact with objects and equipment (22.8%), and traumatic acute exposures to harmful substances or environments (17.9%). Black or African American workers had higher death rates, while Hispanic or Latino workers accounted for over one-third of all occupational-related fatalities. CONCLUSIONS: Each year, fatal work injury rates were consistently nearly five times higher among those employed in grounds maintenance work than all US worker fatalities. Wide-ranging safety intervention and prevention measures are needed to protect workers. Future research efforts should employ methods that include qualitative approaches to gain a better understanding of worker's perspectives and employer's operational work practices to mitigate risks that contribute to these high work-related fatalities.

Health Literacy Among Adults With Multiple Chronic Health Conditions.

Low health literacy (HL) is associated with poorer health outcomes. We examined HL among adults with multiple chronic conditions (CCs), using 2016 Behavioral Risk Factor Surveillance System data. Health literacy was measured by 3 subjective questions about difficulty with the following tasks: (1) obtaining health information or advice; (2) understanding spoken health information; and (3) understanding written health information. We estimated the prevalence of low HL (difficulty with ≥1 HL tasks) and used multiple logistic regression analysis to examine associations between HL and number of CCs. The prevalence of low HL was 13.8% overall and increased with the number of CCs from 10.6% among those with no CC to 24.7% among those with 3 or more CCs, with the latter having more than twice the adjusted odds of low HL compared with the former (adjusted odds ratio = 2.65; 95% confidence interval, 2.36-2.97). Efforts to improve HL in this population are needed.

Associations of Percent Body Fat and Motor Skill Development in Preschool-Aged Children: National Youth Fitness Survey.

Background: Body composition and motor skill development are important for the engagement in physical activity and healthy development of children. This study examined the associations between body composition and motor skill development in 3- to 5-year-old children. Methods: Data from preschool-aged children (N = 342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. Skinfold measurements (subscapular, calf, and triceps) were taken and percent body fat (%BF) was calculated using sex-specific equations. Lean muscle mass and fat mass were also calculated. Motor skill development was determined by the Test of Gross Motor Development-2nd Edition. Regression analyses were performed to determine the associations among %BF and locomotor skills, object control skills, and overall gross motor quotient (GMQ), controlling for sex, race, and poverty index ratio. Results: Most children were classified as with underweight/healthy weight (69%) and 31% were either with overweight or obesity. Average %BF was 17.02% ± 0.27%. The standard scores for locomotor skills, object control skills, and GMQ were 9.99 ± 0.16, 8.52 ± 0.14, and 95.57 ± 0.68, respectively. These scores were considered average. Regression analyses indicated that neither the %BF nor sum of skinfolds was associated with locomotor skills (ß = -0.07 ± 0.05, p = 0.63; ß = -0.03 ± 0.03, p = 0.22), object control skills (ß = 0.03 ± 0.04, p = 0.55; ß = 0.00 ± 0.02, p = 0.87), or GMQ (ß = -0.13 ± 0.28, p = 0.63; ß = -0.09 ± 0.14, p = 0.52). Furthermore, neither lean muscle mass nor fat mass was related with any motor skill measure (p > 0.05). Conclusions: Using different measures of body composition may provide additional insight into associations between obesity and motor skill development in preschool-aged children. Given the inconsistent findings in the literature, additional research is needed to elucidate these associations.

Influenza and Pneumonia Vaccinations among North Carolina Adults with Diabetes.

Objectives: In this study, we sought to elucidate the influenza and pneumonia vaccination practices of adults with diabetes in North Carolina. Methods: Using North Carolina Behavioral Risk Factor Surveillance System data, we examined 2011-2018 trend data and demographic and health factors (2014-2018) in influenza (influenza vaccine receipt in the past year among adults ages 18+ years) and pneumonia (lifetime pneumonia vaccination receipt for adults ages 65+ years) vaccination adherence. Results: Influenza and pneumonia vaccination adherence rates were consistently higher for adults with versus without diabetes and remained relatively stable over the study period for both groups. Among adults with diabetes, factors associated with higher influenza vaccination rates included non-Hispanic white race, age 65+ years, poorer health, having insurance, and being a non-smoker. Pneumonia vaccination rates among adults with diabetes were higher for non-Hispanic Whites and those in poorer health. Conclusions: Adults with diabetes may be more likely to receive influenza and pneumonia vaccinations compared to adults without diabetes, but these rates remain below recommended levels. African Americans, younger adults, those without health insurance and cigarette smokers are vulnerable to being non-compliant with vaccination recommendations that could reduce their risk of developing and suffering complications from these diseases.

Rural, Suburban, and Urban Differences in Chronic Pain and Coping Among Adults in North Carolina: 2018 Behavioral Risk Factor Surveillance System.

INTRODUCTION: Our study aimed to examine the prevalence of chronic pain, its severity, its causes, and coping mechanisms that are used by North Carolina adults in rural, suburban, and urban areas. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System's first chronic pain module in 2018, representing 3,598 respondents. Self-reported chronic pain was defined as the affirmative response to the question, "Do you suffer from any type of chronic pain, that is, pain that occurs constantly or flares up often?" We computed prevalence of chronic pain and use of coping mechanisms by rural, suburban, or urban residential status. We used multiple logistic regression to assess the association between chronic pain and residential location, adjusting for demographic characteristics, employment, and health insurance. RESULTS: In 2018, an estimated 27.5% (95% confidence interval [CI], 25.6%-29.3%) of North Carolina adults experienced chronic pain. Prevalence of chronic pain in rural areas (30.9%) and suburban areas (30.8%) was significantly higher, compared with urban areas (19.6%). Compared with urban residents with chronic pain, those with chronic pain in suburban areas (adjusted odds ratio [AOR], 0.44; 95% CI, 0.26-0.76) and in rural areas (AOR, 0.39; 95% CI, 0.24-0.65) were less likely to use nonmedication therapies (eg, acupuncture, physical therapy, yoga) and were less likely to use 3 or more types of chronic pain treatment (suburban AOR, 0.47; 95% CI, 0.25-0.88; rural AOR, 0.53; 95% CI, 0.29-0.95). CONCLUSION: Our results indicate that persons living in rural and suburban areas may be more likely to have chronic pain and less likely to use nonmedication treatments than those in urban areas.

Tracking Trends in the Opioid Epidemic in North Carolina : Early Results from the Opioid Action Plan Metrics.

BACKGROUND Deaths from unintentional opioid overdose have increased markedly over the last decade in North Carolina. In 2017 the state created a North Carolina Opioid Action Plan, which laid out a multisectoral response to the crisis that included the medical community, law enforcement, emergency medical services, and treatment professionals. It also created a website providing county-level data associated with the crisis. Using this publicly available data, we examine trends and associations between opioid-related mortality and strategies to reduce opioid prescriptions, reduce fatality of overdose, and improve treatment and recovery.METHOD We examine yearly trends from 2010-2017 for statewide unintentional opioid-related death rates, prescription of opioid pills, buprenorphine prescription rates, naloxone administrations, and number of Certified Peer Support Specialists. We compare recent opioid-related death rates for 2015-2017 with an earlier period (2010-2012) at the county level, and examine the association between death rates and rates of the supply, treatment, and recovery metrics.RESULTS Trends for all metrics increased from 2010-2017, although the number of opioid pills per capita has declined since 2015. Between 2010 and 2017, 84 of the state's 100 counties experienced an increase in opioid-related mortality. County-level mortality was positively associated with opioid prescription rate (r = +0.12, P = 0.24) and with naloxone administrations (r = +0.20, P = 0.05). Prescription of buprenorphine was associated with a reduction in opioid mortality (r = -0.27, P = 0.01). The effect of Certified Peer Support Specialists was not discernable.LIMITATIONS Data are available for only eight years and aggregated at the county level. Mortality data are based on death certificates using ICD-10 codes from the North Carolina State Center for Health Statistics, Vital Statistics, which may not capture all opioid-related fatalities. Drug-related deaths may involve multiple non-opioid substances; in addition, determining the intent of the deceased individual may be difficult (suicide versus unintentional). Naloxone administration data only includes data from emergency medical services, not community-administered naloxone, because that data was only available for 2013 and later and is based only on self-reports.CONCLUSIONS The potential efficacy of buprenorphine is promising and should be further explored. All interventions should be monitored.

Self-reported Health Literacy Among North Carolina Adults and Associations with Health Status and Chronic Health Conditions.

BACKGROUND Low health literacy is a recognized contributor to health disparities. Significant proportions of the adult population, especially the underserved, have low health literacy. The purpose of this study was to examine health literacy and its associations with health status and chronic health conditions among North Carolina adults.METHODS The 2016 North Carolina Behavioral Risk Factor Surveillance System included health literacy questions that focused on accessing and understanding health information. Using these self-reported data, we estimated the prevalence of low health literacy and assessed its associations with general health status and chronic health conditions after adjusting for sociodemographic characteristics and health care access.RESULTS Overall, 4.8% of adults reported having difficulty getting health information or advice, 7.5% understanding oral information from health professionals, and 8.3% understanding written health information; 14.8% reported having difficulty with at least one of these tasks. The adjusted odds of low health literacy were moderately higher for those who had been diagnosed with the following conditions compared to those not diagnosed: heart attack, coronary heart disease, or stroke (AOR = 1.81, 95% CI=1.33, 2.47); COPD (AOR = 1.67, 95% CI = 1.19, 2.34); arthritis (AOR = 1.68, 95% CI = 1.32, 2.15); depression (AOR = 1.95, 95% CI=1.52, 2.50); and kidney disease (AOR = 1.62, 95% CI = 1.02, 2.60).LIMITATIONS All data were self-reported.CONCLUSIONS A notable segment of the North Carolina adult population has low health literacy, and those who do are particularly vulnerable to adverse health status. Targeted efforts are needed to identify strategies to improve health literacy and decrease health disparities.

Adverse childhood experiences and mental health in adulthood: Evidence from North Carolina.

BACKGROUND: About 1.4 million adults in North Carolina (NC) have mental illnesses. Many get no treatment because of mental health care provider shortages. Necessary prevention requires identification of covariates of mental illness. STUDY OBJECTIVE: We tested the hypotheses: There is no difference in adulthood mental health of the ACE-affected and the unaffected; ACEs do not significantly predict adulthood mental health. METHODS: ACEs studied were: living with a mentally ill person, an alcoholic, or drug abuser; witnessing violence; having divorced or unmarried parents; and being physically, mentally or sexually abused. We used data from 2012 and 2014 NC Behavioral Risk Factor Surveillance System. We had 19,187 observations with about 13,900 including ACE data. We conducted t- and χ2 tests of mental health differences between ACE-affected and unaffected and regression analysis to determine mental health predictors. RESULTS: ACE distribution was: 26.2% had parents or adults swearing at- or insulting them; 25% had divorced or unmarried parents; 22.6% lived with an alcoholic; 15.7% witnessed their parents beat each other; 13.8% lived with a mentally ill person; and 13.6% were hit or beaten by an adult in the home. Respondents also reported being touched sexually (9.4%); living with an adult who abused drugs (7.9%); and 4.1% were forced to have sex. The ACE-affected experienced significantly (p < 0.001) more days of poor mental health and had a higher likelihood of depression diagnosis than the unaffected. ACEs are statistically significant predictors of poor mental health in adulthood.

Physical activity types and motor skills in 3-5-year old children: National Youth Fitness Survey.

OBJECTIVE: This study examined relationships between specific types of physical activity (PA) and motor skill development in preschool-aged children. DESIGN: This study was completed using a cross-sectional study design. METHODS: Data from children 3-5years old (N=342, 51% males) who participated in the 2012 National Youth Fitness Survey were analyzed. PA was measured using a questionnaire by parent report and motor skill development determined by Test of Gross Motor Development-2nd Edition (TGMD-2). Multiple regression analyses were conducted to examine the relationship between PA type and overall Gross Motor Quotient (GMQ) controlling for age, sex, race, and parental socioeconomic status. RESULTS: Commonly reported activities were running (43%), playing outdoor games (35%), and riding a bike (34%). Based on the standard scores, participants' motor skill development for Locomotor, Object Control, and overall GMQ were considered average. Participation in the following physical activities were positively associated with GMQ: riding a bike (ß (SE)=5.27 (2.02), p=0.02), scooter riding (ß (SE)=9.83 (2.59), p=0.002), swimming (ß (SE)=4.01 (1.17), p=0.004), and jumping on a trampoline (ß (SE)=7.45 (3.09), p=0.03). With the exception of riding a bike, the physical activities positively related to GMQ had a reported range of participation between 7-12%. CONCLUSIONS: Participation in specific physical activities was related to higher GMQ in preschool-aged children. Also, with the exception of riding a bike, the activities that the children participated in the most were not the same as the activities that were positively related to motor skill development.

Increased Mortality and Health Risk Behaviors of Midlife White North Carolinians: A Marked Contrast to Nonwhites.

BACKGROUND Death rates for white, middle-aged Americans are increasing after decades of steady decline. In this paper, mortality and health behavior trends are examined for midlife North Carolinians.METHODS Mortality rates were calculated for midlife whites from 2000 to 2013 for the state as a whole and in counties grouped by level of economic distress. Trend lines were used to estimate future death rates, and comparisons were made to rates for nonwhites. Current and past health risk behaviors were also analyzed.RESULTS The all-cause mortality rate for midlife whites in North Carolina was higher than the 2000 base in 11 of 13 years; white midlife mortality increased by 5.9%. In contrast, nonwhite mortality decreased by 30.6%. By 2020, midlife mortality for whites is predicted to increase by 9.1%; for nonwhites, there is a predicted decrease of 47.2%. Midlife white mortality increased most in economically distressed counties. Major contributors were suicide and liver disease. Risk factors that increased were drinking, obesity, and lack of health insurance.LIMITATIONS Mortality and risk factor data could not be analayzed by ethnicity. Deaths due to drug and alcohol poisoning were not included.CONCLUSIONS The statewide mortality rate for midlife whites in North Carolina is increasing and is in marked contrast to the decreasing rate for nonwhites. The racial disparity in this metric is likely to be eliminated by 2020, perhaps even reversed. Midlife white mortality increased most dramatically in the state's poorest counties. Policymakers should consider links between economic issues and health behaviors involved in midlife mortality and why they may affect whites and nonwhites differently.

Does Pregnancy Increase Use and Awareness of Nutrition Information in Food Labels?

Objectives This study aims to examine food label use, specific reading behaviors and the awareness of dietary recommendations among U.S. pregnant women in comparison to non-pregnant women. Methods A cross-sectional data analysis was conducted using a representative national sample of U.S. women aged 16 to 44 years from the National Health and Nutrition Examination Survey 2005-2006 (n = 1875). Food label users were defined as woman who used the Nutrition Facts panel when making a food choice in the frequency of always, most of the time, or sometimes. Pregnancy status was assessed in relation to food label use, specific reading behaviors and the awareness of dietary recommendations by conducting hierarchical multivariable logistic regression models including covariates of SES and perceived health and weight variables. Results The prevalence of using food labels at purchase greatly differs by SES, perceived health and weight variables, and awareness of dietary recommendations but not by pregnancy: 68.6% of pregnant and 66.1% of non-pregnant women used food labels in the U.S. However, after controlling for SES and perceived health and weight status, pregnant women are more likely to read food labels than their counterparts (OR = 1.43, 95% CI = 1.07-1.89). Pregnant women were less likely to check cholesterol (OR = 0.58, 95% CI = 0.44-0.77) and calories from fat content (OR = 0.61, 95% CI = 0.42-0.89), after adjusting for SES variables. Pregnant women may not have a higher awareness of dietary recommendations compared to non-pregnant women in the U.S. Conclusions While pregnancy itself is a factor that appears to encourage the reading of food labels, pregnancy does not encourage positive reading behaviors. The findings suggest a great need for prenatal nutrition education programs in the U.S.

Oral Health in North Carolina: Relationship With General Health and Behavioral Risk Factors.

BACKGROUND: Oral health is an integral part of general health, and loss of teeth may affect both physical and mental health. We examined how an individual's perception of his or her general health is related to oral care and loss of teeth, as well as how socioeconomic and behavioral factors are related to loss of teeth and oral care. METHODS: Logistic regression was used to analyze data from the North Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey to investigate how oral health relates to general health. We examined the effects of loss of teeth and recency of dental clinic visits on perceived general health; we also examined the effects of demographic characteristics and health-related behavioral risk factors on oral health. RESULTS: Adults who had lost 6 or more teeth were more likely to report poor or fair general health, especially among those who were younger than 65 years (adjusted odds ratio = 3.59) compared to those who were 65 years or older (adjusted odds ratio = 1.87). Those who had not visited a dentist within the past year, those who had less education, those with lower incomes, and smokers were more likely to have lost 6 or more teeth. LIMITATIONS: BRFSS is a large-scale survey that collects self-reported data using random telephone methods; during the years included in this analysis, the sample included only households with landline phones that answered the survey. The measure of general health is subjective. As the BRFSS survey is a cross-sectional survey, causal relationships cannot be established. CONCLUSIONS: Loss of teeth and poor oral care are significant predictors of poor general health, indicating that oral health and oral care are integral parts of general health. Loss of teeth and oral care are affected by demographic factors such as educational attainment, income, and health-related risk factors.

Biogas production using anaerobic groundwater containing a subterranean microbial community associated with the accretionary prism.

In a deep aquifer associated with an accretionary prism, significant methane (CH4) is produced by a subterranean microbial community. Here, we developed bioreactors for producing CH4 and hydrogen (H2) using anaerobic groundwater collected from the deep aquifer. To generate CH4, the anaerobic groundwater amended with organic substrates was incubated in the bioreactor. At first, H2 was detected and accumulated in the gas phase of the bioreactor. After the H2 decreased, rapid CH4 production was observed. Phylogenetic analysis targeting 16S rRNA genes revealed that the H2 -producing fermentative bacterium and hydrogenotrophic methanogen were predominant in the reactor. The results suggested that syntrophic biodegradation of organic substrates by the H2 -producing fermentative bacterium and the hydrogenotrophic methanogen contributed to the CH4 production. For H2 production, the anaerobic groundwater, amended with organic substrates and an inhibitor of methanogens (2-bromoethanesulfonate), was incubated in a bioreactor. After incubation for 24 h, H2 was detected from the gas phase of the bioreactor and accumulated. Bacterial 16S rRNA gene analysis suggested the dominance of the H2 -producing fermentative bacterium in the reactor. Our study demonstrated a simple and rapid CH4 and H2 production utilizing anaerobic groundwater containing an active subterranean microbial community.

Development and validation of a tool for assessing glucose impairment in adolescents.

INTRODUCTION: Childhood obesity is associated with an increased risk for type 2 diabetes. Early identification of adolescents at risk for impaired fasting glucose may lead to earlier and more comprehensive evaluation and intervention. Because widespread glucose testing of adolescents is not recommended, community-based tools are needed to identify those who could benefit from further testing. One such tool, developed for adults, was the Tool for Assessing Glucose ImpairmenT (TAG-IT). Our objective was to validate whether a similar tool could be useful for community-based screening of glucose impairment risk among adolescents. METHODS: Our study sample consisted of 3,050 adolescents aged 12 to 18 years who had participated in the 1999-2008 National Health and Nutrition Examination Survey (NHANES). Half of participants were female and 40% were nonwhite. NHANES measured fasting glucose and height, weight, and resting heart rate. We used Pearson correlations and regression analysis to determine key variables for predicting glucose impairment. From these measurements, we created a composite TAG-IT score for adolescents called TAG-IT-A. We then applied the TAG-IT-A model to 1988-1994 NHANES data, using linear regression analysis and receiver operating characteristic analysis to determine how well the TAG-IT-A score predicted a fasting glucose at or above 100 mg/dL. RESULTS: We determined that age, sex, body mass index, and resting heart rate were important predictors of impaired fasting glucose and that TAG-IT-A was a better predictor of impaired fasting glucose than body mass index alone (area under the curve, 0.61, P < .001 vs 0.55, P = .10, respectively). A TAG-IT-A score of 3 or higher correctly identified 50% of adolescents with impaired fasting glucose, while a score of 5 or higher correctly identified 76%. CONCLUSION: The TAG-IT-A score is a simple screening tool that clinicians and public health professionals could use to easily identify adolescents who may have impaired fasting glucose and need a more comprehensive evaluation.

Effects of outdoor housing of piglets on behavior, stress reaction and meat characteristics.

Well-designed housing systems are important from the viewpoint of animal welfare and improvement of meat production. In this study, we investigated the effects of outdoor housing of pigs on their behavior, cortisol levels, and meat characteristics. Two groups that were born and raised in a spacious outdoor pen (4×10 m for every two sows) or a minimum-sized standard pen in a piggery (1.9×2.2 m for every sow) were studied. When their behaviors at the age of 2 to 3 wk were observed, the number of rooting episodes tended to be larger (p = 0.0509) and the total time of rooting tended to be longer (p = 0.0640) in the outdoor-housed piglets although the difference was not significant. Basal salivary cortisol levels of the outdoor piglets at the age of 4 wk were significantly lower than those of the indoor piglets (5.0±0.59 ng/ml vs. 11.6±0.91 ng/ml, 30 min after treatment), although their plasma cortisol levels were similar (53.3±3.54 ng/ml vs. 59.9±4.84 ng/ml, 30 min after treatment). When the ears were pierced at weaning, plasma and salivary cortisol levels were increased in both groups, even at 15 min after piercing. However, the increase in the outdoor-housed group was significantly less than that in the indoor-housed group. Throughout their lives, body weight and daily gain of the pigs were not significantly different between the two groups. In a meat taste preference test taken by 20 panelists, saltiness, flavor, and color of the outdoor-housed pork were found to be more acceptable. Moreover, when an electronic taste-sensing device was utilized, the C00 and CPA-C00 outputs (3.78±0.07 and -0.20±0.023), which correspond to compounds of bitterness and smells, respectively, were significantly lower in the outdoor-housed pork (5.03±0.16 and -0.13±0.009). Our results demonstrate that the outdoor housing system for piglets induces natural behaviors such as rooting and suppresses the strongest stress reaction of piglets, which could be important for animal welfare. Moreover, the outdoor housing system might change muscle characteristics and improve pork bitterness, flavor, and color. These changes may be preferred by consumers, increasing the sale of these meats.

Associations between natural amenities, physical activity, and body mass index in 100 North Carolina counties.

PURPOSE: To examine associations between county-level natural amenities, physical activity (PA), and body mass index (BMI). DESIGN AND SETTING: Cross-sectional study among 100 North Carolina counties. MEASURES: We obtained percentage of county residents meeting PA criteria and county-wide means for reported height and weight from the North Carolina Behavioral Risk Factor Surveillance System, combining years 2003, 2005, and 2007. The county natural amenities scale was the independent variable. Potential county-level covariates were percentage rural, percentage black, median age, and median household income (Census 2000). ANALYSIS: We conducted weighted bivariate and linear regression analyses to examine relationships between natural amenities, aggregate PA, and aggregate BMI. RESULTS: BMI and natural amenities were negatively associated (parameter estimate  =  -.13 (.06), p  =  .03). When percentage meeting PA criteria was included, the parameter estimate attenuated 15%. CONCLUSION: There was an inverse relationship between natural amenities and BMI, partially mediated by PA.

Measuring the retail food environment in rural and urban North Carolina counties.

BACKGROUND: Development of accurate and sensitive methods to characterize the food environment is needed. Thus, we examined convergent and criterion validity of 2 retail food environment data sources and then examined differences in predictive validity between 3 ways of measuring the rural and urban food environment. METHODS: Ten counties were selected in each of 3 North Carolina regions (n = 30). Number of fast-food restaurants and chain supermarkets were calculated using 2 data sources. Convergent validity was percent agreement between the 2 sources. Criterion validity was percent agreement between each source and the most accurate venue count. Predictive validity of food environment measures (Retail Food Environment Index, fast-food restaurants/capita, and supermarkets/capita) was calculated by associations with county-level mean-weighted body mass index (BMI). RESULTS: Percent agreement for fast-food restaurants ranged from 50% to 100% (mean = 87%) and for supermarkets ranged from 58% to 100% (mean = 89%). The 2 data sources had similar percent agreement with the most accurate count. Retail Food Environment Index was positively associated with BMI, while fast-food restaurants per capita were negatively associated with BMI. CONCLUSIONS: Our results lend support to studies using both food environment data sources examined.

Fitness versus Fatness and Insulin Resistance in U.S. Adolescents.

Background. The present study examined the relationship between insulin resistance and both waist circumference and cardiorespiratory fitness in U.S. adolescents. Methods. NHANES assessed a nationally representative sample of U.S. adolescents (12-18 yrs) between 1999-2002. Abdominal adiposity was estimated by waist circumference, overall adiposity by BMI, and cardiorespiratory fitness (maximal oxygen uptake (VO(2)max) from a treadmill exercise test). Insulin resistance was estimated from fasting insulin and glucose using the homeostatic model assessment method (i.e., HOMA) and was log-transformed. Results. 1078 adolescents were included in the study. Positive correlations existed between lnHOMA and waist circumference (r = 0.59; r = 0.54) for boys and girls, respectively. lnHOMA and VO(2)max were inversely related in boys (r = -0.29) but not girls (r = -0.06). Gender-specific analyses by BMI category showed that the significant inverse relationship in lnHOMA and VO(2)max was primarily present in obese boys. Conclusion. Among adolescents, important gender and BMI differences exist in the relationship between insulin resistance and fitness. While waist circumference and BMI are important predictors in all children, fitness appears especially important in obese boys. These findings may have important implications for gender-specific interventions to prevent adult obesity and diabetes mellitus.

Disparities in motor vehicle crash fatalities of young drivers in North Carolina.

BACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of death for young people, but rates based on the general population do not account for differences in risk across groups as proportions of people driving vary. We examine disparities in MVC death rates for various demographic groups based on numbers of drivers in each group. METHODS: North Carolina driver license holders 16 through 24 years of age are determined. Fatality rates per population and per licensed driver are calculated and compared by age, gender, race/ethnicity, and region. RESULTS: Proportions of individuals holding a license vary substantially by age, race/ethnicity, and region. Eighty-three percent of young Whites hold licenses compared to 68% of Hispanics, 55% of African Americans, and 52% of Native Americans. Substantial disparities in fatality by race/ethnicity and age exist using a rate per licensed driver. In younger age groups, fatality rates per licensed drivers are much greater than rates per population: 300%, 200%, 50%, and 25% greater for 16, 17, 18, and 19-year-olds, respectively. African Americans have the lowest fatality rate per population, but their rate per driver is equal to that of Whites. The rate for Native Americans is 2.2 times greater than Whites; for Hispanics, 1.5 times greater. Disparities are 20%-60% greater when rates per driver are used. LIMITATIONS: Potential misspecification of race and ethnicity in records, inability to count unlicensed drivers, and exclusion of those with learner's permits may unequally bias rates across subgroups. CONCLUSIONS: Significant disparities are revealed using a rate based on number of drivers. Policy makers and physicians should tailor prevention efforts accordingly.

Lexical frequency and neighborhood density effects on the recognition of native and Spanish-accented words by native English and Spanish listeners.

This study examined the effect of presumed mismatches between speech input and the phonological representations of English words by native speakers of English (NE) and Spanish (NS). The English test words, which were produced by a NE speaker and a NS speaker, varied orthogonally in lexical frequency and neighborhood density and were presented to NE listeners and to NS listeners who differed in English pronunciation proficiency. It was hypothesized that mismatches between phonological representations and speech input would impair word recognition, especially for items from dense lexical neighborhoods which are phonologically similar to many other words and require finer sound discrimination. Further, it was assumed that L2 phonological representations would change with L2 proficiency. The results showed the expected mismatch effect only for words from dense neighborhoods. For Spanish-accented stimuli, the NS groups recognized more words from dense neighborhoods than the NE group did. For native-produced stimuli, the low-proficiency NS group recognized fewer words than the other two groups. The-high proficiency NS participants' performance was as good as the NE group's for words from sparse neighborhoods, but not for words from dense neighborhoods. These results are discussed in relation to the development of phonological representations of L2 words. (200 words).