1
|
Jones SE, Brener ND, Queen B, Hershey-Arista M, Harris W, Underwood JM. Reliability of the 2020 School Health Profiles Principal and Lead Health Education Teacher Questionnaires. J Sch Health 2024; 94:395-405. [PMID: 38278775 DOI: 10.1111/josh.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND School Health Profiles assesses school health policies and practices among US secondary schools. METHODS The 2020 School Health Profiles principal and teacher questionnaires were used for a test-retest reliability study. Cohen's kappa coefficients tested the agreement in dichotomous responses to each questionnaire variable at 2 time points. The aggregate prevalence estimates between time 1 and time 2 were compared for each questionnaire item via overlapping 95% confidence intervals. Chi-square tests examined whether the prevalence at time 2 differed between paper and web administration for both questionnaires. RESULTS For the principal (N = 50) and teacher (N = 34) data, there were no significant differences in the prevalence of any items between time 1 and time 2. For the principal survey, the mean kappa for 191 variables was 0.49. For the teacher survey, the mean kappa for 260 variables was 0.65. Overall, 60.7% of principal and 91.1% of teacher questionnaire items had at least "moderate" reliability. CONCLUSIONS School Health Profiles offers education and health agencies a reliable tool to monitor school policies and practices.
Collapse
Affiliation(s)
- Sherry Everett Jones
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, MS S107-6, Chamblee, GA, 30341
| | - Nancy D Brener
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, MS S107-6, Chamblee, GA, 30341
| | | | | | - William Harris
- Contractor to General Dynamics information Technology | Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, MS S107-6, Chamblee, GA 30341, Atlanta, GA, 30341
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, MS S107-6, Chamblee, GA, 30341
| |
Collapse
|
2
|
Brener N, Underwood JM, Mpofu J. New Online Tool From the Centers for Disease Control and Prevention Tracks School Health Policies and Practices. J Adolesc Health 2024; 74:634-636. [PMID: 38323961 PMCID: PMC11022274 DOI: 10.1016/j.jadohealth.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Nancy Brener
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Jonetta Mpofu
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| |
Collapse
|
3
|
Jones SE, Brener ND, Queen B, Hershey-Arista M, Harris WA, Mpofu JJ, Underwood JM. Reliability of the 2021 National Youth Risk Behavior Survey Questionnaire. Am J Health Promot 2024:8901171241239735. [PMID: 38491956 DOI: 10.1177/08901171241239735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
PURPOSE The Youth Risk Behavior Survey (YRBS) monitors behaviors, experiences, and conditions affecting the health of high school students nationwide. This study examined the test-retest reliability of the 2021 national YRBS questionnaire. DESIGN Respondents completed a Time 1 and Time 2 paper-and-pencil questionnaire approximately 2 weeks apart during February to May 2022. Data were linked in such a way as to preserve anonymity. SETTING Convenience sample of high schools. SUBJECTS High school students (N = 588). MEASURES Health risk behaviors and experiences assessed on the 2021 national YRBS questionnaire. ANALYSIS Time 1 and Time 2 responses were compared for each questionnaire item using the McNemar's test. Then, Cohen's kappa coefficients tested the agreement between Time 1 and Time 2 responses overall, and by sex, grade, and Black, White, and Hispanic race and ethnicity. RESULTS Among the 74 items analyzed, 96% had at least moderate reliability, and 73% had substantial or almost perfect reliability. The mean Cohen's kappa was .68. McNemar's test findings showed Time 1 and Time 2 data significantly differed (P < .01) for 9 items (12%). CONCLUSION Reliable health behavior measures are important in the development of youth-focused public health programs and policies. Findings suggest the national YRBS questionnaire is a reliable instrument. Such findings lend support to relying on adolescent self-reported data when monitoring health behaviors using the YRBS.
Collapse
Affiliation(s)
- Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nancy D Brener
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - William A Harris
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonetta J Mpofu
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
4
|
Swaminath M, Clayton HB, Lowry R, Hertz MF, Underwood JM. Health-Risk Behaviors and Experiences Among Asian American and Native Hawaiian/Pacific Islander Adolescents in the United States, 2011-2019. Public Health Rep 2023; 138:925-935. [PMID: 36633365 PMCID: PMC10576474 DOI: 10.1177/00333549221137325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Understanding the health-risk behaviors of racial and ethnic groups when disaggregated is an important step in improving the health outcomes of racial and ethnic minority groups. We compared national prevalence estimates for selected health-risk behaviors and experiences of Asian American and Native Hawaiian/Pacific Islander (NHPI) students with those of non-Hispanic White, non-Hispanic Black, and Hispanic students. METHODS We analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of US high school students. To generate a sufficient sample of Asian American and NHPI students for analyses, we combined data from 5 survey administrations, conducted in 2011, 2013, 2015, 2017, and 2019 (N = 73 074). We calculated the prevalence and 95% CIs; we analyzed data on Asian American and NHPI adolescents separately to unmask important differences. RESULTS Compared with students of other races and ethnicities, Asian American students had the lowest prevalence of alcohol use (16.7%) and marijuana use (10.3%). In contrast, NHPI students were more likely than Asian American students to participate in several health-risk behaviors and experiences, such as substance use (ranging from 4.8% for ever injecting an illegal drug to 31.5% for current alcohol use), having been in a physical fight (15.4%), and having been threatened or injured with a weapon (11.6%). Differential patterns in the prevalence of ever having missed school due to feeling unsafe among NHPI and Asian American students were observed among male and female students. CONCLUSION Further disaggregating racial subgroups within broad categories of Asian American and NHPI populations may reveal differences from overall group prevalence, and additional strategies to identify these differences should be investigated.
Collapse
Affiliation(s)
- Meera Swaminath
- Department of Family Medicine and Public Health, University of California–San Diego, La Jolla, CA, USA
- Public Health Leader Fellowship Program, Morehouse College, Atlanta, GA, USA
| | - Heather B. Clayton
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Lowry
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marci F. Hertz
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J. Michael Underwood
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
5
|
McKinnon II, Krause KH, Robin L, King A, Leon-Nguyen M, Zavala E, Suarez NA, Lim C, Smith-Grant J, Underwood JM. Experiences of Unstable Housing Among High School Students - Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023; 72:29-36. [PMID: 37104394 PMCID: PMC10156156 DOI: 10.15585/mmwr.su7201a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Youths experiencing unstable housing face higher risks for poor physical, mental, and sexual health outcomes and increased risk for suicide compared with their peers experiencing stable housing. In addition, youths of color and sexual minority youths are disproportionately more likely to experience homelessness. For the first time, in 2021, the nationally representative Youth Risk Behavior Survey included an item assessing housing stability, or nighttime residence among students in grades 9-12 in the United States. During 2021, 2.7% of U.S. high school students experienced unstable housing. Among racial and ethnic subgroups, Native Hawaiian or other Pacific Islander youths were most likely to experience unstable housing, followed by American Indian or Alaska Native and Black youths. Sexual minority (lesbian, gay, bisexual, and questioning or other) youths were more likely to experience unstable housing compared with their heterosexual peers. Compared with students who were stably housed, students who were unstably housed were more likely to engage in risky sexual behaviors, substance use, and suicide ideation and attempts, and to experience violence. These findings highlight which adverse health risks and behaviors are elevated among youths experiencing housing insecurity. Focused public health interventions are required to address the disproportionate burden of health risks prevalent among youths who are unstably housed.
Collapse
|
6
|
Mpofu JJ, Underwood JM, Thornton JE, Brener ND, Rico A, Kilmer G, Harris WA, Leon-Nguyen M, Chyen D, Lim C, Mbaka CK, Smith-Grant J, Whittle L, Jones SE, Krause KH, Li J, Shanklin SL, McKinnon I, Arrey L, Queen BE, Roberts AM. Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021. MMWR Suppl 2023; 72:1-12. [PMID: 37104281 PMCID: PMC10156160 DOI: 10.15585/mmwr.su7201a1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. In 2021, these surveys were conducted during the COVID-19 pandemic. The pandemic underscored the importance of data in understanding changes in youth risk behaviors and addressing the multifaceted public health needs of youths. This overview report describes 2021 YRBSS survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses. The 2021 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2021, in addition to the national YRBS, a total of 78 surveys were administered to high school students across the United States, representing the national population, 45 states, two tribal governments, three territories, and 28 local school districts. YRBSS data from 2021 provided the first opportunity since the onset of the COVID-19 pandemic to compare youth health behaviors using long-term public health surveillance. Approximately half of all student respondents represented racial and ethnic minority groups, and approximately one in four identified as lesbian, gay, bisexual, questioning, or other (a sexual identity other than heterosexual) (LGBQ+). These findings reflect shifts in youth demographics, with increased percentages of racial and ethnic minority and LGBQ+ youths compared with previous YRBSS cycles. Educators, parents, local decision makers, and other partners use YRBSS data to monitor health behavior trends, guide school health programs, and develop local and state policy. These and future data can be used in developing health equity strategies to address long-term disparities so that all youths can thrive in safe and supportive environments. This overview and methods report is one of 11 featured in this MMWR supplement. Each report is based on data collected using methods presented in this overview. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).
Collapse
|
7
|
Smith Grant J, Pierre K, Stinson J, Thornton J, Mpofu JJ, Rasberry CN, Sims VM, Underwood JM. The Increasing Utility of School Health Data to Guide Evidence-Based Interventions. J Sch Health 2022; 92:1214-1216. [PMID: 36320177 DOI: 10.1111/josh.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer Smith Grant
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kimberly Pierre
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joi Stinson
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jemekia Thornton
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonetta J Mpofu
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catherine N Rasberry
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Valerie M Sims
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - J Michael Underwood
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
8
|
Krause KH, Mpofu J, Brown M, Rico A, Andrews C, Underwood JM. At the Intersections: Examining Trends in Experiences of Violence, Mental Health Status, and Suicidal Risk Behaviors Among US High School Students Using Intersectionality, National Youth Risk Behavior Survey, 2015-2019. J Adolesc Health 2022; 71:293-300. [PMID: 35562300 DOI: 10.1016/j.jadohealth.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Surveillance data are used for public health action, but the practice of analyzing data by single demographic characteristics may produce findings that reflect abstract categories rather than a person's lived experience. Intersectionality is a theoretical framework that advocates for individuals to be recognized as the whole of their identity and within context of power structures. Using the national Youth Risk Behavior Survey 2015-2019, we examined 5-year trends in experiencing violence, poor mental health, and suicidal risk behavior among US high school students using intersections of race/ethnicity and sex. METHODS We used SUDAAN to calculate prevalence estimates and logistic regression models to assess for linear trends while accounting for the weighting and complex survey design. RESULTS Among all students in aggregate, experiencing dating violence decreased while being threatened with a weapon at school and feeling persistently sad or hopeless increased over time; however, these trends did not apply to most students when stratified by identity. The one near-universal experience was that students in aggregate and almost all identities had an increased trend of skipping school because they felt unsafe there. DISCUSSION By focusing on identities defined by two main drivers of health disparities-race/ethnicity and sex-we found that changes in risk behaviors did not occur equally among students and that prevalence estimates were highest among Black males, Black females, and Hispanic females. We outlined the power structures that frame the current educational environment. Patterns of health disparities can be highlighted by analyzing surveillance data through an intersectional lens.
Collapse
Affiliation(s)
- Kathleen H Krause
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jonetta Mpofu
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa Brown
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adriana Rico
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Courtni Andrews
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
9
|
Demissie Z, Ethier K, Williams K, Dunville R, Cavalier Y, Payne R, Underwood JM. Racial-ethnic disparities in adolescent sexual behaviours: the cross-sectional Youth Risk Behavior Survey, 2009-19. Sex Health 2022; 19:456-463. [PMID: 35919962 DOI: 10.1071/sh22007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are notable disparities by race/ethnicity in the sexual health of US adolescents and young adults. Our objective was to examine change over time in racial-ethnic disparities in sexual behaviours among US high school students. METHODS Data were analysed from six biennial cycles of the national Youth Risk Behavior Survey (2009-19), conducted among cross-sectional, nationally representative samples of 9th-12th grade students. Data were collected via self-administered questionnaires. Multivariable logistic regression models tested for linear trends by race/ethnicity (White, Black, Hispanic) and differences in these trends in: ever had sex, current sexual activity, having four or more lifetime sexual partners, and condomless sex. Prevalence ratios and risk differences by race/ethnicity for each cycle were used to calculate average percent change in the estimates to determine if health disparities changed over time. RESULTS During 2009-19, prevalence estimates for ever had sex, current sexual activity, and having four or more lifetime sexual partners decreased overall and across all racial-ethnic groups. For condomless sex, prevalence estimates increased over time overall (38.9-45.7%) and for Black (37.6-51.8%) and White (36.7-44.2%) students, but not Hispanic (45.1-43.8%) students. Significant differences in trends by race/ethnicity were observed for all variables. Data suggest that racial-ethnic health disparities for sexual behaviours decreased over time, except for condomless sex. CONCLUSIONS Although racial-ethnic gaps in sexual behaviours may be shrinking for many behaviours, work is still needed to achieve health equity in risks associated with HIV/AIDS, sexually transmitted infections, and pregnancy.
Collapse
Affiliation(s)
- Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA; and U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Kathleen Ethier
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA
| | - Kymber Williams
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA; and U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Yolanda Cavalier
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA
| | - Rebecca Payne
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US8-1, Atlanta, GA 30329, USA
| |
Collapse
|
10
|
Bryan LN, Smith-Grant J, Brener N, Kilmer G, Lo A, Queen B, Underwood JM. Electronic Versus Paper and Pencil Survey Administration Mode Comparison: 2019 Youth Risk Behavior Survey. J Sch Health 2022; 92:804-811. [PMID: 35445407 DOI: 10.1111/josh.13184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Since the inception of the Youth Risk Behavior Surveillance System in 1991, all surveys have been conducted in schools, using paper and pencil instruments (PAPI). For the 2019 YRBSS, sites were offered the opportunity to conduct their surveys using electronic data collection. This study aimed to determine whether differences in select metrics existed between students who completed the survey electronically versus using PAPI. METHODS Thirty risk behaviors were examined in this study. Data completeness, response rates and bivariate comparisons of risk behavior prevalence between administration modes were examined. RESULTS Twenty-nine of 30 questions examined had more complete responses among students using electronic surveys. Small differences were found for student and school response rates between modes. Twenty-five of 30 adolescent risk behaviors showed no mode effect. CONCLUSIONS Seven of 44 states and DC participated electronically. Because survey data were more complete; school and student response rates were consistent; and minor differences existed in risk behaviors between modes, the acceptability of collecting data electronically was demonstrated.
Collapse
Affiliation(s)
- Leah N Bryan
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer Smith-Grant
- Centers for Disease Control and Prevention, Atlanta, GA
- United States Public Health Service, Washington, DC
| | - Nancy Brener
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Greta Kilmer
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | |
Collapse
|
11
|
Krause KH, Mpofu JJ, Underwood JM, Ethier KA. The CDC's Adolescent Behaviors and Experiences Survey - Using Intersectionality and School Connectedness to Understand Health Disparities During the COVID-19 Pandemic. J Adolesc Health 2022; 70:703-705. [PMID: 35461653 PMCID: PMC8849860 DOI: 10.1016/j.jadohealth.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kathleen H. Krause
- Address correspondence to: Kathleen H. Krause, Ph.D., 1600 Clifton Rd, NE, MS: US8-1, Atlanta, GA 30329-4027
| | | | | | | |
Collapse
|
12
|
Krause KH, Verlenden JV, Szucs LE, Swedo EA, Merlo CL, Niolon PH, Leroy ZC, Sims VM, Deng X, Lee S, Rasberry CN, Underwood JM. Disruptions to School and Home Life Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. MMWR Suppl 2022. [PMID: 35358164 DOI: 10.15585/mmwr.su7103a5externalico] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Youths have experienced disruptions to school and home life since the COVID-19 pandemic began in March 2020. During January-June 2021, CDC conducted the Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9-12 (N = 7,705). ABES data were used to estimate the prevalence of disruptions and adverse experiences during the pandemic, including parental and personal job loss, homelessness, hunger, emotional or physical abuse by a parent or other adult at home, receipt of telemedicine, and difficulty completing schoolwork. Prevalence estimates are presented for all students and by sex, race and ethnicity, grade, sexual identity, and difficulty completing schoolwork. Since the beginning of the pandemic, more than half of students found it more difficult to complete their schoolwork (66%) and experienced emotional abuse by a parent or other adult in their home (55%). Prevalence of emotional and physical abuse by a parent or other adult in the home was highest among students who identified as gay, lesbian, or bisexual (74% emotional abuse and 20% physical abuse) and those who identified as other or questioning (76% and 13%) compared with students who identified as heterosexual (50% and 10%). Overall, students experienced insecurity via parental job loss (29%), personal job loss (22%), and hunger (24%). Disparities by sex and by race and ethnicity also were noted. Understanding health disparities and student disruptions and adverse experiences as interconnected problems can inform school and community initiatives that promote adolescent health and well-being. With community support to provide coordinated, cross-sector programming, schools can facilitate linkages to services that help students address the adverse experiences that they faced during the ongoing COVID-19 pandemic. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand how students' lives have been affected during the pandemic and what challenges need to be addressed to promote adolescent health and well-being during and after the pandemic.
Collapse
|
13
|
Rico A, Brener ND, Thornton J, Mpofu JJ, Harris WA, Roberts AM, Kilmer G, Chyen D, Whittle L, Leon-Nguyen M, Lim C, Saba A, Bryan LN, Smith-Grant J, Underwood JM. Overview and Methodology of the Adolescent Behaviors and Experiences Survey - United States, January-June 2021. MMWR Suppl 2022; 71:1-7. [PMID: 35358169 PMCID: PMC8979603 DOI: 10.15585/mmwr.su7103a1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Many U.S. schools closed nationwide in March 2020 to prevent the spread of COVID-19. School closures and online-only instruction have negatively affected certain students, with studies showing adverse effects of the pandemic on mental health. However, little is known about other experiences such as economic and food insecurity and abuse by a parent, as well as risk behaviors such as alcohol and drug use among youths across the United States during the pandemic. To address this gap, CDC developed the one-time, online Adolescent Behaviors and Experiences Survey (ABES), which was conducted during January–June 2021 to assess student behaviors and experiences during the COVID-19 pandemic among high school students, including unintentional injury, violence, tobacco product use, sexual behaviors, and dietary behaviors. This overview report of the ABES MMWR Supplement describes the ABES methodology, including the student questionnaire and administration, sampling, data collection, weighting, and analysis. ABES used a stratified, three-stage cluster probability-based sampling approach to obtain a nationally representative sample of students in grades 9–12 attending public and private schools. Teachers of selected classes provided students with access to the anonymous online survey while following local consent procedures. Data were collected using a 110-item questionnaire during January–June 2021 in 128 schools. A total of 7,998 students submitted surveys, and 7,705 of these surveys had valid data (i.e., ≥20 questions answered). The school response rate was 38%, the student response rate was 48%, and the overall response rate was 18%. Information on mode of instruction and school-provided equipment was also collected from all sampled schools. This overview report provides student- and school-level characteristics obtained from descriptive analyses, and the other reports in the ABES MMWR Supplement include information on substance use, mental health and suicidality, perceived racism, and disruptions to student life among high school students. Findings from ABES during the COVID-19 pandemic can help guide parents, teachers, school administrators, community leaders, clinicians, and public health officials in decision-making for student support and school health programs.
Collapse
|
14
|
Mpofu JJ, Cooper AC, Ashley C, Geda S, Harding RL, Johns MM, Spinks-Franklin A, Njai R, Moyse D, Underwood JM. Perceived Racism and Demographic, Mental Health, and Behavioral Characteristics Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. MMWR Suppl 2022; 71:22-27. [PMID: 35358163 PMCID: PMC8979604 DOI: 10.15585/mmwr.su7103a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perceived racism in school (i.e., a student’s report of being treated badly or unfairly because of their race or ethnicity) is an important yet understudied determinant of adolescent health and well-being. Knowing how perceived racism influences adolescent health can help reduce health inequities. CDC’s 2021 Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705), was conducted during January–June 2021 to assess student behaviors during the COVID-19 pandemic. CDC analyzed data from ABES to measure perceived racism and the extent to which perceptions of racism are associated with demographic, mental health, and behavioral characteristics. Mental health and behavioral characteristics analyzed included mental health status; virtual connection with others outside of school; serious difficulty concentrating, remembering, or making decisions; and feeling close to persons at school. Demographic characteristics analyzed included sex, race and ethnicity, and grade. Prevalence of perceived racism and associations between perceived racism and demographic, mental health, and behavioral characteristics are reported overall and stratified by race and ethnicity. Approximately one third (35.6%) of U.S. high school students reported perceived racism. Perceived racism was highest among Asian (63.9%), Black (55.2%), and multiracial students (54.5%). Students who reported perceived racism had higher prevalences of poor mental health (38.1%); difficulty concentrating, remembering, or making decisions (44.1%); and not feeling close to persons at school (40.7%). Perceived racism was higher among those students who reported poor mental health than those who did not report poor mental health during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A better understanding of how negative health outcomes are associated with student experiences of racism can guide training for staff and students to promote cultural awareness and antiracist and inclusivity interventions, which are critical for promoting safe school environments for all students.
Collapse
|
15
|
Krause KH, Verlenden JV, Szucs LE, Swedo EA, Merlo CL, Niolon PH, Leroy ZC, Sims VM, Deng X, Lee S, Rasberry CN, Underwood JM. Disruptions to School and Home Life Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. MMWR Suppl 2022; 71:28-34. [PMID: 35358164 PMCID: PMC8979601 DOI: 10.15585/mmwr.su7103a5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Youths have experienced disruptions to school and home life since the COVID-19 pandemic began in March 2020. During January–June 2021, CDC conducted the Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705). ABES data were used to estimate the prevalence of disruptions and adverse experiences during the pandemic, including parental and personal job loss, homelessness, hunger, emotional or physical abuse by a parent or other adult at home, receipt of telemedicine, and difficulty completing schoolwork. Prevalence estimates are presented for all students and by sex, race and ethnicity, grade, sexual identity, and difficulty completing schoolwork. Since the beginning of the pandemic, more than half of students found it more difficult to complete their schoolwork (66%) and experienced emotional abuse by a parent or other adult in their home (55%). Prevalence of emotional and physical abuse by a parent or other adult in the home was highest among students who identified as gay, lesbian, or bisexual (74% emotional abuse and 20% physical abuse) and those who identified as other or questioning (76% and 13%) compared with students who identified as heterosexual (50% and 10%). Overall, students experienced insecurity via parental job loss (29%), personal job loss (22%), and hunger (24%). Disparities by sex and by race and ethnicity also were noted. Understanding health disparities and student disruptions and adverse experiences as interconnected problems can inform school and community initiatives that promote adolescent health and well-being. With community support to provide coordinated, cross-sector programming, schools can facilitate linkages to services that help students address the adverse experiences that they faced during the ongoing COVID-19 pandemic. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand how students’ lives have been affected during the pandemic and what challenges need to be addressed to promote adolescent health and well-being during and after the pandemic.
Collapse
|
16
|
Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood JM. Risk Behaviors and Experiences Among Youth Experiencing Homelessness-Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts, 2019. J Community Health 2022; 47:324-333. [PMID: 35013979 PMCID: PMC9119052 DOI: 10.1007/s10900-021-01056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
Youth experiencing homelessness experience violence victimization, substance use, suicide risk, and sexual risk disproportionately, compared with their stably housed peers. Yet few large-scale assessments of these differences among high school students exist. The youth risk behavior survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2019, 23 states and 11 local school districts included a measure for housing status on their YRBS questionnaire. The prevalence of homelessness was assessed among states and local sites, and relationships between housing status and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with stably housed students, students experiencing homelessness were twice as likely to report misuse of prescription pain medicine, three times as likely to be threatened or injured with a weapon at school, and three times as likely to report attempting suicide. These findings indicate a need for intervention efforts to increase support, resources, and services for homeless youth.
Collapse
Affiliation(s)
- Jennifer Smith-Grant
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA.
- U.S. Public Health Service Commissioned Corps, Washington, DC, USA.
| | - Greta Kilmer
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Nancy Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Leah Robin
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| |
Collapse
|
17
|
Hawkins GT, Lee SH, Michael SL, Merlo CL, Lee SM, King BA, Rasberry CN, Underwood JM. Individual and Collective Positive Health Behaviors and Academic Achievement Among U.S. High School Students, Youth Risk Behavior Survey 2017. Am J Health Promot 2021; 36:651-661. [PMID: 34967223 PMCID: PMC10150493 DOI: 10.1177/08901171211064496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. DESIGN Cross-sectional study design. SETTING Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). SUBJECTS Youth in grades 9th-12th. MEASURES We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. ANALYSIS Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. RESULTS Controlling for covariates, students who reported mostly A's had 2.0 (P < .001) more positive health behaviors; students who reported mostly B's had 1.3 (P < .001) more positive health behaviors; and students who reported mostly C's had .78 (P < .001) more positive health behaviors, compared to students who reported mostly D's/F's. CONCLUSIONS Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity.
Collapse
Affiliation(s)
- Georgianne Tiu Hawkins
- 1242Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Seung Hee Lee
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon L Michael
- 1242Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Caitlin L Merlo
- 1242Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah M Lee
- 1242Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine N Rasberry
- Division of Adolescent and School Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J M Underwood
- 1242Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
18
|
Underwood JM, Pampati S, Everett Jones S, Bryan LN, Demissie Z, Cavalier Y, Rasberry CN. School-Level Poverty and Rurality Associated With Differences in Sexual Risk Behaviors Among U.S. Public High School Students. J Adolesc Health 2021; 69:964-969. [PMID: 34304989 DOI: 10.1016/j.jadohealth.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE This study examined associations between student sexual behaviors and both school-level socioeconomic status and metropolitan status. METHODS National Youth Risk Behavior Survey data from 2017 (N = 14,765, response rate = 60%) and 2019 (N = 13,677, 60%) were combined. School-level socioeconomic status (low-, mid-, and high-poverty based on the percentage of students eligible for free or reduced-price meals) and metropolitan status (urban, suburban/town, or rural) were identified for students attending public high schools. Sexual behaviors included currently sexually active, four or more lifetime sexual partners, condom use during the last sexual intercourse, hormonal birth control use during the last sexual intercourse, condom and hormonal birth control use during the last sexual intercourse, and drank alcohol or used drugs before the last sexual intercourse. Adjusted prevalence ratios were calculated using logistic regression models, controlling for sex, race/ethnicity, and grade. RESULTS Compared to students attending low-poverty schools, high-poverty school students were significantly more likely to be currently sexually active (adjusted prevalence ratio = 1.4 [95% confidence interval = 1.1-1.8]) and have four or more lifetime sexual partners (1.6 [1.0-2.5]), but were significantly less likely to have drank alcohol or used drugs before the last sexual intercourse (.7 [.5-.9]) and have used hormonal birth control during the last sexual intercourse (.7 [.6-1.0]). Compared to students attending rural schools, urban school students were significantly less likely to be currently sexually active (.8 [.7-.9]) and have four or more lifetime sexual partners (.7 [.5-.9]). CONCLUSIONS School-level socioeconomic status and metropolitan status were associated with differential risk in sexual behaviors.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leah N Bryan
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zewditu Demissie
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Washington, D.C
| | - Yolanda Cavalier
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine N Rasberry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
19
|
Deputy NP, Bryan L, Lowry R, Brener N, Underwood JM. Health Risk Behaviors, Experiences, and Conditions Among Students Attending Private and Public High Schools. J Sch Health 2021; 91:683-696. [PMID: 34278580 DOI: 10.1111/josh.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Approximately 8.8% of US high school students attended private schools in 2015. Few studies have characterized health risk behaviors among these students or compared prevalence of behaviors between students in private and public schools using a contemporary, nationally representative sample. METHODS Pooled 2007-2017 national Youth Risk Behavior Survey data were used to estimate the prevalence of 35 health risk behaviors for 89,848 public and private high school students. Unadjusted prevalence ratios were used to compare prevalence by school type. Differences in behaviors by school type were explored by sex and grade. RESULTS Among private school students, the prevalence ranged from 5.0% to 31.9% for sexual risk behaviors; from 0.8% to 30.1% for substance use behaviors; from 0.7% to 21.8% for behaviors related mental health and suicide; from 3.2% to 6.8% for violence victimization experiences; and from 3.1% to 52.9% for behaviors related to unhealthy diet and physical inactivity. Private school students were less likely than public school students to report most behaviors; differences by school type were generally consistent across sex and grade. CONCLUSIONS Students in both public and private schools reported health risk behaviors. Findings might inform prevention activities by identifying behaviors to prioritize in each school setting.
Collapse
Affiliation(s)
- Nicholas P Deputy
- Epidemic Intelligence Service Officer, , Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE MS US8-1, Atlanta, GA, 30329., USA
| | - Leah Bryan
- Statistician, , Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE MS US8-1, Atlanta, GA, 30329., USA
| | - Richard Lowry
- Medical Officer, , Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE MS US8-1, Atlanta, GA, 30329., USA
| | - Nancy Brener
- Health Scientist, , Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE MS US8-1, Atlanta, GA, 30329., USA
| | - J Michael Underwood
- Branch Chief, , Division of Adolescent and School Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE MS US8-1, Atlanta, GA, 30329., USA
| |
Collapse
|
20
|
Leidner AJ, Maughan ED, Bjork A, Black C, Mazyck D, Underwood JM. Vaccination-Related Activities at Schools With Kindergartners: Evidence From a School Nurse Survey. J Sch Nurs 2020; 36:464-471. [PMID: 31088201 DOI: 10.1177/1059840519847730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vaccination coverage among children in kindergarten varies across the country and within states. We surveyed a convenience sample of kindergarten school nurses to investigate self-reported vaccination-related activities conducted at schools nationwide. The majority of the 1,435 kindergarten school nurses responding reported that their schools communicate with parents and guardians of undervaccinated students by phone (96%), postal mail (67%), newsletters (61%), and e-mail (59%). Most respondents reported documenting vaccination coverage in electronic systems (85%) and sharing coverage reports with health departments (69%). A total of 41% of school nurses worked with external partners for vaccination efforts, the most common support received from partners being vaccine administration (38%) and providing materials/vaccines (21%). School nurses also reported that 95% of kindergartners were up to date for all vaccines. School-based vaccination-related activities are essential to sustaining high levels of vaccination coverage for the protection of children at schools and in the broader community.
Collapse
Affiliation(s)
| | - Erin D Maughan
- 233071National Association of School Nurses, Silver Springs, MD, USA
| | - Adam Bjork
- Program Operations Branch, Immunization Services Division, National Center for Immunization Services and Respiratory Diseases, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA.,Commissioned Corps, United States Public Health Service, Atlanta, GA, USA
| | - Carla Black
- Commissioned Corps, United States Public Health Service, Atlanta, GA, USA
| | - Donna Mazyck
- 233071National Association of School Nurses, Silver Springs, MD, USA
| | - J Michael Underwood
- School-Based Surveillance Branch, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
21
|
Underwood JM, Brener N, Halpern-Felsher B. Tracking Adolescent Health Behaviors and Outcomes: Strengths and Weaknesses of the Youth Risk Behavior Surveillance System. NAM Perspect 2020; 2020:202010a. [DOI: 10.31478/202010a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
22
|
Underwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shanklin SL, Deputy N, Roberts AM, Queen B, Chyen D, Whittle L, Lim C, Yamakawa Y, Leon-Nguyen M, Kilmer G, Smith-Grant J, Demissie Z, Jones SE, Clayton H, Dittus P. Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2019. MMWR Suppl 2020; 69:1-10. [PMID: 32817611 PMCID: PMC7440204 DOI: 10.15585/mmwr.su6901a1] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Health risk behaviors practiced during adolescence often persist into adulthood and contribute to the leading causes of morbidity and mortality in the United States. Youth health behavior data at the national, state, territorial, tribal, and local levels help monitor the effectiveness of public health interventions designed to promote adolescent health. The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. YRBSS includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate state, local school district, territorial, and tribal school–based YRBSs. This overview report describes the surveillance system and the 2019 survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses presented in this MMWRSupplement. A 2019 YRBS participation map, survey response rates, and student demographic characteristics are included. In 2019, a total of 78 YRBSs were administered to high school student populations across the United States (national and 44 states, 28 local school districts, three territories, and two tribal governments), the greatest number of participating sites with representative data since the surveillance system was established in 1991. The nine reports in this MMWR Supplement are based on national YRBS data collected during August 2018–June 2019. A full description of 2019 YRBS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm). Efforts to improve YRBSS and related data are ongoing and include updating reliability testing for the national questionnaire, transitioning to electronic survey administration (e.g., pilot testing for a tablet platform), and exploring innovative analytic methods to stratify data by school-level socioeconomic status and geographic location. Stakeholders and public health practitioners can use YRBS data (comparable across national, state, tribal, territorial, and local jurisdictions) to estimate the prevalence of health-related behaviors among different student groups, identify student risk behaviors, monitor health behavior trends, guide public health interventions, and track progress toward national health objectives.
Collapse
|
23
|
Mellerson JL, Street E, Knighton C, Calhoun K, Seither R, Underwood JM. Centers for Disease Control and Prevention's School Vaccination Assessment: Collaboration With US State, Local, and Territorial Immunization Programs, 2012-2018. Am J Public Health 2020; 110:1092-1097. [PMID: 32437281 DOI: 10.2105/ajph.2020.305643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the ongoing collaboration of the Centers for Disease Control and Prevention's (CDC's) school vaccination assessment with state, local, and territorial immunization programs to provide data to monitor school entry vaccination.Methods. Departments of health and education partner to collect data from public school, private school, and homeschooled kindergartners in the 50 US states, the District of Columbia, 2 cities, and the US territories. Immunization programs submit vaccination coverage and exemption data to the CDC, and the CDC reports these data annually via multiple sources.Results. Among the 50 states and the District of Columbia, the number of programs using a census for vaccination coverage data increased from 39 to 41 during the school years 2012-2013 to 2017-2018 (which for most states was August or September through May or June), and the number using a census to collect exemption data increased from 40 to 46. The number of states that reported sharing their local-level vaccination coverage data online increased from 11 in 2012-2013 to 31 in 2017-2018.Conclusions. Coverage data can be used to address undervaccination among kindergartners to work with communities and schools that are susceptible to vaccine-preventable diseases. As more states publish local-level data online, access to improved data provides the public more valuable information.
Collapse
Affiliation(s)
- Jenelle L Mellerson
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Erica Street
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Cynthia Knighton
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Kayla Calhoun
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - Ranee Seither
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| | - J Michael Underwood
- All authors are with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jenelle L. Mellerson is also with Certified Technical Experts, Montgomery, AL. Erica Street is also with the Oak Ridge Institute for Science and Education, Oak Ridge, TN. Kayla Calhoun is also with CyberData Technologies, Herndon, VA
| |
Collapse
|
24
|
Jones SE, Underwood JM, Pampati S, Le VD, DeGue S, Demissie Z, Adkins SH, Barrios LC. School-Level Poverty and Persistent Feelings of Sadness or Hopelessness, Suicidality, and Experiences with Violence Victimization among Public High School Students. J Health Care Poor Underserved 2020; 31:1248-1263. [DOI: 10.1353/hpu.2020.0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Affiliation(s)
- Christopher M. Jones
- National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - J. Michael Underwood
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent School Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland
| |
Collapse
|
26
|
Johns MM, Lowry R, Andrzejewski J, Barrios LC, Demissie Z, McManus T, Rasberry CN, Robin L, Underwood JM. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students - 19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep 2019; 68:67-71. [PMID: 30677012 PMCID: PMC6348759 DOI: 10.15585/mmwr.mm6803a3] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Transgender youths (those whose gender identity* does not align with their sex†) experience disparities in violence victimization, substance use, suicide risk, and sexual risk compared with their cisgender peers (those whose gender identity does align with their sex) (1-3). Yet few large-scale assessments of these disparities among high school students exist. The Youth Risk Behavior Survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2017, 10 states (Colorado, Delaware, Hawaii, Maine, Maryland, Massachusetts, Michigan, Rhode Island, Vermont, Wisconsin) and nine large urban school districts (Boston, Broward County, Cleveland, Detroit, District of Columbia, Los Angeles, New York City, San Diego, San Francisco) piloted a measure of transgender identity. Using pooled data from these 19 sites, the prevalence of transgender identity was assessed, and relationships between transgender identity and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with cisgender males and cisgender females, transgender students were more likely to report violence victimization, substance use, and suicide risk, and, although more likely to report some sexual risk behaviors, were also more likely to be tested for human immunodeficiency virus (HIV) infection. These findings indicate a need for intervention efforts to improve health outcomes among transgender youths.
Collapse
|
27
|
Underwood JM, Hyde-Rolland SJ, Thorsness J, Stewart SL. A Novel Public Health Approach to Measuring Tobacco Cessation Needs Among Cancer Survivors in Alaska. J Community Health 2018; 42:956-961. [PMID: 28528524 DOI: 10.1007/s10900-017-0341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cancer survivors who continue to smoke have poorer response to treatment, higher risk for future cancers and lower survival rates than those who quit tobacco after diagnosis. Despite the increased risk for negative health outcomes, tobacco use among Alaskan cancer survivors is 19%, among the highest in the nation. To characterize and address tobacco cessation needs among cancer survivors who called a quit line for help in quitting tobacco, Alaska's Comprehensive Cancer Control program initiated a novel partnership with the state's Tobacco Quit Line. Alaska's Tobacco Quit Line, a state-funded resource that provides confidential coaching, support, and nicotine replacement therapies for Alaskan adults who wish to quit using tobacco, was used to collect demographic characteristics, health behaviors, cessation referral methods and other information on users. From September 2013- December 2014, the Alaska Quit Line included questions about previous cancer status and other chronic conditions to assess this information from cancer survivors who continue to use tobacco. Alaska's Tobacco Quit Line interviewed 3,141 smokers, 129 (4%) of whom were previously diagnosed with cancer. Most cancer survivors who called in to the quit line were female (72%), older than 50 years of age (65%), white (67%), and smoked cigarettes (95%). Cancer survivors reported a higher prevalence of asthma, COPD and heart disease than the non-cancer cohort. Approximately 34% of cancer survivors were referred to the quit line by a health care provider. This report illustrates the need for health care provider awareness of persistent tobacco use among cancer survivors in Alaska. It also provides a sound methodologic design for assessing ongoing tobacco cessation needs among cancer survivors who call a quit line. This survey methodology can be adapted by other public health programs to address needs and increase healthy behaviors among individuals with chronic disease.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-F76, Atlanta, GA, 30341, USA
| | - Samantha J Hyde-Rolland
- Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
| | - Julia Thorsness
- Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
- Alaska Comprehensive Cancer Control Program, Division of Public Health, Department of Health and Social Services, Anchorage, AK, 99503, USA
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-F76, Atlanta, GA, 30341, USA.
| |
Collapse
|
28
|
Tippins A, Murthy N, Meghani M, Solsman A, Apaisam C, Basilius M, Eckert M, Judicpa P, Masunu Y, Pistotnik K, Pedro D, Sasamoto J, Underwood JM. Vaccination Coverage Among Children Aged 2 Years — U.S. Affiliated Pacific Islands, April–October, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:579-584. [PMID: 29795077 PMCID: PMC6433335 DOI: 10.15585/mmwr.mm6720a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
29
|
Tippins A, Leidner AJ, Meghani M, Griffin A, Helgenberger L, Nyaku M, Underwood JM. Timeliness of childhood vaccination in the Federated States of Micronesia. Vaccine 2017; 35:6404-6411. [PMID: 29029941 PMCID: PMC6167924 DOI: 10.1016/j.vaccine.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs). OBJECTIVE To assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak. METHODS Timeliness of the 4th dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1st dose of measles, mumps, and rubella vaccine (MMR) among children 24-35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recovery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination. RESULTS Total coverage for the 4th dose of DTaP ranged from 36.6% to 98.8%, and for the 1st dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4th dose of DTaP ranged from 3.2% to 52.3%, and for the 1st dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8-13.7% increases in measles cases during an outbreak based on these delays. CONCLUSIONS In each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.
Collapse
Affiliation(s)
- Ashley Tippins
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States.
| | | | | | - Aja Griffin
- Association of Schools & Programs of Public Health, Atlanta, GA, United States
| | - Louisa Helgenberger
- Federated States of Micronesia Department of Health & Social Affairs, Pohnpei, Federated States of Micronesia
| | - Mawuli Nyaku
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| | - J Michael Underwood
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division, Atlanta, GA, United States
| |
Collapse
|
30
|
Seither R, Calhoun K, Street EJ, Mellerson J, Knighton CL, Tippins A, Underwood JM. Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten - United States, 2016-17 School Year. MMWR Morb Mortal Wkly Rep 2017; 66:1073-1080. [PMID: 29023430 PMCID: PMC5657930 DOI: 10.15585/mmwr.mm6640a3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
31
|
Pike J, Tippins A, Nyaku M, Eckert M, Helgenberger L, Underwood JM. Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak. Vaccine 2017; 35:5905-5911. [PMID: 28886945 PMCID: PMC5831405 DOI: 10.1016/j.vaccine.2017.08.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.
Collapse
Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States.
| | - Ashley Tippins
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
| | - Mawuli Nyaku
- Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States
| | - Maribeth Eckert
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
| | - Louisa Helgenberger
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Federated States of Micronesia
| | - J Michael Underwood
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Disease, Immunization Services Division, Atlanta, GA, United States
| |
Collapse
|
32
|
Seither R, Calhoun K, Mellerson J, Knighton CL, Street E, Dietz V, Underwood JM. Vaccination Coverage Among Children in Kindergarten - United States, 2015-16 School Year. MMWR Morb Mortal Wkly Rep 2016; 65:1057-1064. [PMID: 27711037 DOI: 10.15585/mmwr.mm6539a3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
State-mandated vaccination requirements for school entry protect children and communities against vaccine-preventable diseases (1). Each school year, federally funded immunization programs (e.g., states, territories, jurisdictions) collect and report kindergarten vaccination data to CDC. This report describes vaccination coverage estimates in all 50 states and the District of Columbia (DC), and the estimated number of kindergartners with at least one vaccine exemption in 47 states and DC, during the 2015-16 school year. Median vaccination coverage* was 94.6% for 2 doses of measles, mumps and rubella vaccine (MMR); 94.2% for diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 94.3% for 2 doses of varicella vaccine. MMR coverage increased in 32 states during the last year, and 22 states reported coverage ≥95% (2). A total of 45 states and DC had either a grace period allowing students to attend school before providing documentation of vaccination or provisional enrollment that allows undervaccinated students to attend school while completing a catch-up schedule. Among the 23 states that were able to voluntarily report state-level data on grace period or provisional enrollment to CDC, a median of 2.0% of kindergartners were not documented as completely vaccinated and were attending school within a grace period or were provisionally enrolled. The median percentage of kindergartners with an exemption from one or more vaccinations† was 1.9%. State and local immunization programs, in cooperation with schools, can improve vaccination coverage by ensuring that all kindergartners are vaccinated during the grace period or provisional enrollment.
Collapse
|
33
|
Puckett M, Neri A, Underwood JM, Stewart SL. Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans. J Community Health 2016; 41:1013-20. [PMID: 26994988 PMCID: PMC5011446 DOI: 10.1007/s10900-016-0184-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Obesity, diet and physical inactivity are risk factors for some cancers. Grantees of the National Comprehensive Cancer Control Program (NCCCP) in US states, tribes, and territories develop plans to coordinate funding and activities for cancer prevention and control. Including information and goals related to nutrition and physical activity (NPA) is a key opportunity for primary cancer prevention, but it is currently unclear to what extent NCCCP plans address these issues. We reviewed 69 NCCCP plans and searched for terms related to NPA. Plans were coded as (1) knowledge of NPA and cancer link; (2) goals to improve NPA behaviors; and (3) strategies to increase healthy NPA activities, environments, or systems changes. NPA content was consistently included in all cancer plans examined across all years. Only 4 (6 %) outlined only the relationship between NPA and cancer without goals or strategies. Fifty-nine plans (89 %) contained goals or strategies related to NPA, with 53 (82 %) including both. However, numbers of goals, strategies, and detail provided varied widely. All programs recognized the importance of NPA in cancer prevention. Most plans included NPA goals and strategies. Increasing the presence of NPA strategies that can be modified or adapted appropriately locally could help with more widespread implementation and measurement of NPA interventions.
Collapse
Affiliation(s)
- Mary Puckett
- Division of Cancer Prevention and Control, Comprehensive Cancer Control Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA.
| | - Antonio Neri
- Division of Cancer Prevention and Control, Comprehensive Cancer Control Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA
| | - J Michael Underwood
- Division of Cancer Prevention and Control, Comprehensive Cancer Control Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, Comprehensive Cancer Control Branch, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-76, Atlanta, GA, 30341, USA
| |
Collapse
|
34
|
Puckett M, Neri A, Rohan E, Clerkin C, Underwood JM, Ryerson AB, Stewart SL. Evaluating Early Case Capture of Pediatric Cancers in Seven Central Cancer Registries in the United States, 2013. Public Health Rep 2016; 131:126-36. [PMID: 26843678 DOI: 10.1177/003335491613100119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cancer is the second-leading cause of death in children, but incidence data are not available until two years after diagnosis, thereby delaying data dissemination and research. An early case capture (ECC) surveillance program was piloted in seven state cancer registries to register pediatric cancer cases within 30 days of diagnosis. We sought to determine the quality of ECC data and understand pilot implementation. METHODS We used quantitative and qualitative methods to evaluate ECC. We assessed data quality by comparing demographic and clinical characteristics from the initial ECC submission to a resubmission of ECC pilot data and to the most recent year of routinely collected cancer data for each state individually and in aggregate. We conducted telephone focus groups with registry staff to determine ECC practices and difficulties in August and September 2013. Interviews were recorded, transcribed, and coded to identify themes. RESULTS Comparing ECC initial submissions with submissions for all states, ECC data were nationally representative for age (9.7 vs. 9.9 years) and sex (673 of 1,324 [50.9%] vs. 42,609 of 80,547 [52.9%] male cases), but not for primary site (472 of 1,324 [35.7%] vs. 27,547 of 80,547 [34.2%] leukemia/lymphoma cases), behavior (1,219 of 1,324 [92.1%] vs. 71,525 of 80,547 [88.8%] malignant cases), race/ethnicity (781 of 1,324 [59.0%] vs. 64,518 of 80,547 [80.1%] white cases), or diagnostic confirmation (1,233 of 1,324 [93.2%] vs. 73,217 of 80,547 [90.9%] microscopically confirmed cases). When comparing initial ECC data with resubmission data, differences were seen in race/ethnicity (808 of 1,324 [61.1%] vs. 1,425 of 1,921 [74.2%] white cases), primary site (475 of 1,324 [35.9%] vs. 670 of 1,921 [34.9%] leukemia/lymphoma cases), and behavior (1,215 of 1,324 [91.8%] vs. 1,717 of 1,921 [89.4%] malignant cases). Common themes from focus group analysis included implementation challenges and facilitators, benefits of ECC, and utility of ECC data. CONCLUSIONS ECC provided data rapidly and reflected national data overall with differences in several data elements. ECC also expanded cancer reporting infrastructure and increased data completeness and timeliness. Although challenges related to timeliness and increased work burden remain, indications suggest that researchers may reliably use these data for pediatric cancer studies.
Collapse
Affiliation(s)
- Mary Puckett
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA; Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - Antonio Neri
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - Elizabeth Rohan
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - Castine Clerkin
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - J Michael Underwood
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - A Blythe Ryerson
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| | - Sherri L Stewart
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, GA
| |
Collapse
|
35
|
Underwood JM, Lakhani N, Finifrock D, Pinkerton B, Johnson KL, Mallory SH, Migliore Santiago P, Stewart SL. Evidence-Based Cancer Survivorship Activities for Comprehensive Cancer Control. Am J Prev Med 2015; 49:S536-42. [PMID: 26590649 PMCID: PMC7894748 DOI: 10.1016/j.amepre.2015.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of six priorities of CDC's National Comprehensive Cancer Control Program (NCCCP) is to address the needs of cancer survivors within the local population served by individually funded states, tribes, and territories. This report examines cancer survivorship activities implemented in five NCCCP grantees, which have initiated evidence-based activities outlined in A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). METHODS NCCCP action plans, submitted annually to CDC, from 2010 to 2014 were reviewed in February 2015 to assess implementation of cancer survivorship activities and recommended strategies consistent with the NAP. Four state-level and one tribal grantee with specific activities related to one of each of the four NAP strategies were chosen for inclusion. Brief case reports describing the initiation and impact of implemented activities were developed in collaboration with each grantee program director. RESULTS New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band of Lake Superior Chippewa programs each implemented activities in surveillance and applied research; communication, education, and training; programs, policies, and infrastructure; and access to quality care and services. CONCLUSIONS This report provides examples for incorporating cancer survivorship activities within Comprehensive Cancer Control programs of various sizes, demographic makeup, and resource capacity. New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band developed creative cancer survivorship activities that meet CDC recommendations. NCCCP grantees can follow these examples by implementing evidence-based survivorship interventions that meet the needs of their specific populations.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Naheed Lakhani
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - DeAnna Finifrock
- Fond du Lac Human Services Division, Community Health Services Department, Cloquet, Minnesota
| | - Beth Pinkerton
- New Mexico Comprehensive Cancer Program, New Mexico Department of Health, Albuquerque, New Mexico
| | - Krystal L Johnson
- Division of Cancer Prevention and Control, Bureau of Community Health & Chronic Disease Prevention, South Carolina Department of Health & Environmental Control, Columbia, South Carolina
| | - Sharon H Mallory
- Vermont Comprehensive Cancer Control Program, Vermont Department of Health, Burlington, Vermont
| | - Patricia Migliore Santiago
- Washington State Comprehensive Cancer Control Program, Office of Healthy Communities, Washington State Department of Health, Olympia, Washington
| | - Sherri L Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| |
Collapse
|
36
|
Singh E, Ruff P, Babb C, Sengayi M, Beery M, Khoali L, Kellett P, Underwood JM. Establishment of a cancer surveillance programme: the South African experience. Lancet Oncol 2015; 16:e414-21. [PMID: 26248849 DOI: 10.1016/s1470-2045(15)00162-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/30/2022]
Abstract
Cancer is projected to become a leading cause of morbidity and mortality in low-income and middle-income countries in the future. However, cancer incidence in South Africa is largely under-reported because of a lack of nationwide cancer surveillance networks. We describe present cancer surveillance activities in South Africa, and use the International Agency for Research on Cancer framework to propose the development of four population-based cancer registries in South Africa. These registries will represent the ethnic and geographical diversity of the country. We also provide an update on a cancer surveillance pilot programme in the Ekurhuleni Metropolitan District, and the successes and challenges in the implementation of the IARC framework in a local context. We examine the development of a comprehensive cancer surveillance system in a middle-income country, which might serve to assist other countries in establishing population-based cancer registries in a resource-constrained environment.
Collapse
Affiliation(s)
- Elvira Singh
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
| | - Paul Ruff
- Division of Medical Oncology, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Chantal Babb
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; University of Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mazvita Sengayi
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Moira Beery
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; South African Field Epidemiology and Laboratory Training Programme, University of Pretoria, School of Public Health, Pretoria, South Africa
| | - Lerato Khoali
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Patricia Kellett
- Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
37
|
Underwood JM, Lakhani N, Rohan E, Moore A, Stewart SL. An evaluation of cancer survivorship activities across national comprehensive cancer control programs. J Cancer Surviv 2015; 9:554-9. [PMID: 25732543 DOI: 10.1007/s11764-015-0432-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP) funds states, the District of Columbia, tribal organizations, territories, and jurisdictions across the USA develop and implement jurisdiction-specific comprehensive cancer control (CCC) plans. The objective of this study was to analyze NCCCP action plan data for incorporation and appropriateness of cancer survivorship-specific goals and objectives. METHODS In August 2013, NCCCP action plans maintained within CDC's Chronic Disease Management Information System (CDMIS) from years 2010 to 2013 were reviewed to assess the inclusion of cancer survivorship objectives. We used the CDMIS search engine to identify "survivorship" within each plan and calculated the proportion of programs that incorporate cancer survivorship-related content during the study period and in each individual year. Cancer survivorship objectives were then categorized by compatibility with nationally accepted, recommended strategies from the report A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). RESULTS From 2010 to 2013, 94% (n = 65) of NCCCP action plans contained survivorship content in at least 1 year during the time period and 38% (n = 26) of all NCCCP action plans addressed cancer survivorship every year during the study period. Nearly 64% (n = 44) of NCCCP action plans included cancer survivorship objectives recommended in NAP. CONCLUSION Nearly all NCCCP action plans addressed cancer survivorship from 2010 to 2013, and most programs implemented recommended cancer survivorship efforts during the time period. IMPLICATIONS FOR CANCER SURVIVORS NCCCP grantees can improve cancer survivorship support by incorporating recommended efforts within each year of their plans.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-F76, Atlanta, GA, 30333, USA,
| | | | | | | | | |
Collapse
|
38
|
Puckett M, Neri A, Thompson T, Underwood JM, Momin B, Kahende J, Zhang L, Stewart SL. Tobacco cessation among users of telephone and web-based interventions--four states, 2011-2012. MMWR Morb Mortal Wkly Rep 2015; 63:1217-1221. [PMID: 25551593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Smoking caused an average of 480,000 deaths per year in the United States from 2005 to 2009, and three in 10 cancer deaths in the United States are tobacco related. Tobacco cessation is a high public health priority, and all states offer some form of tobacco cessation service. Quitlines provide telephone-based counseling services and are an effective intervention for tobacco cessation. In addition to telephone services, 96% of all U.S. quitlines offer Web-based cessation services. Evidence is limited on the number of tobacco users who use more than one type of service, and studies report mixed results on whether combined telephone and Web-based counseling improves long-term cessation compared with telephone alone. CDC conducted a survey of users of telephone and Web-based cessation services in four states to determine the cessation success of users of these interventions. After adjusting for multiple variables, persons who used both telephone and Web-based services were more likely to report abstinence from smoking for 30 days at follow up (odds ratio = 1.3) compared with telephone-only users and with Web-only users (odds ratio = 1.5). These findings suggest that states might consider offering both types of cessation services to increase cessation success.
Collapse
|
39
|
Plescia M, Henley SJ, Pate A, Underwood JM, Rhodes K. Lung cancer deaths among American Indians and Alaska Natives, 1990-2009. Am J Public Health 2014; 104 Suppl 3:S388-95. [PMID: 24754613 DOI: 10.2105/ajph.2013.301609] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We examined regional differences in lung cancer among American Indians/Alaska Natives (AI/ANs) using linked data sets to minimize racial misclassification. METHODS On the basis of federal lung cancer incidence data for 1999 to 2009 and deaths for 1990 to 2009 linked with Indian Health Service (IHS) registration records, we calculated age-adjusted incidence and death rates for non-Hispanic AI/AN and White persons by IHS region, focusing on Contract Health Service Delivery Area (CHSDA) counties. We correlated death rates with cigarette smoking prevalence and calculated mortality-to-incidence ratios. RESULTS Lung cancer death rates among AI/AN persons in CHSDA counties varied across IHS regions, from 94.0 per 100,000 in the Northern Plains to 15.2 in the Southwest, reflecting the strong correlation between smoking and lung cancer. For every 100 lung cancers diagnosed, there were 6 more deaths among AI/AN persons than among White persons. Lung cancer death rates began to decline in 1997 among AI/AN men and are still increasing among AI/AN women. CONCLUSIONS Comparison of regional lung cancer death rates between AI/AN and White populations indicates disparities in tobacco control and prevention interventions. Efforts should be made to ensure that AI/AN persons receive equal benefit from current and emerging lung cancer prevention and control interventions.
Collapse
Affiliation(s)
- Marcus Plescia
- Marcus Plescia, Sarah Jane Henley, and J. Michael Underwood are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Anne Pate is with the Chronic Disease Service, Oklahoma State Department of Health, Oklahoma City. Kris Rhodes is with the American Indian Cancer Foundation, Minneapolis, MN
| | | | | | | | | |
Collapse
|
40
|
Henley SJ, Richards TB, Underwood JM, Eheman CR, Plescia M, McAfee TA. Lung cancer incidence trends among men and women--United States, 2005-2009. MMWR Morb Mortal Wkly Rep 2014; 63:1-5. [PMID: 24402465 PMCID: PMC5779336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer (excluding skin cancer) among men and women in the United States. Although lung cancer can be caused by environmental exposures, most efforts to prevent lung cancer emphasize tobacco control because 80%-90% of lung cancers are attributed to cigarette smoking and secondhand smoke. One sentinel health consequence of tobacco use is lung cancer, and one way to measure the impact of tobacco control is by examining trends in lung cancer incidence rates, particularly among younger adults. Changes in lung cancer rates among younger adults likely reflect recent changes in risk exposure. To assess lung cancer incidence and trends among men and women by age group, CDC used data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the period 2005-2009, the most recent data available. During the study period, lung cancer incidence decreased among men in all age groups except <35 years and decreased among women aged 35-44 years and 54-64 years. Lung cancer incidence decreased more rapidly among men than among women and more rapidly among adults aged 35-44 years than among other age groups. To further reduce lung cancer incidence in the United States, proven population-based tobacco prevention and control strategies should receive sustained attention and support.
Collapse
Affiliation(s)
- S. Jane Henley
- Div of Cancer Prevention and Control,Corresponding author: S. Jane Henley, , 770-488-4157
| | | | | | | | | | - Timothy A. McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| |
Collapse
|
41
|
Dunne K, Henderson S, Stewart SL, Moore A, Hayes NS, Jordan J, Underwood JM. An update on tobacco control initiatives in comprehensive cancer control plans. Prev Chronic Dis 2013; 10:E107. [PMID: 23806802 PMCID: PMC3696075 DOI: 10.5888/pcd10.120331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Comprehensive cancer control (CCC) coalitions address tobacco use, the leading cause of preventable death in the United States, through formal plans to guide tobacco control activities and other cancer prevention strategies. Best Practices for Comprehensive Tobacco Control Programs (Best Practices) and The Guide to Community Preventive Services(The Community Guide) are used to assist with this effort. We examined CCC plans to determine the extent to which they followed the Centers for Disease Control and Prevention’s (CDC’s) tobacco control and funding recommendations. Methods We obtained 69 CCC plans, current as of August 1, 2011, to determine which CDC recommendations from Best Practices and The Community Guide were incorporated. Data were abstracted through a content review and key word search and then summarized across the plans with dichotomous indicators. Additionally, we analyzed plans for inclusion of tobacco control funding goals and strategies. Results CCC plans incorporated a mean 4.5 (standard deviation [SD], 2.1) of 5 recommendations from Best Practices and 5.2 (SD, 0.9) of 10 recommendations from The Community Guide. Two-thirds of plans (66.7%) addressed funding for tobacco control as a strategy or action item; 47.8% of those plans (31.9% of total) defined a specific, measurable funding goal. Conclusion Although most CCC plans follow CDC-recommended tobacco control recommendations and funding levels, not all recommendations are addressed by every plan and certain recommendations are addressed in varying numbers of plans. Clearer prioritization of tobacco control recommendations by CDC may improve the extent to which they are followed and therefore maximize their public health benefit.
Collapse
Affiliation(s)
- Katherine Dunne
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Silk BJ, Foltz JL, Ngamsnga K, Brown E, Muñoz MG, Hampton LM, Jacobs-Slifka K, Kozak NA, Underwood JM, Krick J, Travis T, Farrow O, Fields BS, Blythe D, Hicks LA. Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study. BMC Infect Dis 2013; 13:291. [PMID: 23806063 PMCID: PMC3700825 DOI: 10.1186/1471-2334-13-291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 06/20/2013] [Indexed: 11/29/2022] Open
Abstract
Background During a Legionnaires’ disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis. Methods Survey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella. Results Eight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62–77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02–1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples. Conclusions Managers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults.
Collapse
|
43
|
Dunne K, Henderson S, Stewart S, Underwood JM. Abstract B82: Tobacco control in comprehensive cancer control plans: A 5 year update. Cancer Prev Res (Phila) 2012. [DOI: 10.1158/1940-6207.prev-12-b82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Tobacco use, specifically cigarette smoking, is the leading preventable cause of morbidity and mortality in the United States. Tobacco control is essential to cancer prevention and an integral component of the National Comprehensive Cancer Control Program (NCCCP), which is funded by the Centers for Disease Control and Prevention (CDC). NCCCP provides support and guidance to comprehensive cancer control (CCC) coalitions, which are comprised of a variety of public health and clinical practitioners, among others. CCC coalitions develop and publish cancer plans to address cancer burden and prevention in their population, which also include tobacco control. CDC provides recommendations for tobacco control through Best Practices for Comprehensive Tobacco Control Programs (Best Practices) and The Guide to Community Preventive Services (Community Guide). We aimed to determine the extent to which CCC plans incorporate CDC tobacco control and funding recommendations, updating a 2007 study which found that plans incorporated a mean of 5.6 out of 9 Best Practices recommendations and 3.9 out of 6 Community Guide recommendations, with 48.7% of plans addressing tobacco control funding and 25.7% identifying a specific funding goal.
Methods: We searched the Cancer Control PLANET Web page (http://cancercontrolplanet.cancer.gov) to obtain the most recent CCC plans available as of August 1, 2011 and analyzed tobacco-related content from 69 available plans to determine which of the CDC recommendations from Best Practices and the Community Guide were incorporated. Data was abstracted through a content review of the tobacco-related sections of each cancer plan, supplemented with a keyword search. We then summarized these data across the plans by using dichotomous indicators: yes, the recommendation was addressed in the plan, or no, the recommendation was not addressed in the plan. In addition, we analyzed whether the plan addressed funding for tobacco programs and, if so, whether the plan defined a specific funding goal.
Results: The 69 CCC plans incorporated a mean of 4.2 out of 5 recommendations from Best Practices (SD 2.8) and 4.8 out of 10 recommendations from the Community Guide (SD 2.1). Nearly sixty-one percent of plans (60.9%) addressed funding for tobacco control with 33.3% of those plans (20.3% of total) defining a specific, measurable funding goal.
Conclusions: The majority of CCC plans incorporated Best Practices and Community Guide recommendations and addressed funding for tobacco control. The proportion of Best Practices tobacco control recommendations incorporated into CCC plans has increased since the previous 2007 study, while the proportion of Community Guide recommendations incorporated into plans has decreased. Additionally, a larger proportion of plans addressed tobacco control funding in this study compared to the 2007 study. We recommend that CCC plans continue to incorporate CDC tobacco control recommendations and specific funding goals.
Citation Format: Katherine Dunne, Susan Henderson, Sherri Stewart, J. Michael Underwood. Tobacco control in comprehensive cancer control plans: A 5-year update. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B82.
Collapse
Affiliation(s)
- Katherine Dunne
- 1Emory University, Atlanta, GA, 2Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan Henderson
- 1Emory University, Atlanta, GA, 2Centers for Disease Control and Prevention, Atlanta, GA
| | - Sherri Stewart
- 1Emory University, Atlanta, GA, 2Centers for Disease Control and Prevention, Atlanta, GA
| | - J. Michael Underwood
- 1Emory University, Atlanta, GA, 2Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
44
|
Underwood JM, Townsend JS, Tai E, White A, Davis SP, Fairley TL. Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis. J Cancer Surviv 2012; 6:333-44. [PMID: 22706885 DOI: 10.1007/s11764-012-0230-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/28/2012] [Indexed: 01/29/2023]
Abstract
INTRODUCTION People who continue to smoke after a cancer diagnosis have an increased risk for recurrences or development of new malignancies. These risks may be even higher among tobacco-related cancer survivors (TRCS). We describe tobacco use behaviors among TRCS, other cancer survivors, and people without a history of cancer. METHODS We used 2009 Behavioral Risk Factor Surveillance System data to describe demographic characteristics, smoking history, current smoking prevalence, and smokeless tobacco use among TRCS, other cancer survivors, and people without a history of cancer (cigarette smoking and smokeless tobacco use were calculated after adjusting for age, sex, race, and insurance status). Tobacco-related cancers were defined as lung/bronchial, pharyngeal, laryngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical, and acute myeloid leukemia. RESULTS A total of 20 % of all cancer survivors were TRCS. TRCS were primarily female (68 %) and white (78 %). Smoking prevalence was higher among TRCS (27 %) compared with other cancer survivors (16 %) and respondents without a history of cancer (18 %). Smokeless tobacco use was higher among respondents without a history of cancer (4 %) compared with TRCS (3 %) and other cancer survivors (3 %). CONCLUSIONS The self-reported smoking prevalence among TRCS is higher than among other cancer survivors and people without a history of cancer. Targeted smoking prevention and cessation interventions are needed for cancer survivors, especially those diagnosed with a tobacco-related cancer. IMPLICATIONS FOR CANCER SURVIVORS We recommend all cancer survivors be made aware of the health risks associated with smoking after a cancer diagnosis, and smoking cessation services be offered to those who currently smoke. We provide the first population-based report on demographic characteristics and tobacco use behaviors among self-reported tobacco-related cancer survivors.
Collapse
Affiliation(s)
- J Michael Underwood
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Underwood JM, Rim SH, Fairley TL, Tai E, Stewart SL. Cervical cancer survivors at increased risk of subsequent tobacco-related malignancies, United States 1992-2008. Cancer Causes Control 2012; 23:1009-16. [PMID: 22588679 DOI: 10.1007/s10552-012-9957-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/05/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE Persistent smoking among cancer survivors may increase their risk of subsequent malignancies, including tobacco-related malignancies. Despite these risks, nearly 40 % of women diagnosed with cervical cancer continue to smoke after diagnosis. This study describes the relative risk of developing any subsequent and tobacco-related malignancy among cervical cancer survivors. METHODS We examined data from the year 1992 to 2008 in 13 Surveillance, Epidemiology and End Results registries. We calculated the standardized incidence ratio (SIR) and 95 % confidence limits (CLs) for all subsequent and tobacco-related malignancies among cervical cancer survivors. Tobacco-related malignancies were defined according to the 2004 Surgeon General's Report on the Health Consequences of Smoking. For comparison with cervical cancer survivors, SIRs for subsequent malignancies were also calculated for female survivors of breast or colorectal cancers. RESULTS The SIR of developing a subsequent tobacco-related malignancy was higher among cervical cancer survivors (SIR = 2.2, 95 % CL = 2.0-2.4). Female breast (SIR = 1.1, 95 % CL = 1.0-1.1) and colorectal cancer survivors (1.1, 1.1-1.2) also had an elevated risk. The increased risk of a subsequent tobacco-related malignancy among cervical cancer survivors was greatest in the first 5 years after the initial diagnosis and decreased as time since diagnosis elapsed. CONCLUSION Women with cervical cancer have a two-fold increased risk of subsequent tobacco-related malignancies, compared with breast and colorectal cancer survivors. In an effort to decrease their risk of subsequent tobacco-related malignancies, cancer survivors should be targeted for tobacco prevention and cessation services. Special attention should be given to cervical cancer survivors whose risk is almost twice that of breast or colorectal cancer survivors.
Collapse
|
46
|
Underwood JM, Townsend JS, Stewart SL, Buchannan N, Ekwueme DU, Hawkins NA, Li J, Peaker B, Pollack LA, Richards TB, Rim SH, Rohan EA, Sabatino SA, Smith JL, Tai E, Townsend GA, White A, Fairley TL. Surveillance of demographic characteristics and health behaviors among adult cancer survivors--Behavioral Risk Factor Surveillance System, United States, 2009. MMWR Surveill Summ 2012; 61:1-23. [PMID: 22258477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PROBLEM/CONDITION Approximately 12 million people are living with cancer in the United States. Limited information is available on national and state assessments of health behaviors among cancer survivors. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this report provides a descriptive state-level assessment of demographic characteristics and health behaviors among cancer survivors aged ≥18 years. REPORTING PERIOD COVERED 2009 DESCRIPTION OF SYSTEM BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years. BRFSS collects information on health risk behaviors and use of preventive health services related to leading causes of death and morbidity. In 2009, BRFSS added questions about previous cancer diagnoses to the core module. The 2009 BRFSS also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage for cancer survivors. In 2009, all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands administered the core cancer survivorship questions, and 10 states administered the optional supplemental cancer survivorship module. Five states added questions on mammography and Papanicolaou (Pap) test use, eight states included questions on colorectal screening, and five states included questions on prostate cancer screening. RESULTS An estimated 7.2% of the U.S. general population aged ≥18 years reported having received a previous cancer diagnosis (excluding nonmelanoma skin cancer). A total of 78.8% of cancer survivors were aged ≥50 years, and 39.2% had received a diagnosis of cancer >10 years previously. A total of 57.8% reported receiving an influenza vaccination during the previous year, and 48.3% reported ever receiving a pneumococcal vaccination. At the time of the interview, 6.8% of cancer survivors had no health insurance, and 12% had been denied health insurance, life insurance, or both because of their cancer diagnosis. The prevalence of cardiovascular disease was higher among male cancer survivors (23.4%) than female cancer survivors (14.3%), as was the prevalence of diabetes (19.6% and 14.7%, respectively). Overall, approximately 15.1% of cancer survivors were current cigarette smokers, 27.5% were obese, and 31.5% had not engaged in any leisure-time physical activity during the past 30 days. Demographic characteristics and health behaviors among cancer survivors varied substantially by state. INTERPRETATION Health behaviors and preventive health care practices among cancer survivors vary by state and demographic characteristics. A large proportion of cancer survivors have comorbid conditions, currently smoke, do not participate in any leisure-time physical activity, and are obese. In addition, many are not receiving recommended preventive care, including cancer screening and influenza and pneumococcal vaccinations. PUBLIC HEALTH ACTION Health-care providers and patients should be aware of the importance of preventive care, smoking cessation, regular physical activity, and maintaining a healthy weight for cancer survivors. The findings in this report can help public health practitioners, researchers, and comprehensive cancer control programs evaluate the effectiveness of program activities for cancer survivors, assess the needs of cancer survivors at the state level, and allocate appropriate resources to address those needs.
Collapse
|
47
|
Underwood JM, Townsend JS, Tai E, Davis SP, Stewart SL, White A, Momin B, Fairley TL. Racial and regional disparities in lung cancer incidence. Cancer 2011; 118:1910-8. [PMID: 21918961 DOI: 10.1002/cncr.26479] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/25/2011] [Accepted: 07/01/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the United States (US). We examined data from 2004 to 2006 for lung cancer incidence rates by demographics, including race and geographic region, to identify potential health disparities. METHODS Data from cancer registries affiliated with the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR), and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) were used for this study; representing 100% of the US population. Age-adjusted incidence rates and 95% confidence intervals for demographic (age, sex, race, ethnicity, and US Census region), and tumor (stage, grade, and histology) characteristics were calculated. RESULTS During 2004 to 2006, 623,388 people (overall rate of 68.9 per 100,000) were diagnosed with lung cancer in the US. Lung cancer incidence rates were highest among men (86.2), Blacks (73.0), persons aged 70 to 79 years (431.1), and those living in the South (74.7). Among Whites, the highest lung cancer incidence rate was in the South (75.6); the highest rates among Blacks (88.9) and American Indians/Alaska Natives (65.4) in the Midwest, Asians/Pacific Islanders in the West (40.0), and Hispanics in the Northeast (40.3). CONCLUSIONS Our findings of racial, ethnic, and regional disparities in lung cancer incidence suggest a need for the development and implementation of more effective culturally specific preventive and treatment strategies that will ultimately reduce the disproportionate burden of lung cancer in the US.
Collapse
|
48
|
Underwood JM, Fairley TL, Tai E. Abstract B90: Smoking prevalence among tobacco-related cancer survivors in the United States, BRFSS 2009. Cancer Prev Res (Phila) 2010. [DOI: 10.1158/1940-6207.prev-10-b90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Cancer survivors who continue to smoke are at increased risk for primary cancer recurrences or development of new malignancies. Risks may be even higher among Tobacco Related Cancer Survivors (TRCS). We provide a national report on smoking behavior among TRCS.
Methods: Tobacco-related cancers (lung/bronchial, pharyngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical and leukemia) are defined according to the 2004 report of the Surgeon General on The Health Consequences of Smoking. Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were used to describe demographic characteristics and tobacco use behaviors reported by TRCS, other cancer survivors and the non cancer BRFSS cohort. Self reported prevalence percentages and confidence intervals were calculated using SAS version 9.2 (SAS Institute, Inc, Cary, North Carolina).
Results: Overall, 10% of BRFSS respondents reported being diagnosed with cancer. Approximately 17% of all cancer survivors were diagnosed with a tobacco related cancer. Survivors in this group were primarily white (85.4%) and female (71.9%). Approximately 8.8% of TRCS were Hispanic. TRCS report a substantially higher proportion of current and past tobacco use. Among TRCS, 68% (95%CI 66.0-69.0) reported a history of smoking and 27.1% (95%CI 25.4-28.9) reported currently smoking; among other cancer survivors, 45.7% (95%CI 45.4-45.9) reported a history of smoking and 27.6% (95%CI 27.3-27.9) reported currently smoking.
Conclusion: When compared to other cancer survivors, persons diagnosed with tobacco related cancers have higher past and current smoking rates. Smoking cessation interventions should target TRCS, and increased surveillance of smoking behaviors is needed in this population.
Citation Information: Cancer Prev Res 2010;3(12 Suppl):B90.
Collapse
Affiliation(s)
| | | | - Eric Tai
- 1Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
49
|
Heisterkamp A, Maxwell IZ, Mazur E, Underwood JM, Nickerson JA, Kumar S, Ingber DE. Pulse energy dependence of subcellular dissection by femtosecond laser pulses. Opt Express 2005; 13:3690-6. [PMID: 16035172 DOI: 10.1364/opex.13.003690] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Precise dissection of cells with ultrashort laser pulses requires a clear understanding of how the onset and extent of ablation (i.e., the removal of material) depends on pulse energy. We carried out a systematic study of the energy dependence of the plasma-mediated ablation of fluorescently-labeled subcellular structures in the cytoskeleton and nuclei of fixed endothelial cells using femtosecond, near-infrared laser pulses focused through a high-numerical aperture objective lens (1.4 NA). We find that the energy threshold for photobleaching lies between 0.9 and 1.7 nJ. By comparing the changes in fluorescence with the actual material loss determined by electron microscopy, we find that the threshold for true material ablation is about 20% higher than the photobleaching threshold. This information makes it possible to use the fluorescence to determine the onset of true material ablation without resorting to electron microscopy. We confirm the precision of this technique by severing a single microtubule without disrupting the neighboring microtubules, less than 1 micrometer away.
Collapse
Affiliation(s)
- A Heisterkamp
- Department of Engineering and Applied Science, Harvard University, Cambridge, MA 02138, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Zand T, Hoffman AH, Savilonis BJ, Underwood JM, Nunnari JJ, Majno G, Joris I. Lipid deposition in rat aortas with intraluminal hemispherical plug stenosis. A morphological and biophysical study. Am J Pathol 1999; 155:85-92. [PMID: 10393841 PMCID: PMC1866656 DOI: 10.1016/s0002-9440(10)65103-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A new method was devised to create a stenosis in the rat abdominal aorta. To restrict blood flow, a hemispherical plug was inserted into the aorta through a renal artery. This type of intrinsic (intraluminal) stenosis minimizes possible intramural effects associated with external compression or ligation which severely deform the arterial wall. In the aorta of hypercholesterolemic rats, lipid deposits were distributed in crescent-shaped patches proximal and distal to the plug, whereas lipid deposition in the opposite aortic wall was inhibited. Based on enlarged physical scale models used to study the flow field, the regions of lipid deposition were found to coincide with regions of low shear stress, stagnation, and recirculation. Shear stress was elevated at the wall opposite the plug. These results show that when confounding mural effects are minimized, lipid deposition is promoted in regions of low shear stress with recirculation and inhibited in regions of elevated shear stress.
Collapse
Affiliation(s)
- T Zand
- Department of Pathology,* University of Massachusetts Medical School, Worcester, Massachusetts Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|