PURPOSE: Characteristics of parents who purchased kids' meals, reasons for the purchase, and desire for healthy options were examined. DESIGN: Quantitative, cross-sectional study. SETTING: National. PARTICIPANTS: The SummerStyles survey data of 1147 parents (>/=18 years). MEASURES: Self-reported outcome variables were purchase of kids' meals (yes/no), reasons for the purchase (13 choices), and desire for healthy options (yes/no). ANALYSIS: We used multivariable logistic regression to estimate odds ratios (ORs) for purchasing kids' meals based on parental sociodemographic and behavioral characteristics. RESULTS: Over half (51%) of parents reported purchasing kids' meals in the past month. The adjusted OR of purchasing kids' meals were significantly higher among younger parents (OR = 3.44 vs >/=50 years) and among parents who consumed sugar-sweetened beverages (SSBs) daily (OR = 2.70 vs none). No differences were found for race/ethnicity, income, and education. Parents who purchased kids' meals reported that the top 3 reasons for purchase were (1) because their children asked for kids' meals, (2) habit, and (3) offering of healthier sides such as fruits or fruit cups. Thirty-seven percent of parents who did not purchase kids' meals expressed willingness to purchase kids' meals if healthy options were available; this willingness was highest among younger parents (47%; P < .05). CONCLUSIONS: Kids' meal purchases were somewhat common. Our findings on characteristics of parents who frequently bought kids' meals (ie, younger parents and SSB consumers), common reasons for purchasing kids' meals, and willingness to buy healthier kids' meal can be used to inform intervention efforts to improve quality of kids' meals.

Physical activity offers many benefits to health, whether it be | preventing disease, contributing to emotional and cognitive health, | or helping to maintain independence later in life. 1,2 Many consider | it the “wonder drug” of health promotion. And while the benefits | are multiple, the behavior is simple. People only need to be active | for at least 150 minutes a week for adults and 60 minutes a day for | school-age youth. 2 It can even occur in short bouts, lasting at least | 10 minutes. Unfortunately, only one-half of adults3 and about one- | quarter of high school students4 are sufficiently active to realize the | health benefits of physical activity. To improve population levels | of physical activity, an increase in walking may be an important | place to start. In this supplement, titled “Walking and Walkability: | Approaches to Increase Physical Activity and Improve Health,” | the selected authors turn their attention to walking as the most | common and preferred activity for many teens and adults. Watson | et al report that 54% of US women and 41% of men cite walking as | their most common activity during the past month. 5 Similarly, Song | et al report that walking was the most frequently reported physical | activity among US high school students

Childhood obesity is a serious national health problem with 17% of American youth living with obesity.1 In 2010, the Patient Protection and Affordable Care Act (ACA) appropriated $25 million for a 4-year community-based study to determine whether an integrated model of primary care and public health services can improve underserved children's risk factors for obesity. In response, the CDC established the Childhood Obesity Research Demonstration (CORD) to meet the requirements of the ACA and address the call by expert groups for comprehensive, multilevel, multisetting approaches to prevent and reduce childhood obesity.2 This commentary introduces the nine articles in this issue that describe the research collaboration funded by the CDC. | Obesity-related health behaviors, such as nutrition and physical activity, are shaped by multiple sources of influence and environments, including the home, early care and education, school, healthcare, and other community settings. Therefore, a host of setting stakeholders who influence these settings, including government, education, the private setting, nonprofit organizations, and families, have a role to play in creating healthier communities. CORD will add to the limited research available on comprehensive, community-wide models for childhood obesity prevention. A recent comparative effectiveness review of the peer-reviewed childhood obesity prevention literature in developed countries found there is a need for more studies that include results from interventions occurring in multiple settings.3 The systematic review found a very limited number of articles with multiple settings and only one community-based, multiple-setting, early childhood obesity prevention study that measured weight and had at least 1 year of follow-up.4 In school-aged youth in the United States, Shape Up Somerville has been novel in its results of reducing BMI over 2 years through a community-based participatory research approach that met the community's interests and strengths and interventions that could be included into existing “platforms” (schools, afterschool, and community).5

The 2 articles by Urban and colleagues published this week in Preventing Chronic Disease report 15-year trends in sodium, trans fat, and saturated fat, 3 food components associated with increased risk for cardiovascular disease and obesity, in frequently ordered meal items (French fries, cheeseburgers, grilled chicken sandwiches, and regular cola) from leading US national fast food chain restaurants (1,2). These longitudinal findings track these 3 food components in foods that are frequently consumed by Americans. In recent surveys, almost half of Americans report eating fast food at least weekly (http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx), and similarly, nearly half report drinking soda daily (http://www.gallup.com/poll/156116/Nearly-Half-Americans-Drink-Soda-Daily.aspx). The findings by Urban et al confirm a substantial reduction in the content of trans fat and saturated fat in French fries but not in cheeseburgers or chicken sandwiches. Changes were inconsistent in sodium, saturated fat, and calories among food products, with the exception of sodas, where there was an increase in portion size. The authors conclude that, unlike the reduction observed in artificial trans fat in French fries, the content of sodium, saturated fat, and calories in the selected foods did not change much. Taken together, these findings indicate that little improvement has been made in the quality or energy density of popular fast food products and suggest the need for interventions to improve population health. | It is important to consider these findings in the larger context as public health researchers, practitioners, and policy makers develop and implement interventions to reduce intake of excessive calories, saturated fat, and artificial trans fat. Cheeseburgers, French fries, and a soda represent a quintessential part of American culture. Banter about them was central to the Saturday Night Live skit made famous by the late John Belushi. Similarly, songs made popular by performers such as Jimmy Buffett, Charlie Pride, the Gang of Four, and the Village People are all about having a cheeseburger, French fries, and a soda. These staples of the American diet are unlikely to disappear. However, central to American food choices is an unacceptably high prevalence of diet-related risk factors that compromise the health of Americans and contribute to the high costs of chronic disease. During the period examined by Urban and colleagues, the late 1990s through 2013, the US prevalence of chronic disease risk factors such as overweight, obesity, and hypertension have remained high, cardiovascular disease remains the leading cause of death, and prevalence of prediabetes and diabetes continues to increase (3). The continued popularity of fast food restaurants and continued high prevalence of diet-related risk factors remind public health researchers, practitioners, and policy makers that there is much that needs to be done.

In 2010, the top five causes of death in the United States were 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries. The rates of death from each cause vary greatly across the 50 states and the District of Columbia (2). An understanding of state differences in death rates for the leading causes might help state health officials establish disease prevention goals, priorities, and strategies. States with lower death rates can be used as benchmarks for setting achievable goals and calculating the number of deaths that might be prevented in states with higher rates. To determine the number of premature annual deaths for the five leading causes of death that potentially could be prevented ("potentially preventable deaths"), CDC analyzed National Vital Statistics System mortality data from 2008-2010. The number of annual potentially preventable deaths per state before age 80 years was determined by comparing the number of expected deaths (based on average death rates for the three states with the lowest rates for each cause) with the number of observed deaths. The results of this analysis indicate that, when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year. In addition, states in the Southeast had the highest number of potentially preventable deaths for each of the five leading causes. The findings provide disease-specific targets that states can use to measure their progress in preventing the leading causes of deaths in their populations.

The findings described in this supplement can help improve collaboration among public health and other stakeholders who influence population health, including employers, health plans, health professionals, and voluntary associations, to increase the use of a set of clinical preventive services that, with improved use, can substantially reduce morbidity and mortality in the U.S. adult population. This supplement highlighted that the use of the clinical preventive services in the U.S. adult population is not optimal and is quite variable, ranging from approximately 10% to 85%, depending on the particular service. Use was particularly low for tobacco cessation, aspirin use to reduce risk of cardiovascular disease, and influenza vaccination; however, ample opportunity exists to improve use of all of these services. Among the specific populations least likely to have used the recommended services, persons with no insurance, no usual source of care, or no recent use of the health-care system (if included in the analysis) were the groups least likely to have used the services. Use among the uninsured was generally 10 to 30 percentage points below the general population averages, suggesting that improvements in insurance coverage are likely to increase use of these clinical preventive services. A randomized, controlled trial of an expansion of Medicaid coverage by Oregon in 2008 supports this hypothesis by demonstrating improved use of clinical services with increased health insurance coverage. A recent survey among the uninsured found a low level of awareness of the provisions of the Patient Protection and Affordable Care Act of 2010 as amended by the Healthcare and Education Reconciliation Act of 2010 (referred to collectively as the Affordable Care Act [ACA]). Therefore, improving opportunities for coverage might be insufficient, and focused efforts by governmental health agencies and other stakeholders are likely to be needed to enroll uninsured persons in health plans. In addition, although use of the preventive services in insured populations was greater than among the uninsured, use among the insured was generally <75%, and often much less. Therefore, having health insurance coverage might not itself be sufficient to optimize use of clinical preventive services, and additional measures to improve use are likely to be necessary.

This paper reports the outcome of the Galway Consensus Conference, an effort undertaken as a first step toward international collaboration on credentialing in health promotion and health education. Twenty-nine leading authorities in health promotion, health education, and public health convened a 2-day meeting in Galway, Ireland, during which the available evidence on credentialing in health promotion was reviewed and discussed. Conference participants reached agreement on core values and principles, a common definition, and eight domains of core competency required to engage in effective health promotion practice. The domains of competency are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships. The long-term aim of this work is to stimulate a global dialogue that will lead to the development and widespread adoption of standards and quality assurance systems in all countries to strengthen capacity in health promotion, a critical element in achieving goals for the improvement of global population health.