Last data update: Jul 08, 2025. (Total: 49524 publications since 2009)
Records 1-26 (of 26 Records) |
Query Trace: Zaganjor I[original query] |
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Self-Reported Reasons Preventing US Adults From Walking to Places Within 10 Minutes of Home
Zaganjor H , Chen TJ , Van Dyke ME , Soto GW , Whitfield GP , Smith A , Devlin HM , Irani K , Rose K , Matjasko JL . Prev Chronic Dis 2025 22 E29 INTRODUCTION: Increasing walking for transportation is a strategy to integrate physical activity into daily life. We examined reported environmental, access, and individual reasons for not walking to places near home among US adults, by sociodemographic characteristics and geographic location. METHODS: We used data from the 2022 SummerStyles survey on 3,967 US adults aged 18 years or older. We calculated prevalence of reporting 11 selected reasons for not walking to places within 10 minutes of home, overall and by sex, race or ethnicity, age, education, income, US census region, and metropolitan residence (an area with at least 1 urban area of ≥50,000 inhabitants) versus nonmetropolitan residence. We used Bonferroni-corrected pairwise comparisons and orthogonal polynomial contrasts (ordered groups) to compare prevalence by subgroup. RESULTS: Overall, 79.0% of respondents identified at least 1 reason for not walking to places near home (within 10 minutes). Commonly reported reasons were hot and humid conditions (36.0%), no places to walk within 10 minutes (24.9%), a preference for driving (22.1%), and inconvenience (21.5%). The reasons varied significantly across sociodemographic and geographic subgroups. The prevalence of reporting none of the listed reasons was higher among males than females, higher among non-Hispanic Black and non-Hispanic Asian adults than non-Hispanic White adults, and higher among adults from the Northeast versus the South. CONCLUSION: Eight of 10 US adults reported at least 1 environmental, access, or individual reason for not walking to places near home. Designing communities to make walking for transportation more accessible, convenient, and desirable may help address the leading reasons reported, which may support adults in adding more physical activity to their daily lives. |
Factors Preventing Walking to Near-Home Destinations by Transportation Walking Status, U.S. Adults, 2022
Chen TJ , Zaganjor H , Van Dyke ME , Matjasko JL , Whitfield GP . J Healthy Eat Act Living 2024 4 (3) 120-127 Increasing transportation walking (i.e., walking to get to and from destinations) is a key strategy for increasing physical activity, but what is not well understood are factors preventing people who do not walk for transportation from initiating that practice and current transportation walkers from maintaining or increasing this behavior. This study describes factors preventing adults who report walking or not walking for transportation from regularly walking to destinations near home. National data from the 2022 Summer Styles survey included 3,955 U.S. adults who indicated factors preventing them from regularly walking to places within a 10-minute walk of their home, selecting all that apply from 11 environmental, access, or individual factors, or "None of the above." We estimated weighted prevalence for each factor and conducted pairwise t-tests to identify significant differences (p<.05) by transportation walking status. About 31% of adults not walking for transportation in the past 7 days reported having no places to walk to within a 10-minute walk, more than double the prevalence among transportation walkers (14%). Compared to transportation walkers, more adults not walking for transportation reported individual factors (i.e., 24% preferred driving or being driven, vs. 19%; 23% reported inconvenience, vs. 19%), while more transportation walkers reported environmental factors (e.g., 40% reported hot or humid conditions, vs. 34%) or none of the factors. These findings suggest those not walking for transportation may need varied interventions, such as mixed land use for near-home destinations and individual supports, to meet their needs for transportation walking. |
Developing a computable phenotype for identifying children, adolescents, and young adults with diabetes using electronic health records in the DiCAYA Network
Shao H , Thorpe LE , Islam S , Bian J , Guo Y , Li P , Bost S , Dabelea D , Conway R , Crume T , Schwartz BS , Hirsch AG , Allen KS , Dixon BE , Grannis SJ , Lustigova E , Reynolds K , Rosenman M , Zhong VW , Wong A , Rivera P , Le T , Akerman M , Conderino S , Rajan A , Liese AD , Rudisill C , Obeid JS , Ewing JA , Bailey C , Mendonca EA , Zaganjor I , Rolka D , Imperatore G , Pavkov ME , Divers J . Diabetes Care 2025 OBJECTIVE: The Diabetes in Children, Adolescents, and Young Adults (DiCAYA) network seeks to create a nationwide electronic health record (EHR)-based diabetes surveillance system. This study aimed to develop a DiCAYA-wide EHR-based computable phenotype (CP) to identify prevalent cases of diabetes. RESEARCH DESIGN AND METHODS: We conducted network-wide chart reviews of 2,134 youth (aged <18 years) and 2,466 young adults (aged 18 to <45 years) among people with possible diabetes. Within this population, we compared the performance of three alternative CPs, using diabetes diagnoses determined by chart review as the gold standard. CPs were evaluated based on their accuracy in identifying diabetes and its subtype. RESULTS: The final DiCAYA CP requires at least one diabetes diagnosis code from clinical encounters. Subsequently, diabetes type classification was based on the ratio of type 1 diabetes (T1D) or type 2 diabetes (T2D) diagnosis codes in the EHR. For both youth and young adults, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) in finding diabetes cases were >90%, except for the specificity and NPV in young adults, which were slightly lower at 83.8% and 80.6%, respectively. The final DiCAYA CP achieved >90% sensitivity, specificity, PPV, and NPV in classifying T1D, and demonstrated lower but robust performance in identifying T2D, consistently maintaining >80% across metrics. CONCLUSIONS: The DiCAYA CP effectively identifies overall diabetes and T1D in youth and young adults, though T2D misclassification in youth highlights areas for refinement. The simplicity of the DiCAYA CP enables broad deployment across diverse EHR systems for diabetes surveillance. |
Pain management and social functioning limitations among adults with chronic pain by diabetes status: National Health Interview Survey, United States, 2019-2020
Zaganjor I , Saelee R , Miyamoto Y , Xu F , Pavkov ME . Prim Care Diabetes 2024 AIMS: This study aims to describe pain management technique usage and social functioning limitations among adults with chronic pain by diabetes status. METHODS: The 2019 and 2020 National Health Interview Survey data were pooled to complete this analysis. Use of the following techniques in the past 3 months were measured: 1) prescription opioids; 2) physical, rehabilitative, or occupational therapy; 3) talk therapies; 4) chiropractic care; 5) yoga, Tai Chi, or Qi Gong; 6) massage; and 7) relaxation techniques. The social functioning limitations assessed were: 1) doing errands alone; 2) participating in social activities; and 3) work limitations. Weighted prevalence and 95 % confidence intervals (CIs) were estimated for each outcome by diabetes status. Logistic regression was used to estimate age- and sex-adjusted odds ratios (aORs) to assess differences by diabetes status. RESULTS: Adults with diabetes and chronic pain were more likely to use prescription opioids (aOR: 1.4; 95 % CI: 1.2, 1.6) but less likely to use various nonpharmacological techniques than those without diabetes. Additionally, adults with diabetes and chronic pain were more likely to report each social functioning limitation than those without diabetes. CONCLUSIONS: Results suggest adults with diabetes and chronic pain may be missing beneficial opportunities to manage pain. |
Telemedicine use among adults with and without diagnosed prediabetes or diabetes, National Health Interview Survey, United States, 2021 and 2022
Zaganjor I , Saelee R , Onufrak S , Miyamoto Y , Koyama AK , Xu F , Bullard KM , Pavkov ME . Prev Chronic Dis 2024 21 E90 We analyzed 2021 and 2022 National Health Interview Survey data to describe the prevalence of past 12-month telemedicine use among US adults with no prediabetes or diabetes diagnosis, diagnosed prediabetes, and diagnosed diabetes. In 2021 and 2022, telemedicine use prevalence was 34.1% and 28.2% among adults without diagnosed diabetes or prediabetes, 47.6% and 37.6% among adults with prediabetes, and 52.8% and 39.4% among adults with diabetes, respectively. Differences in telemedicine use were identified by region, urbanicity, insurance status, and education among adults with prediabetes or diabetes. Findings suggest that telemedicine use can be improved among select populations with prediabetes or diabetes. |
Prevalence of self-reported diagnosed diabetes among adults, by county metropolitan status and region, United States, 2019-2022
Onufrak S , Saelee R , Zaganjor I , Miyamoto Y , Koyama AK , Xu F , Pavkov ME , Bullard KM , Imperatore G . Prev Chronic Dis 2024 21 E81 INTRODUCTION: Previous research suggests that rural-urban disparities in diabetes mortality, hospitalization, and incidence rates may manifest differently across US regions. However, no studies have examined disparities in diabetes prevalence by metropolitan residence and region. METHODS: We used data from the 2019-2022 National Health Interview Survey to compare diabetes status, socioeconomic characteristics, and weight status among adults in each census region (Northeast, Midwest, South, West) according to county metropolitan status of residence (large central metro, large fringe metro, small/medium metro, and nonmetro). We used χ(2) tests and logistic regression models to assess the association of metropolitan residence with diabetes prevalence in each region. RESULTS: Diabetes prevalence ranged from 7.0% in large fringe metro counties in the Northeast to 14.8% in nonmetro counties in the South. Compared with adults from large central metro counties, those from small/medium metro counties had significantly higher odds of diabetes in the Midwest (age-, sex-, and race and ethnicity-adjusted odds ratio [OR] = 1.24; 95% CI, 1.06-1.45) and South (OR = 1.15; 95% CI, 1.02-1.30). Nonmetro residence was also associated with diabetes in the South (OR = 1.62 vs large central metro; 95% CI, 1.43-1.84). After further adjustment for socioeconomic and body weight status, small/medium metro associations with diabetes became nonsignificant, but nonmetro residence in the South remained significantly associated with diabetes (OR = 1.22; 95% CI, 1.07-1.39). CONCLUSION: The association of metropolitan residence with diabetes prevalence differs across US regions. These findings can help to guide efforts in areas where diabetes prevention and care resources may be better directed. |
Maternal exposure to tap water disinfection by-products and risk of selected congenital heart defects
Michalski AM , Luben TJ , Zaganjor I , Rhoads A , Romitti PA , Conway KM , Langlois PH , Feldkamp ML , Nembhard WN , Reefhuis J , Yazdy MM , Lin AE , Desrosiers TA , Hoyt AT , Browne ML . Birth Defects Res 2024 116 (9) e2391 ![]() BACKGROUND: The use of chlorine to treat drinking water produces disinfection by-products (DBPs), which have been associated with congenital heart defects (CHDs) in some studies. METHODS: Using National Birth Defects Prevention Study data, we linked geocoded residential addresses to public water supply measurement data for DBPs. Self-reported water consumption and filtration methods were used to estimate maternal ingestion of DBPs. We estimated adjusted odds ratios and 95% confidence intervals using logistic regression controlling for maternal age, education, body mass index (BMI), race/ethnicity, and study site to examine associations between CHDs and both household DBP level and estimated ingestion of DBPs. RESULTS: Household DBP exposure was assessed for 2717 participants (1495 cases and 1222 controls). We observed a broad range of positive, null, and negative estimates across eight specific CHDs and two summary exposures (trihalomethanes and haloacetic acids) plus nine individual DBP species. Examining ingestion exposure among 2488 participants (1347 cases, 1141 controls) produced similarly inconsistent results. CONCLUSIONS: Assessing both household DBP level and estimated ingestion of DBPs, we did not find strong evidence of an association between CHDs and DBPs. Despite a large study population, DBP measurements were available for less than half of participant addresses, limiting study power. |
Urban-rural differences in acute kidney injury mortality in the United States
Xu F , Miyamoto Y , Zaganjor I , Onufrak S , Saelee R , Koyama AK , Pavkov ME . Am J Prev Med 2024 INTRODUCTION: Acute kidney injury (AKI) is associated with increased mortality. AKI-related mortality trends by US urban and rural counties were assessed. METHODS: In the cross-sectional study, based on the Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) Multiple Cause of Death data, age-standardized mortality with AKI as the multiple cause was obtained among adults aged ≥25 years from 2001-2020, by age, sex, race and ethnicity, stratified by urban-rural counties. Joinpoint regressions were used to assess trends from 2001-2019 in AKI-related mortality rate. Pairwise comparison was used to compare mean differences in mortality between urban and rural counties from 2001-2019. RESULTS: From 2001-2020, age-standardized AKI-related mortality was consistently higher in rural than urban counties. AKI-related mortality (per 100,000 population) increased from 18.95 in 2001 to 29.46 in 2020 in urban counties and from 20.10 in 2001 to 38.24 in 2020 in rural counties. In urban counties, AKI-related mortality increased annually by 4.6% during 2001-2009 and decreased annually by 1.8% until 2019 (p<0.001). In rural counties, AKI-related mortality increased annually by 5.0% during 2001-2011 and decreased by 1.2% until 2019 (p<0.01). The overall urban-rural difference in AKI-related mortality was greater after 2009-2011. AKI-related mortality was significantly higher among older adults, men, and non-Hispanic Black adults than their counterparts in both urban and rural counties. Higher mortality was concentrated in rural counties in the Southern United States. CONCLUSIONS: Multidisciplinary efforts are needed to increase AKI awareness and implement strategies to reduce AKI-related mortality in rural and high-risk populations. |
Emergency department visits for pedestrians injured in motor vehicle traffic crashes - United States, January 2021-December 2023
Barry V , Van Dyke ME , Nakayama JY , Zaganjor H , Sheppard M , Stein Z , Radhakrishnan L , Schweninger E , Rose K , Whitfield GP , West B . MMWR Morb Mortal Wkly Rep 2024 73 (17) 387-392 Traffic-related pedestrian deaths in the United States reached a 40-year high in 2021. Each year, pedestrians also suffer nonfatal traffic-related injuries requiring medical treatment. Near real-time emergency department visit data from CDC's National Syndromic Surveillance Program during January 2021-December 2023 indicated that among approximately 301 million visits identified, 137,325 involved a pedestrian injury (overall visit proportion = 45.62 per 100,000 visits). The proportions of visits for pedestrian injury were 1.53-2.47 times as high among six racial and ethnic minority groups as that among non-Hispanic White persons. Compared with persons aged ≥65 years, proportions among those aged 15-24 and 25-34 years were 2.83 and 2.61 times as high, respectively. The visit proportion was 1.93 times as high among males as among females, and 1.21 times as high during September-November as during June-August. Timely pedestrian injury data can help collaborating federal, state, and local partners rapidly monitor trends, identify disparities, and implement strategies supporting the Safe System approach, a framework for preventing traffic injuries among all road users. |
Prevalence of vision zero action plans or strategies: USA, 2021
Webber BJ , Whitfield GP , Rose KM , Stowe EW , Zaganjor H , Ederer DJ , Fulton JE . Inj Prev 2024 BACKGROUND: Vision Zero is a strategy to eliminate traffic fatalities and to promote equitable mobility options for all road users. Using a nationally representative survey, we aimed to estimate the prevalence of Vision Zero action plans or strategies in the USA. METHODS: Municipal officials were surveyed in 2021. In this cross-sectional study, we calculated the prevalence of Vision Zero plans or strategies and compared municipalities with adjusted prevalence ratios (PR) to account for region and sociodemographic characteristics. RESULTS: Among 1955 municipalities participating in the survey (question-specific response rate: 44.3%), the prevalence of a Vision Zero action plan or strategy was 7.7%; 70.5% responded no and 21.8% don't know. Prevalence was 4.8% in small municipalities (1000-2499 residents), 20.3% in medium-large municipalities (50 000-124 999 residents; PR=4.1), and 37.8% in large municipalities (≥125 000 residents; PR=7.6). CONCLUSION: The prevalence of Vision Zero plans and strategies across the USA is low. Additional adoption of Vision Zero plans and strategies could help address traffic fatalities. |
Physical activity according to diabetes and metropolitan status: United States 2020 and 2022
Onufrak S , Saelee R , Zaganjor I , Miyamoto Y , Koyama AK , Xu F , Pavkov ME . Am J Prev Med 2024 INTRODUCTION: Physical activity (PA) can reduce morbidity and mortality among adults with diabetes. While rural disparities in PA exist among the general population, it is not known how these disparities manifest among adults with diabetes. METHODS: Data from the 2020 and 2022 National Health Interview Survey were analyzed in 2023 to assess prevalence of meeting aerobic and muscle-strengthening recommendations according to the 2018 Physical Activity Guidelines for Americans during leisure time. PA prevalence was computed by diabetes status, type of PA, and urban/rural residence (large central metro, large fringe metro, medium/small metro, and non-metro). Logistic regression models were used to estimate prevalence and prevalence ratios of meeting PA recommendations by urban/rural residence across diabetes status. RESULTS: Among adults with diabetes in non-metro counties, only 23.8% met aerobic, 10.9% met muscle-strengthening, and 6.2% met both PA recommendations. By contrast, among adults with diabetes in large fringe metro counties, 32.1% met aerobic, 19.7% met strengthening, and 12.0% met both guidelines. Multivariable adjusted prevalence of meeting muscle-strengthening recommendations was higher among participants with diabetes in large fringe metro compared to large central metro counties (PR=1.27; 95% CI 1.03-1.56). Among those without diabetes, adjusted prevalence of meeting each recommendation or both was lower in non-metro and small/medium metro compared to large central metro counties. CONCLUSIONS: Adults with diabetes are less likely to meet the PA recommendations than those without, and differences exist according to urban/rural status. Improving PA among rural residents with diabetes may mitigate disparities in diabetes-related mortality. |
Change in testing for blood glucose during the COVID-19 pandemic, United States 2019–2021
Miyamoto Y , Saelee R , Koyama AK , Zaganjor I , Xu F , Onufrak S , Pavkov ME . Diabetes Res Clin Pract 2023 205 Aim: This study assessed changes in testing for blood glucose in the United States (US) from 2019 to 2021. Methods: We conducted a serial cross-sectional analysis of the 2019–2021 National Health Interview Survey by including adults aged ≥ 18 years without reported diagnosed diabetes. We estimated the prevalence of testing for blood glucose within 12 months and the difference in the testing prevalence between 2019 and 2021. Results: The study sample included 82,594 respondents without diabetes in 2019––2021, with a mean age between 46.4 and 46.8 years. Overall, the prevalence of testing for blood glucose decreased significantly from 64.2 % (95 % confidence interval [CI] 63.3 %, 65.1 %) in 2019 to 60.0 % (95 % CI 59.1 %, 60.9 %) in 2021. Among adults who met the United States Preventive Services Task Force's 2015 screening recommendation, the prevalence decreased from 73.4 % (95 % CI 72.2 %, 74.6 %) to 69.5 % (95 % CI 68.3 %, 70.6 %). Although decreases in testing were observed in most groups, the extent of the decline differed by subgroups. Conclusions: Testing for blood glucose decreased in the US during the COVID-19 pandemic. This may have delayed diagnosis and treatment of prediabetes and diabetes, underscoring the importance of continued access to diabetes screening during pandemics. © 2023 |
Traffic as a barrier to walking safely in the United States: Perceived reasons and potential mitigation strategies
Soto GW , Whitfield GP , Webber BJ , Omura JD , Chen TJ , Zaganjor H , Rose K . Prev Med Rep 2022 30 102003 Motor vehicle traffic is commonly cited as a barrier to walking, but national level perceptions of traffic characteristics that negatively influence walking and potential traffic mitigation strategies remain unclear. The objectives of this study were to describe perceptions of (1) traffic characteristics that make walking unsafe in the United States and (2) potential mitigation strategies to address these concerns among those who report traffic as a barrier to walking. Data were from FallStyles, a nationwide internet panel survey conducted in October 2019 (n = 3,284 adults). Respondents reported if traffic makes walking unsafe where they live; those who answered yes were then asked about traffic characteristics that make walking unsafe (number of vehicles, speed of vehicles, distracted or impaired driving, types of vehicles, and other reasons) and potential mitigation strategies (new or improved sidewalks, crosswalks, pedestrian signals, street lighting, things that slow vehicles down, separating the sidewalk from the road, fewer vehicle lanes, and other). Prevalence of responses was assessed overall and by select sociodemographic and geographic characteristics, and by walking status. Nearly 25% of US adults reported that traffic is a barrier to walking where they live. Of these, 79% selected vehicle speed as a contributing traffic characteristic, and 57% indicated new or improved sidewalks as a potential mitigation strategy. These top responses were shared across all sociodemographic, geographic, and walking behavior subgroups. Speed reduction efforts and built environment enhancements such as sidewalks may alleviate pedestrian safety concerns. Promotion campaigns may be needed to bring awareness to such changes. |
Is maternal employment site a source of exposure misclassification in studies of environmental exposures and birth outcomes? A simulation-based bias analysis of haloacetic acids in tap water and hypospadias.
Zaganjor I , Keil AP , Luben TJ , Desrosiers TA , Engel LS , Reefhuis J , Michalski AM , Langlois PH , Olshan AF . Environ Epidemiol 2022 6 (2) e207 ![]() In population research, exposure to environmental contaminants is often indirectly assessed by linking residence to geocoded databases of environmental exposures. We explored the potential for misclassification of residence-based environmental exposure as a result of not accounting for the workplace environments of employed pregnant women using data from a National Birth Defects Prevention Study (NBDPS) analysis of drinking water haloacetic acids and hypospadias. METHODS: The original analysis used NBDPS data from women with haloacetic acid exposure information in eight states who delivered an infant with second- or third-degree hypospadias (cases) or a male infant without a birth defect (controls) between 2000 and 2005. In this bias analysis, we used a uniform distribution to randomly select 11%-14% of employed women that were assumed to change municipal water systems between home and work and imputed new contaminant exposures for tap water beverages consumed at work among the selected women using resampled values from the control population. Multivariable logistic regression was used to estimate the association between hypospadias and haloacetic acid ingestion with the same covariates and exposure cut-points as the original study. We repeated this process across 10,000 iterations and then completed a sensitivity analysis of an additional 10,000 iterations where we expanded the uniform distribution (i.e., 0%, 28%). RESULTS: In both simulations, the average results of the 10,000 iterations were nearly identical to those of the initial study. CONCLUSIONS: Our results suggest that household estimates may be sufficient proxies for worksite exposures to haloacetic acids in tap water. |
Priorities and indicators for economic evaluation of built environment interventions to promote physical activity
Cradock AL , Buchner D , Zaganjor H , Thomas JV , Sallis JF , Rose K , Meehan L , Lawson M , Lavinghouze R , Fenton M , Devlin HM , Carlson SA , Bhattacharya T , Fulton JE . J Phys Act Health 2021 18 (9) 1-9 BACKGROUND: Built environment approaches to promoting physical activity can provide economic value to communities. How best to assess this value is uncertain. This study engaged experts to identify a set of key economic indicators useful for evaluation, research, and public health practice. METHODS: Using a modified Delphi process, a multidisciplinary group of experts participated in (1) one of 5 discussion groups (n = 21 experts), (2) a 2-day facilitated workshop (n = 19 experts), and/or (3) online surveys (n = 16 experts). RESULTS: Experts identified 73 economic indicators, then used a 5-point scale to rate them on 3 properties: measurement quality, feasibility of use by a community, and influence on community decision making. Twenty-four indicators were highly rated (≥3.9 on all properties). The 10 highest-rated "key" indicators were walkability score, residential vacancy rate, housing affordability, property tax revenue, retail sales per square foot, number of small businesses, vehicle miles traveled per capita, employment, air quality, and life expectancy. CONCLUSION: This study identified key economic indicators that could characterize the economic value of built environment approaches to promoting physical activity. Additional work could demonstrate the validity, feasibility, and usefulness of these key indicators, in particular to inform decisions about community design. |
Maternal exposure to disinfection by-products and risk of hypospadias in the National Birth Defects Prevention Study (2000-2005)
Zaganjor I , Luben TJ , Desrosiers TA , Keil AP , Engel LS , Michalski AM , Carmichael SL , Nembhard WN , Shaw GM , Reefhuis J , Yazdy MM , Langlois PH , Feldkamp ML , Romitti PA , Olshan AF , The National Birth Defects Prevention Study . Int J Environ Res Public Health 2020 17 (24) The purpose of this study was to estimate the association between 2nd and 3rd degree hypospadias and maternal exposure to disinfection by-products (DBPs) using data from a large case-control study in the United States. Concentration estimates for total trihalomethanes (TTHMs), the sum of the five most prevalent haloacetic acids (HAA5), and individual species of each were integrated with data on maternal behaviors related to water use from the National Birth Defects Prevention Study (NBDPS) to create three different exposure metrics: (1) household DBP concentrations; (2) estimates of DBP ingestion; (3) predicted uptake (i.e., internal dose) of trihalomethanes (THMs) via ingestion, showering, and bathing. The distribution of DBP exposure was categorized as follows: (Q1/referent) < 50%; (Q2) ≥ 50% to < 75%; and (Q3) ≥ 75%. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Generally, null associations were observed with increasing TTHM or HAA5 exposure. An increased risk was observed among women with household bromodichloromethane levels in the second quantile (aOR: 1.8; 95% CI: 1.2, 2.7); however, this association did not persist after the inclusion of individual-level water-use data. Findings from the present study do not support the hypothesis that maternal DBP exposures are related to the occurrence of hypospadias. |
Foods and beverages obtained at worksites in the United States
Onufrak SJ , Zaganjor H , Pan L , Lee-Kwan SH , Park S , Harris DM . J Acad Nutr Diet 2019 119 (6) 999-1008 BACKGROUND: Nutrition interventions are a common component of worksite wellness programs and have been recognized as an effective strategy to change employee dietary behaviors. However, little is known about worksite food behaviors or the foods that are obtained at workplaces at the national level. OBJECTIVE: The aims were to examine the frequency of and the amount of money spent obtaining foods at work among employed US adults, to determine the foods most commonly obtained at work, and to assess the dietary quality of these foods. DESIGN: This is a cross-sectional analysis of data from the US Department of Agriculture Food Acquisition and Purchasing Survey, a nationally representative household survey conducted from April 2012 through January 2013 on food purchases and acquisitions during a 7-day study period. PARTICIPANTS: The study included 5,222 employed adult Americans. MAIN OUTCOME MEASURES: The study assessed the prevalence of obtaining any foods at work overall and according to sociodemographic subgroups, number of acquisitions and calories obtained, most commonly obtained foods and leading food sources of calories, and 2010 Healthy Eating Index (HEI) scores that represent dietary quality. STATISTICAL ANALYSES PERFORMED: Prevalence estimates of obtaining >/=1 foods at work were compared according to sociodemographic characteristic using chi(2) tests. RESULTS: Nearly a quarter (23.4%) of working adults obtained foods at work during the week, and the foods they obtained averaged 1,292 kcal per person per week. The leading food types obtained included foods typically high in solid fat, added sugars, or sodium, such as pizza, regular soft drinks, cookies or brownies, cakes and pies, and candy. HEI scores suggest that work foods are high in empty calories, sodium, and refined grains and low in whole grains and fruit. CONCLUSIONS: Working adults commonly obtain foods at work, and the foods they obtain have limited dietary quality. Future research should examine the role worksites can play to help ensure access to and promote healthier options. |
Food service guideline policies on local government-controlled properties
Zaganjor H , Bishop Kendrick K , Onufrak S , Ralston Aoki J , Whitsel LP , Kimmons J . Am J Health Promot 2019 33 (8) 890117119865146 PURPOSE: Local governments can implement food service guideline (FSG) policies, which, in large cities, may reach millions of people. This study identified FSG policies among the 20 largest US cities and analyzed them for key FSG policy attributes. DESIGN: Quantitative research. SETTING: Local government facilities. PARTICIPANTS: Twenty largest US cities. MEASURES: Frequency of FSG policies and percent alignment to tool. ANALYSIS: Using municipal legal code libraries and other data sources, FSG policies enacted as of December 31, 2016, were identified. Full-text reviews were conducted of identified policies to determine whether they met inclusion criteria. Included policies were analyzed for key policy attributes specific to nutrition, behavioral design, implementation, and facility efficiency. RESULTS: Searches identified 469 potential FSG policies, of which 6 policies across 5 cities met inclusion criteria. Five policies met a majority of criteria assessed by the classification tool. Overall alignment to the tool ranged from 17% to 88%. Of the 6 policies, 5 met a majority of the nutrition attributes and 5 met at least 50% of attributes associated with implementation. No policies met the attributes associated with facility efficiency. CONCLUSION: The FSG policies were identified in 5 of the 20 US cities. Policy alignment was high for nutrition and implementation attributes. This analysis suggests that when cities adopt FSG policies, many develop policies that align with key policy attributes. These policies can serve as models for other jurisdictions to create healthier food access through FSGs. |
Systematic review and Bayesian meta-analysis of the dose-response relationship between folic acid intake and changes in blood folate concentrations
Crider KS , Devine O , Qi YP , Yeung LF , Sekkarie A , Zaganjor I , Wong E , Rose CE , Berry RJ . Nutrients 2019 11 (1) ![]() The threshold for population-level optimal red blood cell (RBC) folate concentration among women of reproductive age for the prevention of neural tube defects has been estimated at 906 nmol/L; however, the dose-response relationship between folic acid intake and blood folate concentrations is uncharacterized. To estimate the magnitude of blood folate concentration increase in response to specific dosages of folic acid under steady-state conditions (as could be achieved with food fortification), a systematic review of the literature and meta-analysis was conducted. Of the 14,002 records we identified, 533 were selected for full-text review, and data were extracted from 108 articles. The steady-state concentrations (homeostasis) of both serum/plasma and RBC folate concentrations were estimated using a Bayesian meta-analytic approach and one-compartment physiologically-based pharmacokinetic models. RBC folate concentrations increased 1.78 fold (95% credible interval (CI): 1.66, 1.93) from baseline to steady-state at 375(-)570 microg folic acid/day, and it took a median of 36 weeks of folic acid intake (95% CI: 27, 52) to achieve steady-state RBC folate concentrations. Based on regression analysis, we estimate that serum/plasma folate concentrations increased 11.6% (95% CI: 8.4, 14.9) for every 100 microg/day folic acid intake. These results will help programs plan and monitor folic acid fortification programs. |
Foods consumed by US adults from cafeterias and vending machines: NHANES 2005 to 2014
Onufrak SJ , Zaganjor H , Moore LV , Hamner HC , Kimmons JE , Maynard LM , Harris D . Am J Health Promot 2019 33 (5) 890117118821846 PURPOSE:: As part of wellness efforts, employers may seek to improve the nutritional quality of foods offered and consumed in cafeterias and vending machines. However, little is known about who consumes food from these venues and the types and dietary quality of the foods consumed. DESIGN:: Cross-sectional. SETTING:: Nonschool cafeterias and vending machines. PARTICIPANTS:: US adults >/=20 years old. MEASURES:: Prevalence of consuming foods, most common foods eaten, leading calorie sources, 2010 Healthy Eating Index. ANALYSIS:: Using 24-hour dietary recall data from NHANES 2005-2014 (N = 25,549 adults), we estimated the prevalence of consuming foods, assessed the most commonly consumed foods, and calculated dietary quality of foods. RESULTS:: On a given day, 3.1% of adults consumed foods from cafeterias and 3.9% from vending machines. Consumers averaged 692 kcal from cafeterias and 264 kcal from vending machines. Cafeteria consumers had higher income and education, while vending consumers were more likely to be male and younger adults. Common cafeteria foods included vegetables and fruits, but cafeteria foods were generally high in sodium and low in whole grains. Sugar-sweetened beverages and candies accounted for approximately half of all vending calories. CONCLUSION:: Foods chosen from cafeterias and vending machines do not align well with the Dietary Guidelines for Americans. Improving the dietary quality of foods consumed from these venues could impact millions of adults. |
Development and Utility of a Birth Defects Surveillance Toolkit
Flores AL , Turay K , Valencia D , Hillard CL , Sekkarie A , Zaganjor I , Williams J , Qi YP , Cordero AM , Mulinare J , Botto LD , Peña-Rosas JP , Groisman B , Mastroiacovo P . J Glob Health Perspect 2018 0 According to the World Health Organization (WHO), an estimated 303,000 neonates die within their first month of age every year globally as a result of a birth defect. Neural tube defects, serious birth defects of the brain and spine, are among the most common and severe of these birth defects. Since some low- and middle-income countries lack comprehensive, accurate data documenting the burden of these defects, providing technical assistance to help build birth defects surveillance programs can accelerate the collection of data needed to demonstrate this burden and advance prevention initiatives. We developed a birth defects surveillance toolkit, a technical assistance tool for country staff to help them implement birth defects surveillance. An evaluation of the toolkit with partners in Africa was conducted to assess perceptions of the usefulness, effectiveness, and policy impact of the surveillance toolkit and surveillance-related technical assistance provided to countries thus far. Overall, respondents provided very positive feedback about the toolkit components. Recommendations for improvement included customization to country contexts, such as photos reflective of African babies; surveillance examples from other countries; and consistent use of terms. |
Nutrition standards for food service guidelines for foods served or sold in municipal government buildings or worksites, United States, 2014
Onufrak SJ , Zaganjor H , Moore LV , Carlson S , Kimmons J , Galuska D . Prev Chronic Dis 2016 13 E172 INTRODUCTION: The Institute of Medicine and Centers for Disease Control and Prevention have recommended that government agencies use nutrition standards for foods and beverages sold and provided at their facilities. In this study, we examine written nutrition standards for foods sold or served in local government buildings or worksites among US municipalities. METHODS: We used data from a 2014 national survey of 1,945 municipal governments serving populations of 1,000 or more to assess the presence of written nutrition standards, the food groups or nutrients addressed by standards, and the populations served by facilities where standards are applied. The prevalence of standards was estimated by municipality population size, rural-urban status, census region, poverty prevalence, education level, and racial/ethnic composition. RESULTS: Overall, 3.2% of US municipalities reported nutrition standards with greater prevalence observed among large municipalities (12.8% of municipalities with ≥50,000 people vs 2.2% of municipalities with <2,500 people, P < .001). Prevalence differed by region, and standards were most common in the West (6.6%) and least common in the Midwest (2.0%, P = .003).The most common nutrition topics addressed in standards were offering low-calorie beverages, fruits and vegetables, and free drinking water. Most standards applied to facilities serving government employees (67%) or the general public (66%), with fewer serving institutionalized populations (23%). CONCLUSION: Few municipal governments reported having written nutrition standards for foods and beverages sold in their facilities in 2014. Implementing nutrition standards for foods sold or served by local governments is a strategy for increasing access to healthier foods and beverages among municipal employees and local residents. |
Food service guideline policies on state government-controlled properties
Zaganjor H , Bishop Kendrick K , Warnock AL , Onufrak S , Whitsel LP , Ralston Aoki J , Kimmons J . Am J Health Promot 2016 32 (6) 1340-1352 PURPOSE: Food service guideline (FSG) policies can impact millions of daily meals sold or provided to government employees, patrons, and institutionalized persons. This study describes a classification tool to assess FSG policy attributes and uses it to rate FSG policies. DESIGN: Quantitative content analysis. SETTING: State government facilities in the United States. PARTICIPANTS: Participants were from 50 states and District of Columbia in the United States. MEASURES: Frequency of FSG policies and percentage alignment to tool. ANALYSIS: State-level policies were identified using legal research databases to assess bills, statutes, regulations, and executive orders proposed or adopted by December 31, 2014. Full-text reviews were conducted to determine inclusion. Included policies were analyzed to assess attributes related to nutrition, behavioral supports, and implementation guidance. RESULTS: A total of 31 policies met the inclusion criteria; 15 were adopted. Overall alignment ranged from 0% to 86%, and only 10 policies aligned with a majority of the FSG policy attributes. Western states had the most FSG policies proposed or adopted (11 policies). The greatest number of FSG policies were proposed or adopted (8 policies) in 2011, followed by the years 2013 and 2014. CONCLUSION: The FSG policies proposed or adopted through 2014 that intended to improve the food and beverage environment on state government property vary considerably in their content. This analysis offers baseline data on the FSG landscape and information for future FSG policy assessments. |
Possible Zika virus infection among pregnant women - United States and Territories, May 2016
Simeone RM , Shapiro-Mendoza CK , Meaney-Delman D , Petersen EE , Galang RR , Oduyebo T , Rivera-Garcia B , Valencia-Prado M , Newsome KB , Perez-Padilla J , Williams TR , Biggerstaff M , Jamieson DJ , Honein MA , Ahmed F , Anesi S , Arnold KE , Barradas D , Barter D , Bertolli J , Bingham AM , Bollock J , Bosse T , Bradley KK , Brady D , Brown CM , Bryan K , Buchanan V , Bullard PD , Carrigan A , Clouse M , Cook S , Cooper M , Davidson S , DeBarr A , Dobbs T , Dunams T , Eason J , Eckert A , Eggers P , Ellington SR , Feldpausch A , Fredette CR , Gabel J , Glover M , Gosciminski M , Gay M , Haddock R , Hand S , Hardy J , Hartel ME , Hennenfent AK , Hills SL , House J , Igbinosa I , Im L , Jeff H , Khan S , Kightlinger L , Ko JY , Koirala S , Korhonen L , Krishnasamy V , Kurkjian K , Lampe M , Larson S , Lee EH , Lind L , Lindquist S , Long J , Macdonald J , MacFarquhar J , Mackie DP , Mark-Carew M , Martin B , Martinez-Quinones A , Matthews-Greer J , McGee SA , McLaughlin J , Mock V , Muna E , Oltean H , O'Mallan J , Pagano HP , Park SY , Peterson D , Polen KN , Porse CC , Rao CY , Ropri A , Rinsky J , Robinson S , Rosinger AY , Ruberto I , Schiffman E , Scott-Waldron C , Semple S , Sharp T , Short K , Signs K , Slavinski SA , Stevens T , Sweatlock J , Talbot EA , Tonzel J , Traxler R , Tubach S , Van Houten C , VinHatton E , Viray M , Virginie D , Warren MD , Waters C , White P , Williams T , Winters AI , Wood S , Zaganjor I . MMWR Morb Mortal Wkly Rep 2016 65 (20) 514-9 Zika virus is a cause of microcephaly and brain abnormalities (1), and it is the first known mosquito-borne infection to cause congenital anomalies in humans. The establishment of a comprehensive surveillance system to monitor pregnant women with Zika virus infection will provide data to further elucidate the full range of potential outcomes for fetuses and infants of mothers with asymptomatic and symptomatic Zika virus infection during pregnancy. In February 2016, Zika virus disease and congenital Zika virus infections became nationally notifiable conditions in the United States (2). Cases in pregnant women with laboratory evidence of Zika virus infection who have either 1) symptomatic infection or 2) asymptomatic infection with diagnosed complications of pregnancy can be reported as cases of Zika virus disease to ArboNET* (2), CDC's national arboviral diseases surveillance system. Under existing interim guidelines from the Council for State and Territorial Epidemiologists (CSTE), asymptomatic Zika virus infections in pregnant women who do not have known pregnancy complications are not reportable. ArboNET does not currently include pregnancy surveillance information (e.g., gestational age or pregnancy exposures) or pregnancy outcomes. To understand the full impact of infection on the fetus and neonate, other systems are needed for reporting and active monitoring of pregnant women with laboratory evidence of possible Zika virus infection during pregnancy. Thus, in collaboration with state, local, tribal, and territorial health departments, CDC established two surveillance systems to monitor pregnancies and congenital outcomes among women with laboratory evidence of Zika virus infection(dagger) in the United States and territories: 1) the U.S. Zika Pregnancy Registry (USZPR),( section sign) which monitors pregnant women residing in U.S. states and all U.S. territories except Puerto Rico, and 2) the Zika Active Pregnancy Surveillance System (ZAPSS), which monitors pregnant women residing in Puerto Rico. As of May 12, 2016, the surveillance systems were monitoring 157 and 122 pregnant women with laboratory evidence of possible Zika virus infection from participating U.S. states and territories, respectively. Tracking and monitoring clinical presentation of Zika virus infection, all prenatal testing, and adverse consequences of Zika virus infection during pregnancy are critical to better characterize the risk for congenital infection, the performance of prenatal diagnostic testing, and the spectrum of adverse congenital outcomes. These data will improve clinical guidance, inform counseling messages for pregnant women, and facilitate planning for clinical and public health services for affected families. |
Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review
Zaganjor I , Sekkarie A , Tsang BL , Williams J , Razzaghi H , Mulinare J , Sniezek JE , Cannon MJ , Rosenthal J . PLoS One 2016 11 (4) e0151586 BACKGROUND: Folate-sensitive neural tube defects (NTDs) are an important, preventable cause of morbidity and mortality worldwide. There is a need to describe the current global burden of NTDs and identify gaps in available NTD data. METHODS AND FINDINGS: We conducted a systematic review and searched multiple databases for NTD prevalence estimates and abstracted data from peer-reviewed literature, birth defects surveillance registries, and reports published between January 1990 and July 2014 that had greater than 5,000 births and were not solely based on mortality data. We classified countries according to World Health Organization (WHO) regions and World Bank income classifications. The initial search yielded 11,614 results; after systematic review we identified 160 full text manuscripts and reports that met the inclusion criteria. Data came from 75 countries. Coverage by WHO region varied in completeness (i.e., % of countries reporting) as follows: African (17%), Eastern Mediterranean (57%), European (49%), Americas (43%), South-East Asian (36%), and Western Pacific (33%). The reported NTD prevalence ranges and medians for each region were: African (5.2-75.4; 11.7 per 10,000 births), Eastern Mediterranean (2.1-124.1; 21.9 per 10,000 births), European (1.3-35.9; 9.0 per 10,000 births), Americas (3.3-27.9; 11.5 per 10,000 births), South-East Asian (1.9-66.2; 15.8 per 10,000 births), and Western Pacific (0.3-199.4; 6.9 per 10,000 births). The presence of a registry or surveillance system for NTDs increased with country income level: low income (0%), lower-middle income (25%), upper-middle income (70%), and high income (91%). CONCLUSIONS: Many WHO member states (120/194) did not have any data on NTD prevalence. Where data are collected, prevalence estimates vary widely. These findings highlight the need for greater NTD surveillance efforts, especially in lower-income countries. NTDs are an important public health problem that can be prevented with folic acid supplementation and fortification of staple foods. |
State and local perspective on implementation of the Centers for Disease Control and Prevention dog confinement agreement
Zaganjor I , Sinclair JR , Coleman MS . Zoonoses Public Health 2015 62 (8) 590-2 The Centers for Disease Control and Prevention (CDC) works in conjunction with state, territorial, local and tribal agencies (STLTAs) to prevent the transmission of infectious agents. Issuance of confinement agreements using CDC Form 75.37 'Notice to Owners and Importers of Dogs' to importers of dogs that are not vaccinated or incompletely vaccinated against rabies is part of the agency's regulatory programme to prevent the entry of dogs infected with rabies. Although this is a regulatory programme that depends heavily on partnerships between CDC and STLTAs, CDC had never formally evaluated the acceptability of the confinement agreement process with these partners. Thus, a short survey of nine STLTAs was conducted to evaluate whether these partners have enough personnel and resources to implement the regulation and their general opinions of the confinement agreement process. The results illustrate that CDC partners are dissatisfied to some extent with the process, and there are multiple issues limiting their success in enforcing the regulation. |
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