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Preventing Chronic Disease Dialogue

The Preventing Chronic Disease journal welcomes comments from readers on selected published articles to encourage dialogue between chronic disease prevention, researchers, practitioners and advocates.

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Select Month: June 2011

Getting Serious About the Prevention of Chronic Diseases

ESSAY
Getting Serious About the Prevention of Chronic Diseases

Nicholas Freudenberg, DrPH; Kenneth Olden, PhD

Suggested citation for this article: Freudenberg N, Olden K. Getting serious about the prevention of chronic diseases. Prev Chronic Dis 2011;8(4):A90. http://www.cdc.gov/pcd/issues/2011/jul/10_0243.htm. Accessed [date].

Passage of the Patient Protection and Affordable Care Act of 2010 marks an important step toward making health care available to all Americans. However, implementation of the legislation over the next decade faces organizational, political, and economic challenges (1). One of the surest ways to maximize the chances for health care reform to achieve its aims is to reduce the burden of chronic disease on the nation’s health care system.

Chronic diseases such as heart disease, cancer, hypertension, stroke, and diabetes now account for 80% of deaths in the United States and 75% of health care costs. In 2005, 44% of all Americans had at least 1 chronic condition and 13% had 3 or more. By 2020, an estimated 157 million US residents will have 1 chronic condition or more (2). Although an aging population has contributed to the increase in chronic conditions, children and young adults face a growing prevalence of obesity, diabetes, and asthma. Between 1996 and 2005, the number of people aged 25 to 44 years with more than 1 chronic disease doubled (2).

Health care reform legislation promises better access to screening and early intervention for chronic conditions for vulnerable populations. Similarly, advances in understanding the role of the human genome in the expression of chronic conditions offers hope for new treatments (3). Unfortunately, evidence suggests that innovations in genomic medicine are unlikely to reduce the prevalence or costs of chronic conditions in the coming decade (4).

The Role of State Health Departments in Supporting Community-Based Obesity Prevention

COMMUNITY CASE STUDY
The Role of State Health Departments in Supporting Community-Based Obesity Prevention

Jamie M. Cousins, MPA; Sarah M. Langer, MPH; Lori K. Rhew, MA, CHES, PAPHS; Cathy Thomas, MAEd

Suggested citation for this article: Cousins JM, Langer SM, Rhew LK, Thomas C. The role of state health departments in supporting community-based obesity prevention. Prev Chronic Dis 2011;8(4):A87. http://www.cdc.gov/pcd/issues/2011/jul/10_0181.htm. Accessed [date].

PEER REVIEWED

Abstract

Background
Recent national attention to obesity prevention has highlighted the importance of community-based initiatives. State health departments are in a unique position to offer resources and support for local obesity prevention efforts.

Community Context
In North Carolina, one-third of children are overweight or obese. North Carolina’s Division of Public Health supports community-based obesity prevention by awarding annual grants to local health departments, providing ongoing training and technical assistance, and engaging state-level partners and resources to support local efforts.

Methods
The North Carolina Division of Public Health administered grants to 5 counties to implement the Childhood Obesity Prevention Demonstration Project; counties simultaneously carried out interventions in the community, health care organizations, worksites, schools, child care centers, and faith communities.

Outcome
The North Carolina Division of Public Health worked with 5 local health departments to implement community-wide policy and environmental changes that support healthful eating and physical activity. The state health department supported this effort by working with state partners to provide technical assistance, additional funding, and evaluation.

Interpretation
State health departments are well positioned to coordinate technical assistance and leverage additional support to increase the strength of community-based obesity prevention efforts.

Effect of School District Policy Change on Consumption of Sugar-Sweetened Beverages Among High School Students, Boston, Massachusetts, 2004-2006

Volume 8: No. 4, July 2011

ORIGINAL RESEARCH
Effect of School District Policy Change on Consumption of Sugar-Sweetened Beverages Among High School Students, Boston, Massachusetts, 2004-2006

Angie L. Cradock, ScD; Anne McHugh, MS; Helen Mont-Ferguson, MBA, RD; Linda Grant, MD; Jessica L. Barrett, MPH; Y. Claire Wang, MD, ScD; Steven L. Gortmaker, PhD

Suggested citation for this article: Cradock AL, McHugh A, Mont-Ferguson H, Grant L, Barrett JL, Wang C, et al. Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006. Prev Chronic Dis 2011;8(4):A74. http://www.cdc.gov/pcd/issues/2011/jul/10_0149.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Consumption of sugar-sweetened beverages has increased among youth in recent decades, accounting for approximately 13% of total calories consumed. The Boston Public Schools passed a policy restricting sale of sugar-sweetened beverages in Boston schools in June 2004. The objective of this study was to determine whether high school students’ consumption of sugar-sweetened beverages declined after this new policy was implemented.

Methods
We conducted a quasi-experimental evaluation by using data on consumption of sugar-sweetened beverages by public high school students who participated in the Boston Youth Survey during February through April 2004 and February through April 2006 (N = 2,033). We compared the observed change with national trends by using data from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Regression methods were adjusted for student demographics.

Results
On average, Boston’s public high school students reported daily consumption of 1.71 servings of sugar-sweetened beverages in 2004 and 1.38 servings in 2006. Regression analyses showed significant declines in consumption of soda (−0.16 servings), other sugar-sweetened beverages (−0.14 servings), and total sugar-sweetened beverages (−0.30 servings) between 2004 and 2006 (P < .001 for all). NHANES indicated no significant nationwide change in adolescents’ consumption of sugar-sweetened beverages between 2003-2004 and 2005-2006.

Discussion
Data from Boston youth indicated significant reductions in consumption of sugar-sweetened beverages, which coincided with a policy change restricting sale of sugar-sweetened beverages in schools. Nationally, no evidence was found for change in consumption of sugar-sweetened beverages among same-aged youth, indicating that implementing policies that restrict the sale of sugar-sweetened beverages in schools may be a promising strategy to reduce adolescents’ intake of unnecessary calories.

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Playground Renovations and Quality at Public Parks in Boston, Massachusetts, 1996-2007

Volume 8: No. 4, July 2011

ORIGINAL RESEARCH
Playground Renovations and Quality at Public Parks in Boston, Massachusetts, 1996-2007

Jessica L. Barrett, MPH; Cynthia Hannon, MSW; Linda Keefe; Steven L. Gortmaker, PhD; Angie L. Cradock, ScD

Suggested citation for this article: Barrett JL, Hannon C, Keefe L, Gortmaker SL, Cradock AL. Playground renovations and quality at public parks in Boston, Massachusetts, 1996-2007. Prev Chronic Dis 2011;8(4). http://www.cdc.gov/pcd/issues/2011/jul/10_0118.htm. Accessed [date].

PEER REVIEWED

Abstract

Introduction
Recreational and transportation infrastructure can promote physical activity among children and adolescents. The Play Across Boston community-based research project sought to estimate and compare playground renovation rates across Boston areas before and after a playground quality assessment, to describe changes in playground quality among a subset of parks, and to document features of local transportation infrastructure around parks.

Methods
We used an observational pretest-posttest design to estimate playground renovation rates among 103 city-operated parks. Renovation rates were calculated on the basis of annual city Parks Department capital budgets from fiscal years 1996 through 2007. We used the same design to describe changes between a 2000 to 2001 baseline assessment of playground quality and a 2007 follow-up measured via observation of a subsample of 18 low-scoring parks in disadvantaged areas. We used χ2 analysis to compare percentages of playgrounds renovated across city areas before and after baseline assessment, logistic regression analysis to calculate odds ratios comparing renovation rates after baseline by city area, and paired t tests to compare playground quality at baseline and follow-up.

Results
Overall playground renovation rates before (29%) and after (34%) baseline assessment were similar. Parks scoring low on playground quality at baseline were renovated after baseline at a higher rate than high-scoring playgrounds. After accounting for baseline playground quality, parks in disadvantaged areas were renovated at a rate similar to those in other areas. Playground quality scores improved between baseline (mean, 38.3; 95% confidence interval, 35.3-41.3) and 2007 in a subsample of previously low-scoring parks in disadvantaged areas.

Conclusion
The findings of the 2007 follow-up assessment indicate an equitable rate of playground renovation across city areas according to need.

 
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