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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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The Dimensions of Multiple Chronic Conditions: Where Do We Go From Here? A Commentary on the Special Collection of Preventing Chronic Disease

EDITORIAL

Robert B. Wallace, MD, MsC; Marcel E. Salive, MD, MPH

Suggested citation for this article: Wallace RB, Salive ME. The Dimensions of Multiple Chronic Conditions: Where Do We Go From Here? A Commentary on the Special Collection of Preventing Chronic Disease. Prev Chronic Dis 2013;10:130104. DOI: http://dx.doi.org/10.5888/pcd10.130104.

The articles in this issue address the high prevalence and substantial clinical burden of multiple chronic conditions (MCC) among adults. All of these papers further the goals outlined in the US Department of Health and Human Services (DHHS) MCC Strategic Framework (1,2). The article by Goodman, Posner, Huang, Parekh, and Koh (3) introduces the topic and describes the origin of the 20 conditions originally selected by the DHHS for emphasis. The authors also provide a conceptual model for standardizing data approaches to the analyses of MCC. The remaining articles document various distributions and rates of MCC on the national level with analyses of important federal health surveys and databases: Lochner and Cox analyzed Medicare claims data (4); Ashman and Beresovsky analyzed 1 year of the National Ambulatory Medical Care Survey (5); Ford, Croft, Posner, Goodman, and Giles explored the prevalence of lifestyle-related MCC from the National Health Interview Survey (6); Steiner and Friedman examined MCC-related acute care hospitalization rates from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (7); Soni and Machlin analyzed the costs of certain MCC from the Medical Expenditure Panel Survey (8), and Ward and Schiller estimated MCC rates from the National Health Interview Survey (9).

Behaviors and Attitudes Associated With Low Drinking Water Intake Among US Adults, Food Attitudes and Behaviors Survey, 2007

ORIGINAL RESEARCH

Alyson B. Goodman, MD, MPH; Heidi M. Blanck, PhD; Bettylou Sherry, PhD, RD; Sohyun Park, PhD; Linda Nebeling, PhD, MPH, RD; Amy L. Yaroch, PhD

Suggested citation for this article: Goodman AB, Blanck HM, Sherry B, Park S, Nebeling L, Yaroch AL. Behaviors and Attitudes Associated With Low Drinking Water Intake Among US Adults, Food Attitudes and Behaviors Survey, 2007. Prev Chronic Dis 2013;10:120248. DOI: http://dx.doi.org/10.5888/pcd10.120248.

PEER REVIEWED

Abstract

Introduction

Water is vital for life, and plain water is a calorie-free option for hydration. Increasing consumption of drinking water is a strategy to reduce energy intake and lose or maintain weight; however, information on the characteristics of consumers who drink water is limited. Our objective was to describe the characteristics of people who have a low intake of drinking water and to determine associations between their behaviors and attitudes and their intake of water.

Methods

We analyzed data from a nationally representative sample of 3,397 US adults who participated in the National Cancer Institute’s 2007 Food Attitudes and Behaviors Survey. Multivariable logistic regression was used to identify sociodemographic characteristics and health-related behaviors and attitudes associated with self-reported drinking water intake of less than 4 cups per day.

Results

Overall, 7% of adults reported no daily consumption of drinking water, 36% reported drinking 1 to 3 cups, 35% reported drinking 4 to 7 cups, and 22% reported drinking 8 cups or more. The likelihood of drinking less than 4 cups of water daily was significantly higher among participants aged 55 years or older than among those aged 18 to 34 (adjusted odds ratio [AOR], 1.3), among residents of the Northeast than among residents of the South (AOR, 1.4), among participants who consumed 1 cup or less of fruits or vegetables per day than among those who consumed 4.5 cups or more (AOR, 3.0), among participants who did not exercise than among those who exercised 150 minutes or more per week (AOR, 1.7), and among participants who were neither trying to gain nor lose weight than among those trying to lose weight (AOR, 1.3).

Conclusion

Low drinking water intake was associated with age, region of residence, and several unhealthful behaviors and attitudes. Understanding characteristics associated with low drinking water intake may help to identify populations that could benefit from interventions to help adults drink more water.

Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets

TOOLS AND TECHNIQUES

David H. Jernigan, PhD; Michael Sparks, MA; Evelyn Yang, PhD; Randy Schwartz, MSPH

Suggested citation for this article: Jernigan DH, Sparks M, Yang E, Schwartz R. Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets. Prev Chronic Dis 2013;10:120090. DOI: http://dx.doi.org/10.5888/pcd10.120090.

PEER REVIEWED

Abstract

Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets — the number of physical locations in which alcoholic beverages are available for purchase either per area or per population — through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms.

Health Departments in a Brave New World

ESSAY

Christopher Maylahn, MPH; David Fleming, MD; Guthrie Birkhead, MD, MPH

Suggested citation for this article: Maylahn C, Fleming D, Birkhead G. Health Departments in a Brave New World. Prev Chronic Dis 2013;10:130003. DOI:  http://dx.doi.org/10.5888/pcd10.130003.

The number of people at risk for chronic diseases is increasing, and methods for reducing risk and promoting health are becoming more complex. Demands of changing political and social environments, as well as economic and demographic trends, are forcing state and local health departments to reassess what is most important and make judicious choices that will yield the greatest gains. Health departments cannot afford to squander time and resources on ineffective programs and policies; to maintain their relevance, they must adopt a public health agenda that is both ambitious and grounded in science.

The Effect of Price Reduction on Salad Bar Purchases at a Corporate Cafeteria

BRIEF

Thomas E. Kottke, MD, MSPH; Nicolaas P. Pronk, PhD; Abigail S. Katz, PhD; Juliana O. Tillema, MPA; Thomas J. Flottemesch, PhD

Suggested citation for this article: Kottke TE, Pronk NP, Katz AS, Tillema JO,
Flottemesch TJ. The Effect of Price Reduction on Salad Bar Purchases at a Corporate Cafeteria. Prev Chronic Dis 2013;10:120214. DOI: http://dx.doi.org/10.5888/pcd10.120214.

PEER REVIEWED

Abstract

The objective of this study was to determine the effect of a price reduction on salad bar purchases in a corporate cafeteria. We reduced the price of salad bar purchases by 50% during March 2012 and analyzed sales data by month for February through June 2012. We also conducted an anonymous survey. Salad bar sales by weight more than tripled during the price reduction and returned to baseline afterward. Survey respondents reported that the high price of salad relative to other choices is a barrier to purchases. Policies that make the price of salads equal to other choices in cafeterias may significantly increase healthful food consumption.

Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study

SPECIAL TOPIC

Julie A. Schmittdiel, PhD; Susan D. Brown, PhD; Romain Neugebauer, PhD; Sara R. Adams, MPH; Alyce S. Adams, PhD; Deanne Wiley, BA; Assiamira Ferrara, MD, PhD

Suggested citation for this article: Schmittdiel JA, Brown SD, Neugebauer R, Adams SR, Adams AS, Wiley D, et al. Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis 2013;10:120146. DOI: http://dx.doi.org/10.5888/pcd10.120146.

PEER REVIEWED

Abstract

Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente Northern California (KPNC) Division of Research is assessing the effectiveness of 2 health plan-initiated programs to prevent the onset of diabetes in patients at high risk. The first study evaluates a telephonic health-coaching program that provides counseling on healthful eating, active living, and weight loss to KPNC members. The second evaluation examines a postpartum glucose screening and educational diabetes prevention program for women with gestational diabetes mellitus that KPNC implemented in 2006. Identifying effective approaches to preventing diabetes will be of value to health care systems, policy makers, and public health officials seeking to understand the roles systems and employers can play in preventing chronic illness.

Risk Factors for Chronic Disease in Viet Nam: A Review of the Literature

SYSTEMATIC REVIEW

Damian Hoy, PhD; Chalapati Rao, PhD; Nguyen Thi Trang Nhung, MPH; Geoffrey Marks, PhD; Nguyen Phuong Hoa, PhD

Suggested citation for this article: Hoy D, Rao C, Nhung NT, Marks G, Hoa NP. Risk Factors for Chronic Disease in Viet Nam: A Review of the Literature. Prev Chronic Dis 2013;10:120067. DOI: http://dx.doi.org/10.5888/pcd10.120067.

PEER REVIEWED

Abstract

Introduction

Chronic diseases account for most of the disease burden in low- and middle-income countries, particularly those in Asia. We reviewed literature on chronic disease risk factors in Viet Nam to identify patterns and data gaps.

Methods

All population-based studies published from 2000 to 2012 that reported chronic disease risk factors were considered. We used standard chronic disease terminology to search PubMed and assessed titles, abstracts, and articles for eligibility for inclusion. We summarized relevant study information in tables listing available studies, risk factors measured, and the prevalence of these risk factors.

Results

We identified 23 studies conducted before 2010. The most common age range studied was 25 to 64 years. Sample sizes varied, and sample frames were national in 5 studies. A combination of behavioral, physical, and biological risk factors was studied. Being overweight or obese was the most common risk factor studied (n = 14), followed by high blood pressure (n = 11) and tobacco use (n = 10). Tobacco and alcohol use were high among men, and tobacco use may be increasing among Vietnamese women. High blood pressure is common; however, people’s knowledge that they have high blood pressure may be low. A high proportion of diets do not meet international criteria for fruit and vegetable consumption. Prevalence of overweight and obesity is increasing. None of the studies evaluated measured dietary patterns or total caloric intake, and only 1 study measured dietary salt intake.

Conclusion

Risk factors for chronic diseases are common in Viet Nam; however, more recent and context-specific information is required for planning and monitoring interventions to reduce risk factors and chronic disease in this country.

State Variations of Chronic Disease Risk Factors in Older Americans

BRIEF

Stacey L. Tannenbaum, PhD, RD, LDN; Diana Kachan, BS; Cristina A. Fernandez, MSEd; Laura A. McClure, MSPH; William G. LeBlanc, PhD; Kristopher L. Arheart, EdD; David J. Lee, PhD

Suggested citation for this article: Tannenbaum SL, Kachan D, Fernandez CA, McClure LA, LeBlanc WG, Arheart KL, et al. State Variations of Chronic Disease Risk Factors in Older Americans. Prev Chronic Dis 2012;9:120143. DOI: http://dx.doi.org/10.5888/pcd9.120143.

PEER REVIEWED

Abstract

The objective of this study was to examine and compare 3 key health behaviors associated with chronic disease (ie, risky drinking, smoking, and sedentary lifestyle). We used data from the National Health Interview Survey from 1997 through 2010 to calculate the prevalence of these behaviors among older Americans and rank each state, and we analyzed overall trends in prevalence for each behavior over the 14 years. Older adults residing in Arkansas and Montana had the worst chronic disease risk profile compared with other states. These findings indicate the need for improved or increased targeted interventions in these states.

Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States

SPECIAL TOPIC

Daniel S. Morris, MS, PhD; Steven C. Fiala, MPH; Rebecca Pawlak, MPH

Suggested citation for this article: Morris DS, Fiala SC, Pawlak R. Opportunities for Policy Interventions to Reduce Youth Hookah Smoking in the United States. Prev Chronic Dis 2012;9:120082.
DOI: http://dx.doi.org/10.5888/pcd9.120082.

PEER REVIEWED

Abstract

Preventing youth smoking initiation is a priority for tobacco control programs, because most adult tobacco smokers become addicted during adolescence. Interventions that restrict the affordability, accessibility, and marketing of cigarettes have been effective in reducing youth cigarette smoking. However, increasing numbers of youth are smoking tobacco using hookahs. Predictors of smoking tobacco with hookahs are the same as those for smoking cigarettes. Established interventions that curb youth cigarette smoking should therefore be effective in reducing hookah use. Potential policy interventions include equalizing tobacco tax rates for all tobacco types, requiring warning labels on hookah tobacco and accurate labeling of product contents, extending the cigarette flavoring ban to hookah tobacco, enacting smoke-free air laws and removing exemptions for hookah lounges, and expanding shipping restrictions on tobacco products.

Smoking in Movies: A New Centers for Disease Control and Prevention Core Surveillance Indicator

EDITORIAL

Tim McAfee, MD, MPH; Michael Tynan

Suggested citation for this article: McAfee T, Tynan M. Smoking in Movies: A New Centers for Disease Control and Prevention Core Surveillance Indicator. Prev Chronic Dis 2012;9:120261.
DOI: http://dx.doi.org/10.5888/pcd9.120261.

Youth who are heavily exposed to onscreen smoking are approximately 2 to 3 times as likely to begin smoking as youth who are lightly exposed (1), and the Surgeon General concluded that there is a causal relationship between depictions of smoking in the movies and smoking initiation among young people (2). Among the 3 major motion picture companies with policies aimed at reducing tobacco-use incidents in their movies, the number of onscreen incidents per youth-rated movie (rated G, PG, or PG-13 by the Motion Picture Association of America) decreased 95.8% from 2005 through 2010 (3). These results appeared to indicate that movie companies were making progress at reducing smoking depictions in youth-oriented movies and that a company-by-company approach of adopting voluntary policies could be effective in nearly eliminating youth exposure to tobacco imagery in movies. However, new data from 2011 published by Glantz and colleagues (4) in Preventing Chronic Disease raise serious concerns about this individual company approach.

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