Faculty Bibliography
Searched for:
Department/Unit:Population Health
Total Results:
13299
International journal of behavioral nutrition & physical activity. 2014:11.DOI: 10.1186/s12966-014-0091-2
Calorie labeling and consumer estimation of calories purchased
BackgroundStudies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation.FindingsResearchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216 inverted question mark409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p inverted question mark= inverted question mark0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p inverted question mark= inverted question mark0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR inverted question mark= inverted question mark0.25, p inverted question mark< inverted question mark0.001) and for individuals ordering small meals (AOR inverted question mark= inverted question mark0.54, p inverted question mark= inverted question mark0.001). Accuracy worsened for females (AOR inverted question mark= inverted question mark1.38, p inverted question mark< inverted question mark0.001) and for individuals ordering large meals (AOR inverted question mark= inverted question mark1.27, p inverted question mark= inverted question mark0.028).ConclusionsWe concluded that the odds of underestimating calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.
PMCID:4104464
PMID: 25015547
ISSN: 1479-5868
CID: 1074972
Unit of Measurement Used and Parent Medication Dosing Errors
BACKGROUND AND OBJECTIVES: Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship.METHODS: Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site.RESULTS: Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2-4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03-3.5) dose; associations greater for parents with low health literacy and non-English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon-associated measurement errors.CONCLUSIONS: Findings support a milliliter-only standard to reduce medication errors.
PMCID:4187234
PMID: 25022742
ISSN: 0031-4005
CID: 1073512
Imputation and subset based association analysis across different cancer types identifies multiple independent risk loci in the TERT-CLPTM1L region on chromosome 5p15.33
Genome-wide association studies (GWAS) have mapped risk alleles for at least ten distinct cancers to a small region of 63,000 bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis. To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic subset-based meta-analysis (ASSET) across six distinct cancers in 34,248 cases and 45,036 controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single nucleotide polymorphisms (SNPs): five in the TERT gene (region 1: rs7726159, P=2.10x10-39; region 3: rs2853677, P=3.30x10-36 and PConditional=2.36x10-8; region 4: rs2736098, P=3.87x10-12 and PConditional=5.19x10-6, region 5: rs13172201, P=0.041 and PConditional=2.04x10-6; and region 6: rs10069690, P=7.49x10-15 and PConditional=5.35x10-7) and one in the neighboring CLPTM1L gene (region 2: rs451360; P=1.90x10-18 and PConditional=7.06x10-16). Between three and five cancers mapped to each independent locus with both risk-enhancing and protective effects. Allele specific effects on DNA methylation were seen for a subset of risk loci indicating that methylation and subsequent effects on gene expression may contribute to the biology of risk variants on 5p15.33. Our results provide strong support for extensive pleiotropy across this region of 5p15.33, to an extent not previously observed in other cancer susceptibility loci.
PMCID:4240198
PMID: 25027329
ISSN: 0964-6906
CID: 1071172
Hookah Use Among US High School Seniors
OBJECTIVES: Prevalence of hookah use is increasing significantly among adolescents. This study aimed to delineate demographic and socioeconomic correlates of hookah use among high school seniors in the United States. We hypothesized that more impoverished adolescents and those who smoked cigarettes would be more likely to use hookahs.METHODS: Data were examined for 5540 high school seniors in Monitoring the Future (years 2010-2012), an annual nationally representative survey of high school students in the United States. Using data weights provided by Monitoring the Future, we used multivariable binary logistic regression to delineate correlates of hookah use in the last 12 months.RESULTS: Eighteen percent of students reported hookah use in the past year. Compared with white students, black students were at lower odds for use (adjusted odds ratio [AOR] = 0.27, P < .0001). High parent education increased the odds for use (AOR = 1.58, P < .001), and student weekly income from a job of >$50/week (AOR = 1.26, P < .05) or $11 to $50 per week from other sources (AOR = 1.35, P < .01) also increased odds for use. Males and urban students were also at higher odds for use, as were users of alcohol, marijuana, and other illicit substances. Former cigarette smokers were at higher risk, and current smokers were at highest risk for use.CONCLUSIONS: Adolescents of higher socioeconomic status appear to be at particularly high risk for hookah use in the United States. Prevention efforts must target this group as prevalence continues to increase.
PMCID:4531275
PMID: 25002664
ISSN: 0031-4005
CID: 1069032
Six-Month Patient Outcomes After Office-Based Buprenorphine Clinic Disruption During Hurricane Sandy [Meeting Abstract]
ISI:000337244900038
ISSN: 1547-0164
CID: 1067392
The Characteristics and Habits of Patients with Tobacco Addiction and Chronic Pain [Meeting Abstract]
ISI:000337244900049
ISSN: 1547-0164
CID: 1067402
American journal of respiratory & critical care medicine. 2014:190(1).DOI: 10.1164/rccm.201404-0780LE
Reply: the largest problem with climate change policy is not a future event
PMID: 24983223
ISSN: 1073-449x
CID: 1065782
Association of weekend continuity of care with hospital length of stay
OBJECTIVE: The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihood of weekend discharge, in-hospital mortality and 30-day readmission. DESIGN: A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity (UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression models were developed to determine the association between UPC and outcomes. SETTING: An academic medical center. MAIN OUTCOME MEASURE: Length of stay which was calculated as the number of days from the first Saturday of the hospitalization to the day of discharge. RESULTS: Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend of hospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuity of care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI 0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84, 95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission (adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care. CONCLUSIONS: Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes.
PMCID:4207867
PMID: 24994844
ISSN: 1353-4505
CID: 1066022
The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries
BACKGROUND: Cancer continues to rise as a contributor to premature death in the developing world. Despite this, little is known about whether cancer outcomes are related to a country's income level, and what aspects of national healthcare systems are associated with improved cancer outcomes. METHODS: The most recent estimates of cancer incidence and mortality were used to calculate mortality-to-incidence ratio (MIR) for the 85 countries with reliable data. Countries were categorized according to high-income (Gross Domestic Product (GDP)>$15,000) or middle/low-income (GDP<$15,000), and a multivariate linear regression model was used to determine the association between healthcare system indicators and cancer MIR. Indicators study included per capita GDP, overall total healthcare expenditure (THE), THE as a proportion of GDP, total external beam radiotherapy devices (TEBD) per capita, physician density, and the year 2000 WHO healthcare system rankings. RESULTS: Cancer MIR in high-income countries (0.47) was significantly lower than that of middle/low-income countries (0.64), with a p<0.001. In high-income countries, GDP, health expenditure and TEBD showed significant inverse correlations with overall cancer MIR. A $3040 increase in GDP (p=0.004), a $379 increase in THE (p<0.001), or an increase of 0.59 TEBD per 100,000 population (p=0.027) were all associated with a 0.01 decrease in cancer MIR. In middle/low-income countries, only WHO scores correlated with decreased cancer MIR (p=0.022); 12 specific cancer types also showed similar significant correlations (p<0.05) as overall cancer MIR. CONCLUSIONS: The analysis of this study suggested that cancer MIR is greater in middle/low-income countries. Furthermore, the WHO healthcare score was associated with improved cancer outcomes in middle/low-income countries while absolute levels of financial resources and infrastructure played a more important role in high-income countries.
PMID: 24857179
ISSN: 2210-6006
CID: 1058072
More older americans report falling: The epidemiology of falls, 1998-2010 [Meeting Abstract]
Falling is expected to increase among older adults due to demographic shifts. We investigated the epidemiology of falling in the U.S. from 1998 to 2010, hypothesizing that any increase would be due to changes in the population's age-structure. We used data from 7 waves (1998-2010) of the Health and Retirement Study, a nationally-representative longitudinal health survey. The sample included adults >65 years (n>10,590 for each wave). We defined falling as >1 self-reported falls in the prior 2 years. Covariates included: sociodemographic characteristics, 6 diseases, 4 geriatric conditions, body mass index, and participation in prior waves. Cross-sectional and longitudinal analyses used age-stratified logistic models to investigate fall prevalence across waves. Fall prevalence increased from 28.2% (1998) to 36.3% (2010). Fall injury showed no change in prevalence. Stratifying by age (1 year age cohorts), fall prevalence increased from 1998 to 2010 for adults age 65 to 82 years (Figure). Using fully adjusted age-stratified logistic models across waves, linear time predicted increased fall prevalence for all but 3 age strata (p<.05). Increased fall prevalence was not associated with respondents' participation in prior interview waves (either immediate preceding wave or total number of waves). Contrary to our hypothesis, the increase in fall prevalence (1998-2010) is not largely due to demographic changes. Rather, more older adults (at each year of age from 65 to 82) reported falling. A next step is to examine whether this increase in self-report is due to an increase in fall prevalence or an increase in falls awareness. (Figure presented)
EMBASE:71470733
ISSN: 0002-8614
CID: 1058362
