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Longacre M.R.,Community Health Research Program | Drake K.M.,Community Health Research Program | Drake K.M.,Dartmouth Institute of Health Policy and Clinical Practice | MacKenzie T.A.,Dartmouth Institute of Health Policy and Clinical Practice | And 6 more authors.
American Journal of Preventive Medicine | Year: 2012

Background: Little is known about the influence of in-town fast-food availability on family-level fast-food intake in nonmetropolitan areas. Purpose: The purpose of the current study was to determine whether the presence of chain fast-food outlets was associated with fast-food intake among adolescents and parents, and to assess whether this relationship was moderated by family access to motor vehicles. Methods: Telephone surveys were conducted with 1547 adolescent-parent dyads in 32 New Hampshire and Vermont communities between 2007 and 2008. Fast-food intake in the past week was measured through self-report. In-town fast-food outlets were located and enumerated using an onsite audit. Family motor vehicle access was categorized based on the number of vehicles per licensed drivers in the household. Poisson regression was used to determine unadjusted and adjusted risk ratios (RRs). Analyses were conducted in 2011. Results: About half (52.1%) of adolescents and 34.7% of parents consumed fast food at least once in the past week. Adolescents and parents who lived in towns with five or more fast-food outlets were about 30% more likely to eat fast food compared to those in towns with no fast-food outlets, even after adjusting for individual, family, and town characteristics (RR=1.29, 95% CI= 1.10, 1.51; RR=1.32, 95% CI=1.07, 1.62, respectively). Interaction models demonstrated that the influence of in-town fast-food outlets on fast-food intake was strongest among families with low motor vehicle access. Conclusions: In nonmetropolitan areas, household transportation should be considered as an important moderator of the relationship between in-town fast-food outlets and family intake. © 2012 American Journal of Preventive Medicine.


Fischer L.M.,University of North Carolina at Chapel Hill | Sutherland L.A.,Community Health Research Program | Kaley L.A.,University of Southern Maine | Fox T.A.,Nutrition and Policy Consultants LLC | And 4 more authors.
American Journal of Health Promotion | Year: 2011

Purpose. To describe the collaborative process between a grocery retailer and a panel of nutrition experts used to develop a nutrition guidance system (Guiding Stars) that evaluates the nutrient profile of all edible products in the supermarket, and to report the results of the food and beverage ratings. Design. A collaboration between a private retailer and members of the scientific community that led to the development of a scoring algorithm used to evaluate the nutritional quality of foods and beverages. Setting/Subjects. Northeast supermarkets (n=160). Measures. Food and beverage nutrition ratings and distribution of stars across different grocery categories. Analysis. Descriptive statistics for rating distributions were computed. T-tests were conducted to assess differences in mean nutrient values between foods with zero versus three stars or a dichotomized variable representing all foods with one to three stars. Results. All edible grocery items (n=27,466) were evaluated, with 23.6% earning at least one star. Items receiving at least one star had lower mean levels of sodium, saturated fat, and sugars and higher amounts of fiber than products not earning stars. Conclusion. The Guiding Stars system rates edible products without regard to brand or manufacturer, and provides consumers with a simple tool to quickly identify more nutritious choices while shopping. The low percentage of products qualifying for stars reflects poorly on the food choices available to Americans. Copyright © 2011 by American Journal of Health Promotion, Inc.


Dalton M.A.,Community Health Research Program | Longacre M.R.,Community Health Research Program | Drake K.M.,Community Health Research Program | Gibson L.,USA Mobility | And 2 more authors.
American Journal of Preventive Medicine | Year: 2011

Background: Most studies of active travel to school (ATS) have been conducted in urban or suburban areas and focused on young children. Little is known about ATS among rural adolescents. Purpose: To describe adolescent ATS in two predominantly rural states and determine if school neighborhood built environment characteristics (BECs) predict ATS after adjusting for school and individual characteristics. Methods: Sixteen BECs were assessed through census data and onsite observations of 45 school neighborhoods in 2007. ATS and individual characteristics were assessed through telephone surveys with 1552 adolescents and their parents between 2007 and 2008. Active travelers were defined as those who walked/cycled to/from school <1 day/week. Hierarchic linear modeling was used for analysis, conducted in 2009. Results: Slightly less than half (n=735) of the sample lived within 3 miles of school, of whom 388 (52.8%) were active travelers. ATS frequency varied by season, ranging from a mean of 1.7 (SD=2.0) days/week in the winter to 3.7 (SD=1.6) in the spring. Adolescents who attended schools in highly dense residential neighborhoods with sidewalks were most likely to be active travelers. ATS frequency was greater in school neighborhoods with high residential and intersection densities, on-street parking, food outlets, and taller and continuous buildings with small setbacks. Conclusions: The BECs that support safe travel may be necessary to allow for ATS, whereas ATS frequency among adolescents may be influenced by a wider variety of design characteristics. Additional strategies to promote ATS and physical activity are needed in rural areas because of long commuting distances for many students. © 2011 American Journal of Preventive Medicine.


Primack B.A.,University of Pittsburgh | Longacre M.R.,Community Health Research Program | Beach M.L.,Community Health Research Program | Titus L.J.,Community Health Research Program | Dalton M.A.,Community Health Research Program
Journal of the National Cancer Institute | Year: 2012

Background It is not known whether exposure to smoking depicted in movies carries greater influence during early or late adolescence. We aimed to quantify the independent relative contribution to established smoking of exposure to smoking depicted in movies during both early and late adolescence. Methods We prospectively assessed 2049 nonsmoking students recruited from 14 randomly selected public schools in New Hampshire and Vermont. At baseline enrollment, students aged 10-14 years completed a written survey to determine personal, family, and sociodemographic characteristics and exposure to depictions of smoking in the movies (early exposure). Seven years later, we conducted follow-up telephone interviews to ascertain follow-up exposure to movie smoking (late exposure) and smoking behavior. We used multiple regression models to assess associations between early and late exposure and development of established smoking. Results One-sixth (17.3%) of the sample progressed to established smoking. In analyses that controlled for covariates and included early and late exposure in the same model, we found that students in the highest quartile for early exposure had 73% greater risk of established smoking than those in the lowest quartile for early exposure (27.8% vs 8.6%; relative risk for Q4 vs Q1 = 1.73, 95% confidence interval = 1.14 to 2.62). However, late exposure to depictions of smoking in movies was not statistically significantly associated with established smoking (22.1% vs 14.0%; relative risk for Q4 vs Q1 = 1.13, 95% confidence interval = 0.89 to 1.44). Whereas 31.6% of established smoking was attributable to early exposure, only an additional 5.3% was attributable to late exposure. Conclusion s Early exposure to smoking depicted in movies is associated with established smoking among adolescents. Educational and policy-related interventions should focus on minimizing early exposure to smoking depicted in movies. © 2012 The Author.


Owens P.M.,USA Mobility | Titus-Ernstoff L.,Community Health Research Program | Titus-Ernstoff L.,Dartmouth College | Gibson L.,USA Mobility | And 6 more authors.
International Journal of Health Geographics | Year: 2010

Background: Studies involving the built environment have typically relied on US Census data to measure residential density. However, census geographic units are often unsuited to health-related research, especially in rural areas where development is clustered and discontinuous.Objective: We evaluated the accuracy of both standard census methods and alternative GIS-based methods to measure rural density.Methods: We compared residential density (units/acre) in 335 Vermont school neighborhoods using conventional census geographic units (tract, block group and block) with two GIS buffer measures: a 1-kilometer (km) circle around the school and a 1-km circle intersected with a 100-meter (m) road-network buffer. The accuracy of each method was validated against the actual residential density for each neighborhood based on the Vermont e911 database, which provides an exact geo-location for all residential structures in the state.Results: Standard census measures underestimate residential density in rural areas. In addition, the degree of error is inconsistent so even the relative rank of neighborhood densities varies across census measures. Census measures explain only 61% to 66% of the variation in actual residential density. In contrast, GIS buffer measures explain approximately 90% of the variation. Combining a 1-km circle with a road-network buffer provides the closest approximation of actual residential density.Conclusion: Residential density based on census units can mask clusters of development in rural areas and distort associations between residential density and health-related behaviors and outcomes. GIS-defined buffers, including a 1-km circle and a road-network buffer, can be used in conjunction with census data to obtain a more accurate measure of residential density. © 2010 Owens et al; licensee BioMed Central Ltd.


Longacre M.R.,Community Health Research Program | Primack B.A.,University of Pittsburgh | Owens P.M.,USA Mobility | Gibson L.,USA Mobility | And 3 more authors.
Journal of the American Dietetic Association | Year: 2011

Communities are being encouraged to develop locally based interventions to address environmental risk factors for obesity. Online public directories represent an affordable and easily accessible mechanism for mapping community food environments, but may have limited utility in rural areas. The primary aim of this study was to evaluate the efficacy of public directories vs rigorous onsite field verification to characterize the community food environment in 32 geographically dispersed towns from two rural states covering 1,237.6 square miles. Eight types of food outlets were assessed in 2007, including food markets and eating establishments, first using two publically available online directories followed by onsite field verification by trained coders. x2 and univariate binomial regression were used to determine whether the proportion of outlets accurately listed varied by food outlet type or town population. Among 1,340 identified outlets, only 36.9% were accurately listed through public directories; 29.6% were not listed but were located during field observation. Accuracy varied by outlet type, being most accurate for big box stores and least accurate for farm/produce stands. Overall, public directories accurately identified fewer than half of the food outlets. Accuracy was significantly lower for rural and small towns compared to mid-size and urban towns (P<0.001). In this geographic sample, public directories seriously misrepresented the actual distribution of food outlets, particularly for rural and small towns. To inform local obesity-prevention efforts, communities should strongly consider using field verification to characterize the food environment in low-population areas. © 2011 American Dietetic Association.


Longacre M.R.,Community Health Research Program | Drake K.M.,Community Health Research Program | Titus L.J.,Community Health Research Program | Peterson K.E.,University of Michigan | And 6 more authors.
Preventive Medicine | Year: 2014

Objective: The aim of this study is to examine whether school food attenuates household income-related disparities in adolescents' frequency of fruit and vegetable intake (FVI). Method: Telephone surveys were conducted between 2007 and 2008 with adolescent-parent dyads from Northern New England participants were randomly assigned to be surveyed at different times throughout the year. The main analysis comprised 1542 adolescents who typically obtained breakfast/lunch at school at least once/week. FVI was measured using 7-day recall of the number of times adolescents consumed fruits and vegetables. Fully adjusted linear regression was used to compare FVI among adolescents who were surveyed while school was in session (currently exposed to school food) to those who were surveyed when school was not in session (currently unexposed to school food). Results: Mean FVI was 8.0 (SD. =. 5.9) times/week. Among adolescents unexposed to school food, household income and FVI were strongly, positively associated. In contrast, among adolescents exposed to school food, FVI was similar across all income categories. We found a significant cross-over interaction between school food and household income in which consuming food at school was associated with higher FVI among adolescents from low-income households versus lower FVI among adolescents from high-income households. Conclusion: School food may mitigate income disparities in adolescent FVI. The findings suggest that the school food environment positively influences FVI among low-income adolescents. © 2014 .


Sites B.D.,Community Health Research Program | Beach M.L.,Community Health Research Program | Davis M.A.,Dartmouth Institute for Health Policy and Clinical Practice
Regional Anesthesia and Pain Medicine | Year: 2014

Background and Objectives: In the United States, use of oral opioid analgesics has been associated with increasing rates of addiction, abuse, and diversion. However, little is known about the recent national use of non-illicit prescription opioid analgesics (those prescribed in a physician-patient relationship), the primary source of these drugs for the general US population. Our primary objective was to examine trends in the use of prescription opioid analgesics in the United States and to identify defining characteristics of patient users of prescribed opioids from 2000 to 2010. METHODS: We used the nationally representative Medical Expenditure Panel Survey to examine trends in prescription oral opioid analgesic use from 2000 to 2010. We used survey design methods to make national estimates of adults (18 years and older) who reported receiving an opioid analgesic prescription (referred to as opioid users) and used logistic regression to examine predictors of opioid analgesic use. Our primary outcome measures were national estimates of total users of prescription opioid analgesics and total number of prescriptions. Our secondary outcome was that of observing changes in the disability and health of the users. RESULTS: The estimated total number of opioid analgesic prescriptions in the United States increased by 104%, from 43.8 million in 2000 to 89.2 million in 2010. In 2000, an estimated 7.4% (95% confidence interval, 6.9-7.9) of adult Americans were prescription opioid users compared with 11.8% (95% confidence interval, 11.2-12.4) in 2010. On the basis of estimates adjusted for changes in the general population, each year was associated with a 6% increase in the likelihood of receiving an opioid prescription from 2000 to 2010. Despite the apparent increase in use, there were no demonstrable improvements in the age- or sex-adjusted disability and health status measures of opioid users. CONCLUSIONS: The use of prescription opioid analgesics among adult Americans has increased in recent years, and this increase does not seem to be associated with improvements in disability and health status among users. On a public health level, these data suggest that there may be an opportunity to reduce the prescribing of opioid analgesics without worsening of population health metrics. Copyright © 2013 by American Society of Regional Anesthesia and Pain Medicine.


PubMed | Dartmouth Hitchcock Medical Center, University of Michigan and Community Health Research Program
Type: | Journal: Preventive medicine | Year: 2015

The aim of this study is to examine whether school food attenuates household income-related disparities in adolescents frequency of fruit and vegetable intake (FVI).Telephone surveys were conducted between 2007 and 2008 with adolescent-parent dyads from Northern New England; participants were randomly assigned to be surveyed at different times throughout the year. The main analysis comprised 1542 adolescents who typically obtained breakfast/lunch at school at least once/week. FVI was measured using 7-day recall of the number of times adolescents consumed fruits and vegetables. Fully adjusted linear regression was used to compare FVI among adolescents who were surveyed while school was in session (currently exposed to school food) to those who were surveyed when school was not in session (currently unexposed to school food).Mean FVI was 8.0 (SD=5.9) times/week. Among adolescents unexposed to school food, household income and FVI were strongly, positively associated. In contrast, among adolescents exposed to school food, FVI was similar across all income categories. We found a significant cross-over interaction between school food and household income in which consuming food at school was associated with higher FVI among adolescents from low-income households versus lower FVI among adolescents from high-income households.School food may mitigate income disparities in adolescent FVI. The findings suggest that the school food environment positively influences FVI among low-income adolescents.


PubMed | Community Health Research Program
Type: Journal Article | Journal: American journal of preventive medicine | Year: 2012

Little is known about the influence of in-town fast-food availability on family-level fast-food intake in nonmetropolitan areas.The purpose of the current study was to determine whether the presence of chain fast-food outlets was associated with fast-food intake among adolescents and parents, and to assess whether this relationship was moderated by family access to motor vehicles.Telephone surveys were conducted with 1547 adolescent-parent dyads in 32 New Hampshire and Vermont communities between 2007 and 2008. Fast-food intake in the past week was measured through self-report. In-town fast-food outlets were located and enumerated using an onsite audit. Family motor vehicle access was categorized based on the number of vehicles per licensed drivers in the household. Poisson regression was used to determine unadjusted and adjusted risk ratios (RRs). Analyses were conducted in 2011.About half (52.1%) of adolescents and 34.7% of parents consumed fast food at least once in the past week. Adolescents and parents who lived in towns with five or more fast-food outlets were about 30% more likely to eat fast food compared to those in towns with no fast-food outlets, even after adjusting for individual, family, and town characteristics (RR=1.29, 95% CI= 1.10, 1.51; RR=1.32, 95% CI=1.07, 1.62, respectively). Interaction models demonstrated that the influence of in-town fast-food outlets on fast-food intake was strongest among families with low motor vehicle access.In nonmetropolitan areas, household transportation should be considered as an important moderator of the relationship between in-town fast-food outlets and family intake.

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