Behavioral Risk Factor Survey Research Articles

Abstract A072: Cancer health education in high schools: A qualitative analysis of student gains

Abstract Background. Cancer disparities are prevalent in Milwaukee, Wisconsin. Community member feedback highlighted the importance of cancer education in reducing these disparities. Extension into alternative venues, such as high schools, can provide an innovative way to promote and provide cancer health information. The Cancer Health Education Curriculum (CHEC) provides high school students with an overview of cancer biology, cancer risk factors, early detection and screening methods, cancer treatment, survivorship, and cancer disparities. To reinforce their learnings, students complete a group project focused on a particular topic of interest. Integrated into the curriculum is a Service-Learning project in which students disseminate the information they learn to the community via a booth at the class sponsored “Cancer Health Fair,” a 30-second public service announcement or sharing their information with five friends and/or family members. Previously we published the effects on knowledge, beliefs and behaviors. In this presentation, we examine if outcomes differ by type of Service-Learning project. We also explore students’ perceptions of anticipated and achieved gains before and after the curriculum, as well as community feedback on the Service-Learning component. Methods. Data was collected between 2017-2019 at a Milwaukee Public High School. Students completed surveys before and after completion of the CHEC that included measures of cancer health knowledge, a validated measure of cancer fear and fatalism and Behavior Risk Factor Survey Study items querying about fruit and vegetable consumption, physical activity, tobacco use and screen time. Pre-curriculum surveys also include the open-ended question, “What do you hope to gain from CHEC,” and post-curriculum surveys include the question, “What did you gain from CHEC.” Quantitative data pre-post were compared using paired t-tests. Qualitative analysis was completed by participants by semester who responded to both pre and post question through coding and theme creation. Results. 521 students with a mean age of 15 completed the curriculum. Quantitative results showed significant improvements in cancer-related knowledge (p < 0.0001), cancer fear and fatalism (p < 0.0001) and three of eight health behaviors assessed showed significant improvement. Qualitative data analyses showed the most predominate response themes from the “gains” question included 1) understanding cancer better, 2) decreasing fear, 3) wanting to make healthy behavioral changes, 4) gaining skills to talk with family and friends about cancer. Qualitative data suggests that the creation of seminal messaging through health education and Service-Learning contributed to change in perception and attitude. Qualitative data through gains analysis will be presented by Service-Learning type. Study results also support the feasibility of integrating cancer education, leveraging a Service-Learning requirement, and the potential for such programs to impact friend/family communications related to cancer. Citation Format: Kathleen O'Connell, Melinda Stolley, Dakota Berg, Abigail Kerschner. Cancer health education in high schools: A qualitative analysis of student gains [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A072.

Body Mass Index Trends among a Cohort of Subjects Enrolled in Medication-Assisted Treatment Programmes for Opioid Use Disorder: Racial/Ethnic, Gender, and Age Differences.

Opioid use disorder (OUD) and obesity are two pressing public health concerns in the United States (US). However, the relationship between these two epidemics has not been well-studied. Our study aims to describe the prevalence rates of obesity in individuals with OUD from a cohort study and compare that to the expected prevalence that would be observed based upon New Jersey state and US population survey data. Additionally, we sought to study whether Body Mass Index (BMI) distribution in this cohort varied by race/ethnicity, gender, and age. Our subjects (N=151) are part of a drug user cohort study of persons enrolled in medication-assisted treatment (MAT) programmes in New Jersey. Using the New Jersey Behavioral Risk Factor Survey (NJBRFS) and the National Health Interview Survey (NHIS), we generated expected BMI distributions based on race/ethnicity, age, and sex. Expected rates were compared to observed BMI. Standardized prevalence ratios were calculated, and 95% confidence intervals were constructed. Among females, obesity was more prevalent in those with OUD than in the general US population. Among persons ≤50 years old, overweight and obesity were more prevalent in those with OUD than in NJBRFS. Persons who did not inject drugs were more likely to be overweight. The prevalence of underweight was significantly higher among Black non-Hispanic minorities, males, older subjects (aged 66-85), and persons who inject drugs. In our study, the trends in BMI vary based on race/ethnicity, gender and age in these patients with OUD. These varying trends highlight the need for tailored screening and prevention strategies. Primary care providers should be aware that their patients with OUD have multiple health problems that need to be addressed beyond their OUD condition itself. Providers are in a pivotal role to screen and implement interventions to improve their health outcomes.

A double disparity: Rural sexual minorities and tobacco use among U.S. adults

BackgroundMarginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural–urban sexual minority differences in tobacco use in the United States. MethodsData came from the 2018–2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories. FindingsCigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts. ConclusionFindings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Childhood Poverty, Adverse Childhood Experiences, and Adult Health Outcomes.

This study aimed to consider childhood poverty in relation to a count measure of adverse childhood experiences (ACEs) as a predictor of adult health outcomes and to determine whether associations are sensitive to how childhood poverty is operationalized. A sample of 10,784 adult residents was derived using data 2014-2015 Wisconsin annual Behavioral Risk Factor Survey data, derived from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). Adult health outcomes (health risk behaviors, general health problems, chronic health problems, and depression) were predicted using a more conservative and severe indicator of childhood poverty, and authors tested whether observed associations were attenuated by the inclusion of an ACE count variable. Findings showed that severe indicators of childhood poverty are associated with general and chronic health problems as well as adult depression. These associations are attenuated, but remain intact, when ACEs are included in regression models. Using the CDC BRFSS data for Wisconsin, the study showed that associations between childhood poverty and adult health are sensitive to the way in which childhood poverty is operationalized. The relationship between childhood poverty and other ACEs is complex and thus warrants treating the former as a distinct childhood adversity rather than an item in an ACE summary score.

Exploring COVID-19 Case Fatality in Relation to the Prevalence of Chronic Conditions and Health Behaviors in Appalachian Kentucky.

BackgroundResearch has demonstrated that common chronic conditions, especially those related to cardiovascular health, are important risk factors for severe COVID-19 symptoms or hospitalization. Population prevalence rates of such conditions have not previously been examined in relation to COVID-19 case fatality rates in the Central Appalachian region.PurposeThis study examined prevalence rates of selected chronic conditions and COVID-19 case fatality rates to determine whether the relationship between them is consistent across Appalachian and non-Appalachian regions of Kentucky.MethodsData from Kentucky’s Behavioral Risk Factor Survey (KyBRFS) were used to calculate prevalence rates of asthma, diabetes, influenza vaccination, hypertension, obesity, having a personal doctor, physical inactivity, and cigarette smoking. Publicly available COVID-19 case and death counts by county were used to calculate incidence and case fatality rates. Units of analysis were 41 single- and multi-county areas developed to visualize KyBRFS prevalence rates. Analysis included t-tests to compare Appalachian and non-Appalachian regions, and correlations characterizing associations between COVID-19 case fatality and rates of chronic conditions and behaviors.ResultsIncidence and case fatality rates for COVID-19 were slightly lower in the Appalachian region, but not significantly. Significant correlations between COVID-19 case fatality and the prevalence of chronic conditions and behaviors were more common in the non-Appalachian region.ImplicationsCase fatality rates in Appalachia appear lower than expected, given the high prevalence of important chronic conditions and behaviors known to be associated with poor COVID-19 outcomes. This phenomenon merits further research and should be considered by public health researchers when examining COVID-19 outcomes in Kentucky and neighboring states.

Relationship between alpha-1 antitrypsin deficiency and obstructive sleep apnea.

This study aimed to identify if individuals with mild to severe alpha-1 antitrypsin deficiency (AATD) are at higher risk for developing obstructive sleep apnea (OSA) than the general population. A seven-question sleep apnea risk assessment questionnaire, STOP-BAG, was applied to 2338 participant responses from the Alpha-1 Coded Testing Study (ACT) and 4638 participant responses from the Kentucky Behavioral Risk Factor Survey (KyBRFS). Propensity scores were generated from a logistic regression model using continuous variables of age and body mass index (BMI). STOP-BAG scores were analyzed using chi-square analysis on this matched cohort to assess OSA risk in AATD. Self-reported OSA was higher in the KyBRFS cohort (14.5%) than in individuals with mild or severe AATD (11.2%) (p = 0.012). However, a higher percentage of the AATD cohort met clinically meaningful thresholds for STOP-BAG scores ≥ 5 (22.7%) than the KyBRFS cohort (13.0%) (p = 0.001). These differences persisted despite 1:1 propensity score matching on age and BMI to account for differences in baseline characteristics. No statistically significant difference in OSA risk between AATD genotypes was found. AATD appears to have higher risk for OSA than the general population. The 11.2% prevalence of diagnosed OSA in the AATD population is much lower than symptom scores would predict. Further studies are needed to validate the possibility that elastin loss is involved in OSA pathogenesis.

REPRINT OF: The Behavioral Risk Factor Surveys: I. State-Specific Prevalence Estimates of Behavioral Risk Factors

Editor's Note: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Marks JS, Hogelin GC, Gentry EM, et al. The Behavioral Risk Factor Surveys: I. State-specific prevalence estimates of behavioral risk factors. Am J Prev Med. 1985;1(6):1-8. The prevalence of most behavioral risk factors varies substantially among states. The prevalence of current cigarette smoking ranges from 22 percent to 38 percent. Estimates of alcohol use show geographic clustering, with lower rates in the southeastern states. The prevalence of sedentary lifestyle, uncontrolled hypertension, overweight, and seatbelt use differs markedly among states. These findings represent an initial step toward the analysis of state-specific baseline risk-factor data for use in developing state programs aimed at reducing the leading causes of death in the United States.

Estimating Undercoverage Bias of Internet Users.

IntroductionIn the last decade, response rates to the Behavioral Risk Factor Surveillance System (BRFSS) surveys have been declining. Attention has turned to the possibility of using web surveys to complement or replace BRFSS, but web surveys can introduce coverage bias as a result of excluding noninternet users. The objective of this study was to describe undercoverage bias of internet use.MethodsWe used data from 402,578 respondents who completed BRFSS questions in 2017 on internet use, self-reported health, current smoking, and binge drinking. We examined undercoverage bias of internet use by partitioning it into a product of 2 components: proportion of noninternet use and difference in the prevalences of interest (self-reported health, current smoking, and binge drinking) between internet users and noninternet users.ResultsOverall, the weighted proportion of noninternet use overall was 15.0%; the proportion increased with an increase in age and a decrease in education and, by race/ethnicity, was lowest among non-Hispanic white respondents. The overall relative bias was −19.2% for self-reported health, −4.0% for current cigarette smoking, and 8.4% for binge drinking. For all 3 variables of interest, we found large biases and relative biases in some demographic subgroups.ConclusionUndercoverage bias of internet use existed in the 3 studied variables. Both proportion of noninternet users and difference in prevalences of studied variables between internet users and noninternet users contributed to the bias to different degrees. These findings have implications on helping health-related behavioral risk factor surveys transition to more cost-effective survey modes than telephone only.

Characteristics and Behaviors Among a Representative Sample of New Jersey Adults Practicing Environmental Risk-Reduction Behaviors.

Environmental exposure to groundwater contamination from agricultural runoff, chemical pollution, or geology and indoor air hazards from misuse of consumer products or naturally occurring radon contributes to adverse health outcomes. Individuals can reduce exposure to environmental hazards by practicing risk-reduction behaviors. To characterize the demographic and behavioral characteristics of the population practicing environmental risk-reduction behaviors in order to identify gaps in current prevention outreach efforts. The New Jersey Behavioral Risk Factor Survey captures data on self-reported environmental risk-reduction behaviors and health-promoting behaviors (cancer screenings, vaccinations, smoking). To account for complex survey data, weighted analyses were performed in SAS v9.4. New Jersey, 2014-2015. The New Jersey Behavioral Risk Factor Survey is an ongoing telephone health survey of NJ residents. About 1000 NJ residents are selected randomly each month to derive statewide representative prevalence estimates. Self-reported private well testing, radon screening, and carbon monoxide (CO) detector ownership. Statewide prevalence of the practice of environmental risk-reduction practices includes 56.6% for private well testing, 44.3% for radon screening, and 86.1% for CO detector ownership. A larger percentage of individuals who are white or Asian, college-educated, earn more than $50 000, and own their homes reported CO detector ownership and radon screening. Age was the only demographic factor associated with private well testing. Screening for radon and CO detector ownership was positively associated with receiving an influenza shot, colonoscopy, aerobic exercise, and positive self-reported health and not smoking. There is a need to improve rates of environmental risk-reduction behaviors and reduce disparities in the practice of these behaviors through efforts to increase awareness. Public health officials should target outreach to specific populations that do not practice risk-reduction behaviors.

Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample

Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health. To evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health (D/PMH) and (2) adult-reported social and emotional support (ARSES) across ACEs exposure levels. Data were from the cross-sectional 2015 Wisconsin Behavioral Risk Factor Survey, a random digit-dial telephone survey of noninstitutionalized Wisconsin adults 18 years and older (n = 6188). Data were weighted to be representative of the entire population of Wisconsin adults in 2015. Data were analyzed between September 2016 and January 2019. The definition of D/PMH includes adults with a depression diagnosis (ever) and/or 14 or more poor mental health days in the past month. The definition of PCEs includes 7 positive interpersonal experiences with family, friends, and in school/the community. Standard Behavioral Risk Factor Survey ACEs and ARSES variables were used. In the 2015 Wisconsin Behavioral Risk Factor Survey sample of adults (50.7% women; 84.9% white), the adjusted odds of D/PMH were 72% lower (OR, 0.28; 95% CI, 0.21-0.39) for adults reporting 6 to 7 vs 0 to 2 PCEs (12.6% vs 48.2%). Odds were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those reporting 3 to 5 vs 0 to 2 PCEs (25.1% vs 48.2%). Associations were similar in magnitude for adults reporting 1, 2 to 3, or 4 to 8 ACEs. The adjusted odds that adults reported "always" on the ARSES variable were 3.53 times (95% CI, 2.60-4.80) greater for adults with 6 to 7 vs 0 to 2 PCEs. Associations for 3 to 5 PCEs were not significant. The PCE associations with D/PMH remained stable across each ACEs exposure level when controlling for ARSES. Positive childhood experiences show dose-response associations with D/PMH and ARSES after accounting for exposure to ACEs. The proactive promotion of PCEs for children may reduce risk for adult D/PMH and promote adult relational health. Joint assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing possibilities to foster safe, stable nurturing relationships for children that consider the health outcomes of positive experiences.

Abstract P399: Two-Year Trends and Determinants of Electronic Cigarette Use Among Patients With Cardiovascular Disease in the United States

Background: The use of electronic cigarettes (e-cigarettes) is on the rise in the US. It increased in adults aged 25-44 years from 2.4% in 2012 to 4.2% in 2016 and from 2% to 2.8% between ages 55 to 64 over the same period. Among the youth, the increase was 900% between 2011 and 2015. Much remains to be known about the health effects of e-cigarette use, but epidemiologic studies suggest an independent association between e-cigarette use and cardiovascular disease. There is a need for data on the social and demographic factors that are predictive of use in adults with cardiovascular disease (CVD), to identify the appropriate focus of intervention. Methods: This is an analysis of the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, an annual chronic disease and behavioral risk factor survey conducted by the CDC. The sample included the 110,028 respondents that reported a history of heart attack, angina/coronary heart disease or stroke. The rates of e-cigarette use were calculated, and a multiple logistic regression analysis was used to assess associated factors. Results: Among respondents with CVD, there was no change in e-cigarette use between 2016 and 2017 [3.1% to 2.8% adjusted OR (aOR) 1.08 (95% CI 0.95 - 1.24)]. The median age of e-cigarette users was 58 years and that of non-users was 69 years (p<0.0001). Women had a higher rate of e-cigarette use compared with men [3.2% vs 2.7% aOR 1.17(1.04-1.31)]. Other factors associated with e-cigarette use were: race [blacks vs whites 1.9% vs 3% aOR 0.37(0.28-0.49], sexual orientation [LGBTQ vs non-LGBTQ 7.1% vs 2.9% aOR 1.56 (1.24-1.96)], smoking [current smokers vs non-smokers 11.1% vs 1.2% aOR 6.0 (5.3-6.8), smoking on some days vs never smoked 12.7% vs 0.24 aOR 51(35.4-73.5)], mental illness [6.4% vs 1.8% aOR 1.57 (1.37-1.810)] and state of residence (p<0.0001). Conclusion: In conclusion, there was no significant change in e-cigarette use between 2016-2017 among respondents with CVD. The highest rates of e-cigarette use were among subjects who were: smokers on some days, current smokers, LGBTQ and had a mental illness.

Abstract 9: Electronic Cigarette Use is Associated With a Higher Risk of Stroke

Introduction: In 2016, 3.2% of US adults and 11.3% of high school students reported using electronic cigarettes (e-cigarettes) in the preceding 30 days. Its use among young people increased by 900% between 2011 and 2015. Stroke occurs in 795,000 people and causes 133,000 deaths annually in the US. The association between e-cigarette use and stroke is unknown. The purpose of this study was to determine the association between e-cigarette use and stroke. Methods: The study is an analysis of the 2016 Behavioral Risk Factor Surveillance System (BRFSS) an annual chronic disease and behavioral risk factor survey conducted by the CDC. The sample included 66,795 respondents that reported ever regularly using e-cigarettes. The control group was the 343,856 respondents that reported never using e-cigarettes. Odds ratios were calculated using logistic regression analysis. Among the covariates tested, age, sex, smoking status, diabetes, exercise and Body Mass Index (BMI) categories showed significant effects on the model and were adjusted for in the outcomes. Results: Overall 21% of BRFSS respondents reported ever using e-cigarettes, with 48.5% of them being female (P <0.0001). Compared with non-users, e-cigarette users had a lower mean age (44 vs 57 years [P <0.0001]), lower mean BMI (27.7 vs 28.1 [P <0.0001]) and a lower rate of diabetes (9.8% vs 12.1% [P <0.0001]). They however had higher rates of cigarette smoking (78.7% vs 37.4% [P <0.0001]). Compared with non-users, e-cigarette users had higher adjusted odds of stroke (OR 1.71 [1.64 - 1.8]), myocardial infarction (OR 1.59 [1.53 - 1.66]), angina or coronary heart disease (OR 1.4 [1.35 - 1.46]). Conclusion: E-cigarette use is associated with higher odds of stroke, myocardial infarction and angina/coronary heart disease.

Objective and subjective poor mental health indicators among Arab Americans in Michigan: a population-based study

ABSTRACT Background: Arab Americans are at high risk for poor mental health outcomes and are difficult to study at a population level due to a lack of racial/ethnic identifiers for this population. Methods: Using data from the standalone 2013 Michigan Arab Behavioral Risk Factor Survey (MI ABRFS) we aimed to understand whether the burden of mental health differed between Arab Americans and non-Arab, non-Hispanic Whites. Two measures of mental health were used: a subjective (number of poor mental health days experienced in the past 30 days) and an objective (being diagnosed with depression) measure. Additionally, we aimed to understand the sociodemographic, stress, and health-related variables associated with the objective and subjective measures of psychopathologies in the Arab American population in Michigan using population-weighted logistic regression models with survey design correction. Results: Arab Americans had increased odds of adverse mental health when compared to non-Arab, non-Hispanic Whites for the subjective measure of number of poor mental health days (OR: 1.62, 95% CI: 1.08, 2.41) and decreased odds of reporting the objective measure of diagnosed depression (OR: 0.54, 95% CI: 0.30, 0.98). Having more than one poor mental health day and being diagnosed with depression among Arab Americans was associated with being female, unmarried, unemployed, and having experienced abuse as a child. Discussion: Combining mental health screenings with primary care check-ups among Arab Americans may be an important step in identifying individuals with mental health needs and extending access to care.

Socioeconomic Status and the Physical and Mental Health of Arab and Chaldean Americans in Michigan.

Research that explains health of Arab and Chaldean Americans relative to the health of non-Arab White Americans is limited but steadily increasing. This study considers whether socioeconomic status moderates the relationship between race/ethnicity and physical and mental health. Data come from a state representative sample of Arab and Chaldean Americans-the 2013 Michigan Behavioral Risk Factor Survey and the 2013 Michigan Arab/Chaldean Behavioral Risk Factor Survey (N = 12,837 adults with 536 Arab/Chaldean Americans). Structural equation models examine whether socioeconomic status, operationalized as educational attainment, moderates the relationship between Arab/Chaldean identity and health, and whether physical activity, access to healthcare, and depression mediate the relationship between educational attainment and health. Results indicate that while Arab/Chaldean Americans have poor health relative to non-Arab White Americans, these differences are largely explained by educational differences. Depression, access to healthcare, and physical activity mediate the relationship between socioeconomic status and health of Arab/Chaldean Americans.

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS).

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center's Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either "problem/pathological gamblers" or "low-risk gamblers." Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.

Associations between sleep duration and physical activity and dietary behaviors in Chinese adolescents: results from the Youth Behavioral Risk Factor Surveys of 2015

ObjectiveTo assess the association between sleep duration and physical activity and dietary behaviors among adolescents in a representative sample. MethodsThe analysis was performed using data from the 2015 Ningbo Youth Risk Behavior Survey. Associations between physical activity and dietary behaviors and sleep duration were examined on weighted data using logistic regression. ResultsOf the 10726 students, roughly 40% reported sleep duration <8 h. Longer sleep duration was associated with higher likelihood of milk intake, fruit consumption, vegetable consumption, water consumption, moderate physical activity, and muscle-strengthening physical activity, and with a lower likelihood of cigarette use, alcohol use, sweets intake, Western fast food intake, and breakfast skipping. ConclusionInsufficient sleep may be common among Chinese adolescents. Sleep duration was associated with dietary behaviors, physical activity, and other health-related behaviors. These findings suggest that sleep duration could be a potential target for many health-risk behaviors in young adolescents.

Ex-post evaluation of illegalizing juvenile online game after midnight: A case of shutdown policy in South Korea

In November 2011, the Korean government legalized blocking access to online games for youths younger than age 16 late at night; this is called the shutdown policy. Using multiple regressions we examined how the compulsory block affected youths’ Internet hours and sleep duration. Data were drawn from the 2011, 2012 Korea Youth Behavior Risk Factor Survey, a cross-sectional online survey of middle and high school students aged 13–18years. Legalizing a ban of online gaming late at night for youths caused an increase in the predicted probability of being in a high-ranked Internet user group by 1.6 percent points, a decrease in the predicted probability of Internet addiction by 0.7 percent points, and an increase in sleep duration of 1.5min. All results showed a gender difference in the effect of the policy. Although the net effect of the shutdown policy was statistically significant, the small effect size, the partial effect on female youths, and the side effects related to human basic rights and inappropriate regulation of the game industry made the effectiveness of the policy arguable.

Evacuations as a Result of Hurricane Sandy: Analysis of the 2014 New Jersey Behavioral Risk Factor Survey.

We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on October 29, 2012. We analyzed data from the 2014 New Jersey Behavioral Risk Factor Survey. The proportion of respondents reporting evacuation was used to estimate the number of New Jersey adults who evacuated. We determined evacuation rates in heavily impacted and less-impacted municipalities, as well as evacuation rates for municipalities under and not under mandatory evacuation orders. We tested associations between demographic and health factors, such as certain chronic health conditions, and evacuation. Among respondents, 12.7% (95% CI: 11.8%-13.6%) reported evacuating, corresponding to approximately 880,000 adults. In heavily impacted municipalities, 17.0% (95% CI: 15.2%-18.7%) evacuated, compared with 10.1% (95% CI: 9.0%-11.2%) in less-impacted municipalities. In municipalities under mandatory evacuation orders, 42.5% (95% CI: 35.1%-49.8%) evacuated, compared with 11.8% (95% CI: 10.9%-12.9%) in municipalities not under mandatory orders. Female gender (odds ratio [OR]: 1.36; 95% CI: 1.14-1.64), unmarried status (OR: 1.22; 95% CI: 1.02-1.46), shorter length of residence (OR: 1.28; 95% CI: 1.03-1.60), and living in a heavily impacted municipality (OR: 1.84; 95% CI: 1.54-2.20) were significantly associated with evacuation. History of stroke (OR: 1.61; 95% CI: 1.02-2.53) was the only chronic condition associated with evacuation. Approximately 880,000 New Jersey adults evacuated because of Hurricane Sandy. Those in heavily impacted municipalities and municipalities under mandatory evacuation orders had higher evacuation rates; however, still fewer than half evacuated. These findings can be used for future disaster planning. (Disaster Med Public Health Preparedness. 2017;11:720-728).

The Relationship Between Social Support, HIV Serostatus, and Perceived Likelihood of Being HIV Positive Among Self-Settled Female, Foreign Migrants in Cape Town, South Africa.

Female cross-border migrants experience elevated risks for HIV, and migrants in South Africa may face additional risks due to the country's underlying HIV prevalence. These risks may be mitigated by the receipt of social support. A behavioral risk-factor survey was administered using respondent-driven sampling. Multivariable regression models assessed the relationships between social support and two HIV outcomes: HIV serostatus and perceived HIV status. Low social support was not significantly associated with HIV status (aOR = 1.03, 95 % CI 0.43-2.46), but was significantly related to a perception of being HIV positive (aPR = 1.36, 95 % CI 1.04-1.78). Age, marital status, and education level were significantly associated with HIV serostatus. Illegal border-crossing, length of time in South Africa, anal sex, and transactional sex were significantly associated with aperception of being HIV positive. Future research should investigate how HIV risks and the receipt of social support change throughout the migration process.