Child Public Health Research Articles

Immigrant Parents' Knowledge and Attitudes: Sociodemographic Variation Related to Restriction of Children's Sugar Intake.

Focusing on immigrant parents with children aged 0-6 months, this study assessed whether awareness of and attitudes towards restricting children's sugar consumption vary according to family sociodemographic background and parents' oral-health-related behaviours. A cross-sectional study was conducted including immigrant parents attending child public health centers for vaccination of their children. The study included parents born in Asia, Africa, South America, Central America and Eastern Europe. Parents from Western Europe and North America were included if they were partners of the above-mentioned participants. Cross-tabulation and multiple variable logistic regression were used to assess associations of parental knowledge and attitudes with their child's sugar intake and sociodemographic characteristics. Overall, response rate was 72.6%. A total of 345 parents completed personal, structured interviews during their visit to the health centers. Attitudes and knowledge, but not indulgence, related to children's sugar restriction were sociodemographically unequally distributed among immigrant parents. Employed mothers, mothers with immigrant background from North America or Western Europe as well as parents with less frequent own sugar intake were more likely to confirm positive attitudes towards restricting children's sugar snacking. The corresponding odds ratios were OR=1.8 (95% CI 1.1-3.1) and OR=6.6 (95% CI 2.3-18.9). Employed mothers and parents having received dental care information were more likely than their counterparts to possess good oral-health-related knowledge. Parents from sociodemographically disadvantaged backgrounds were less inclined to express positive attitudes and demonstrate sufficient knowledge regarding the limitation of their children's sugar snacking. Culturally adapted oral health intervention programs should be implemented for immigrants, with special reference to children's dietary habits.

Nurse leaders’ recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

BackgroundDiscrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders’ perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems. MethodsTwenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders’ definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation. ResultsNurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices. ConclusionImplementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.

7.N. Round table: Social media & smartphones: Threats to child & adolescent health and public health solutions

Abstract The daily lives of children and adolescents in 2024 are heavily influenced by social media and smartphones, which is unprecedented in previous generations. While this technology offers undoubted benefits, there is strong evidence on the negative effects of social and cognitive development of infants and primary school aged children, and mental health impacts in adolescents including depression, anxiety, sleep disruption, addictive behaviours and self-harm. Internet companies are financially incentivised to maximise screen time of users to generate advertising revenue, and more time spent by young people on these devices in a largely unregulated online domain increases risk of consequences like bullying and harassment, body dysmorphia, gambling addiction, porn addiction, sexual predation and suicide. Comprehensive solutions are urgently needed to regulate the activities of social media and tech companies and support young people to protect themselves from serious harms. Governments have been slow to introduce policies such as smartphone bans or enhanced privacy laws, perhaps because they are perceived as unpopular infringements on the rights of adult users and/or due to a potential detrimental effect on commercial interests. Guidance can be disseminated to young people, schools, families and institutions on how to reduce screen time and smartphone addiction, and improve coping and self-regulation to mitigate these risks. Information campaigns with positive health messages in this area, to compete with the advertising dominance of social media companies, are another opportunity to improve behaviours and reduce adverse health effects. The objectives of this round table workshop are to share examples of strategies, guidance and policies from across Europe, and discuss with the audience how the public health community can collaborate to tackle this problem. Members of the EUPHA Child and Adolescent Public Health (CAPH) section will outline the latest available evidence on the negative impacts of social media and screens, present examples of innovative public health responses and strategies to protect children, and engage conference participants for their input and discussion. Five panellists will present. First, John will start with a quiz of the audience which will include presentation of current data and trends relating to social media and smartphone usage. The second presentation by Cecilia will highlight in detail evidence of both benefits and adverse effects of these technologies in the lives of young people. The third speaker Karin will discuss examples of effective policies to reduce this impact, with a focus on the role of schools. The fourth speaker Jean will give further examples of public health actions, and share recommendations directly from children and young people. The fifth panellist Silja will re-quiz the audience, to gauge the reaction and support of solutions that were covered, and this will lead into the interactive discussion. Key messages • Popularity of smartphones and social media has increased dramatically in recent years, particularly among minors, with significant impacts on mental and physical health. • Public health solutions are urgently needed, and this workshop will share examples of effective innovative responses in European contexts, followed by an interactive audience discussion.

Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial

The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course. In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks' gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age. Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (-0·04 [95% CI -0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (-0·16 [-0·30 to -0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6-18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (-0·43 [95% CI -0·57 to -0·29]) and mean WAZ (-0·35 [95% CI -0·45 to -0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages. Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity might vary by age. In the context of a rapidly warming planet, these findings could have short-term and long-term health effects for the individual, and immediate and future implications for public child health. Wellcome Trust.

Call for Action-Crisis Recovery and Preparedness in Child and Adolescent Public Health.

Call for Action-Crisis Recovery and Preparedness in Child and Adolescent Public Health.

The Impact of Neonatal Curcumin Intake on Key Molecular Markers in Lipid and Glucose Metabolism

The high prevalence of obesity, resulting from the increased consumption of a fructose-rich diet, poses a serious global threat to children's public health. Obesity is linked to several metabolic disorders, including insulin resistance and type-2 diabetes. Furthermore, type-2 diabetes is characterized by impaired lipid and glucose metabolism. This study investigated the impact of neonatal curcumin intake on the expression of key molecular markers related to liver lipid metabolism [Liver kinase B-1 (LKB-1), AMP-activated protein kinase (AMPK), Carnitine palmitoyltransferase-1 (CPT-1), and Acetyl-coenzyme A carboxylase-1 (ACC-1)] and glucose metabolism [serine/threonine-protein kinase (AKT-1), Glucose transporter-2 (GLUT-2), glycogen phosphorylase (GP), and Phosphoglucomutase (PGM)]. Curcumin, a polyphenolic compound derived from turmeric, is currently under extensive research for its potential therapeutic applications in various diseases. In this study, a metabolic syndrome model was induced in Sprague Dawley rats by feeding them a high fructose diet, with curcumin administered as the treatment. Gene expression was assessed through Real-Time quantitative PCR, and protein expression was analyzed using the western blot technique. The study observed that a high fructose diet led to the upregulation of genes and proteins associated with lipid metabolism, such as AMPK, LKB-1, ACC-1, and CPT-1 in liver tissues. Curcumin treatment reversed these effects, restoring normal lipid metabolism. Additionally, the high fructose diet downregulated the expression of AKT-1 in hepatic insulin signaling, which was counteracted by curcumin. Moreover, the high fructose diet increased hepatic glucose production, as indicated by the upregulation of GP and PGM gene and protein expression, while curcumin treatment suppressed hepatic glucose production by downregulating GP and PGM expression. The findings improve our understanding of curcumin's molecular mechanisms, which are not yet fully understood. They offer further evidence of curcumin's positive effects. Thus, early neonatal consumption of curcumin could be a potential strategy to prevent high fructose diet-induced obesity and related metabolic disorders, including insulin resistance and type-2 diabetes. Lipid and Glucose Metabolism. This project was funded by the North-West University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Compromised health: Examining growth and health in a late antique Roman infant and child cemetery.

Combining research from infant and child development, public health, anthropology, and history, this research examines the relationship between growth, growth disruption, and skeletal indicators of chronic and/or episodic physiological stress (stress) among juvenile individuals (n = 60) interred at the late antique infant and child cemetery at Poggio Gramignano (PG) (ca. 5th century CE), associated with a rural agricultural community. Growth disruption-evidenced by decreased long bone length compared to dental age-and stress experience-evidenced by skeletal stress indicators-within these individuals are compared to those within juveniles from a comparative sample (n = 66) from two urban Roman-era cemeteries, Villa Rustica (VR) (0-250 CE) and Tragurium City Necropolis (TCN) (0-700 CE). Results indicate that individuals from PG had significantly smaller femoral lengths-for-age than those from VR and TCN; however, the frequency of skeletal stress indicators was higher among juveniles from VR and TCN. These differences in growth and stress experience are likely related to the different biosocial and ecological environments present in these two regions. For the community at PG, internal and external violent conflicts, as well as social, political, and economic turmoil, and subsistence shortages, endemic and epidemic infectious disease, nutritional deficiencies, and inherited or acquired anemia may have synergized to create chronically and/or episodically deleterious conditions for its juveniles.

P095 Help stopping infant oral mutilation – a global child abuse and public health issue

P095 Help stopping infant oral mutilation – a global child abuse and public health issue

Reflecting on parental insights into healthy lifestyles: a qualitative study

BackgroundChildren living in the most deprived regions are more than twice as likely as their affluent peers to be obese. One way we can explain the social gradient of health (determined by relative position on the scale of social disadvantage or advantage) is by identifying the barriers and drivers to health that different groups of people experience. This study explored the understanding and perceptions of (and barriers and drivers to) a healthy lifestyle to investigate how commissioned services can better support residents to enable behaviour change in an area of high social deprivation. This community engagement activity was also conducted to inform commissioning decisions in children's public health services. MethodsWe used a qualitative study design with a semi-structured interview schedule. Four focus groups (5–8 participants, n=26) were conducted in an area of high deprivation in northwest England. Parents or carers were invited to attend anonymously by the Public Health Community Engagement Officer (in June 2022). The inclusion criteria were previous attendance on a weight management programme. Data were analysed using thematic analysis. Engagement activities do not require ethics approval. All participants provided written informed consent to take part. No further information was collected about personal characteristics. FindingsThe study participants demonstrated an awareness and understanding of factors affecting child and family health and health behaviours: healthy eating, exercise, mental health and emotional wellbeing, family values and attitudes towards a healthy lifestyle, cooking and budgeting, wider social connections, access to open spaces, availability of local activities, costs (including hidden costs), and structural barriers. InterpretationUsing the finding that participants recognise barriers and drivers to behaviour change beyond knowledge and skills, we reflect on why there was no take up for a commissioned intervention that aimed to address childhood obesity in the Lancashire area. These reflections inform arguments for an alternative model of service commission that relies less on established randomised trial evidence base and more on participatory codesign and a place-based approach (working with populations' existing knowledge and skills) and is particularly sensitive to people's own perception of the specific drivers and barriers they experience to behaviour change. Limitations include sampling from an area with low diversity and selection of participants who have previously agreed to uptake a weight management intervention. FundingNone.

Global children's surgery: Economic and policy priorities

An estimated two-thirds of the world's children and adolescents, most of whom live in low- and middle- income countries lack access to safe, quality, and timely surgical care. While much efforts have been made in the last decade to advocate for children’ surgery, several economic and policy gaps remain, hampering progress and investments. These gaps range from lack of adequate data on costs and cost-effectiveness, high rate of out-of-pocket payments and limited health insurance coverage, to non-inclusion of children's surgical care in public child health policies and surgical plans. Given the magnitude of the limitations, actions and initiatives need to be prioritised to facilitate coordinated investments. Urgent investments are required to generate reliable and convincing data on costs of children's surgical care, as well as costs of equipment and supplies. To support actions and initiatives, children's surgery should be included in any existing and planned child public health initiatives and surgical plans. Integration of injury prevention and early identification of surgical conditions into school health initiatives would also strengthen care. The overall return on investment in children's surgical care are enormous with implications for child survival, family, and society stability as well as country workforce and economy. Investments should be well coordinated at country, regional and global levels to avoid waste of resources and duplication of efforts, while encouraging convergence of efforts.

Completeness of Immunization in Infants Aged 0-9 Months: The Role of Mother's Knowledge and Belief

Introduction: Over 1.4 million children have died from Immunization-Preventable Diseases (PD3I). The lack of socialization provided by health workers has an impact on the lack of understanding, admonition, and understanding of mothers when participating in immunization programs. Purpose: to determine the relationship between the knowledge and confidence of mothers on the completeness of immunization in infants aged 0-9 months. Method: using a cross-sectional research design, with a population of 216 infants, sampling using purposive sampling techniques totaling 54 respondents with inclusion criteria: infants aged 0-9 months and residing in the study area, while the exclusion criteria were babies who were sick during the study. The research was conducted in Kombo. Using questionnaires and using chi-square tests of vaccine availability. Results: there were 83.3% of respondents who had good knowledge and had complete immunization 75.9% and there were 16.6% who had less knowledge, had complete immunization of 9.1% with a value of ρ=0.006. Conclusion: there is a relationship between knowledge and maternal confidence in the completeness of immunization in infants aged 0 – 9 months. Parents should pay attention to their children's basic immunizations and public health guarantees the availability of vaccines

2.L. Workshop: Digital health literacy in childhood and adolescence: concepts, assessment tools, and study results

Abstract The on-going digital transformation of societies and our health system has to be taken into account when it comes to child and adolescent public health. Digitalization is also rapidly changing European (public) health systems, impacting the design of healthcare, the delivery of health education, and the necessary training of health professionals working with children and adolescents. Digital health literacy is rooted in health literacy and comprises the competencies to find, understand, appraise, and apply health information and services. Digital health literacy is becoming increasingly relevant to navigate the health system, to be informed and interact on health topics, and to manage one's own health. Digital health literacy not only has a positive impact on health it is also considered a key element to a successful transition to digital health and digital public health. Children and adolescents are born into a digital world and already at young age they start to engage with digital technologies and applications. This familiarity does not, however, imply a high digital health literacy, the competencies relevant to digital health literacy must still be trained and learned. The earlier children and adolescents develop these competencies, the earlier they can take responsibility for their health behaviours and health. Schools and educational institutions are therefore crucial concerning the promotion of digital health literacy. For its promotion it needs knowledge regarding the concept, how it can be measured and effectively promoted. The objectives of this workshop are to: • Provide an introduction into the concept of digital health literacy and its relevance for child and adolescent public health • Provide an overview and current challenges of measuring digital health literacy. • Provide insights into first time representative data on school children's digital health literacy and a collaborative project in schools between public health and paediatrics. • To clarify questions and exchange with the audience on experiences and possible interventions promoting digital health literacy in this age group • To provide data on school teachers' digital health literacy and the implementation of digitial health literacy in schools In this workshop, we wish to share knowledge and evidence on digital health literacy in children and adolescents and enter into an expert discussion on the public health relevance of digital health literacy, evidence and limitations of current digital health instruments, as well as options for the promotion of digital health literacy in children and adolescents. Three presentations will set the foundation for this exchange (3 x 10 minutes, brief Q&A) after which 20 minutes are dedicated to the discussion. Key messages • Digital health literacy is an increasingly important health determinant of child and adolescent health and should be measured and promoted. • Digital health literacy can be promoted in the context of school health promotion, prevention and education.

Measuring digital health literacy in children and adolescents

Abstract The talk will address the different digital health literacy instruments currently existing and present their advantages and limitations. The rapid growth in access and use of digital (health) information resources in our society can also be observed among adolescents and children. However, to date no instrument exists that was specifically designed to measure how children and adolescents find, understand, appraise, and use such digital health information and services. The aim of the talk is to provide an overview of digital literacy instruments and present strengths and limitations of existing instruments. One limitation, the self-reported nature of digital health literacy, will be addressed and potential solutions discussed with the audience. The talk will demonstrate the current lack of instruments to measure digital health literacy in children and adolescents, and what this means for child and adolescent public health and the promotion of digital health literacy.

Current evidence and opportunities in child and adolescent public mental health: a research review.

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents. This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions. In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements. There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial.

Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. DERR1-10.2196/47018.

World Tuberculosis Day: Time to Translate New Clinical Findings in Pediatric Tuberculosis in Routine Practice.

From the *Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy †Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy. Accepted for publication April 1, 2023. D.B. has participated in meetings on the role of IGRAs in children sponsored by Qiagen. Address for correspondence: Danilo Buonsenso, MD, PhD, Largo A. Gemelli 8, 00168, Rome, Italy. E-mail: [email protected].

Rol de la Facultad de Ciencias Médicas en la promoción de la puericultura en la ciudad de Córdoba (1877 - 1918)

Introducción: Desde su fundación, la Facultad de Ciencias Médicas (FCM, UNC, Argentina) y sus miembros participaron en el diseño y la aplicación de políticas públicas eugénicas destinadas a evitar la despoblación y disminuir la mortalidad infantil. El presente trabajo describe dichas políticas desde la fundación de dicha institución hasta el inicio del proceso de Reforma Universitaria. Materiales y Métodos: Se realizó un análisis bibliográfico de bases de datos online y catálogos de bibliotecas para identificar textos referidos a políticas de puericultura y salud pública promovidas por la FCM en el período 1877 - 1918. Resultados: Se obtuvieron un total de 11 referencias bibliográficas: tres libros, dos artículos publicados en revistas científicas y seis Tesis para optar al título de Doctor en Medicina y Cirugía de la FCM. Discusión: Se evidencia en los textos analizados un gran interés en la caracterización de la mortalidad infantil en Córdoba y la promoción de la lactancia materna exclusiva. A ello se asocia la creación y administración de instituciones de salud de puericultura entre los que se destaca el Consultorio Protector de la Infancia. Conclusiones: La FCM, ligada a grupos políticos cordobeses, participó activamente en la difusión de los conceptos de puericultura (cuyas destinatarias eran principalmente las mujeres-madres de estratos socioeconómicos carenciados) y en la implementación de acciones tendientes al crecimiento poblacional y la inculcación de valores morales aceptados por sus académicos.

Exploratory analysis of a cluster randomized controlled trial of a multi-strategy intervention delivered via online canteens on improving the nutritional quality of primary school students’ pre-ordered foods & drinks at recess

School canteens are a recommended setting to deliver public health nutrition strategies given their wide reach, and frequent use by children. Online canteens, where users (i.e. students or their carers) pre-order and pay for food and drinks online, represent attractive systems to deliver strategies that encourage healthier food choices. There have been few studies exploring the efficacy of public health nutrition interventions in online food ordering environments. Therefore, this study aims to assess the efficacy of a multi-strategy intervention implemented in an online school canteen ordering system in reducing the energy, saturated fat, sugar, and sodium content of students’ online recess orders (i.e. foods ordered during the mid-morning or afternoon snack period). This was an exploratory analysis of recess purchases for a cluster randomized controlled trial that initially sought to examine the efficacy of the intervention on lunch orders. A total of 314 students from 5 schools received the multi-strategy intervention (involving menu labelling, placement, prompting and availability) that was integrated into the online ordering system, and 171 students from 3 schools received the control (usual online ordering). Analysis of main outcomes found that the mean energy (difference: −269.3 kJ; P = 0.006), saturated fat (difference: −1.1 g; P = 0.011) and sodium (difference: −128.6 mg; P = 0.014) content per student recess order was significantly lower in the intervention group than the control group at 2-month follow-up. Findings suggest that embedding strategies to encourage healthier choices within online canteen ordering systems can improve the nutrient composition of student recess purchases. These results add to the current evidence base suggesting that interventions delivered via online food ordering systems represent an effective strategy for improving child public health nutrition in schools.

Military Tuberculosis in Children: Mind the Gap.

From the *Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy ‡Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia ‡Pediatrics Infectious Disease Specialist, Department of Pediatrics and Child Health St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia §Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom. Accepted for publication January 26 2023. Address for correspondence: Danilo Buonsenso, PhD, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy. E-mail: [email protected].

Improving Equitability and Inclusion for Testing and Detection of Lead Poisoning in US Children.

Policy Points Child lead poisoning is associated with socioeconomic inequity and perpetuates health inequality. Methods for testing and detection of child lead poisoning are ill suited to the current demographics and characteristics of the problem. A three-pronged revision of current testing approaches is suggested. Employing the suggested revisions can immediately increase our national capacity for equitable, inclusive testing and detection. ABSTRACT: Child lead poisoning, the longest-standing child public health epidemic in US history, is associated with socioeconomic inequity and perpetuates health inequality. Removing lead from children's environments ("primary prevention") is and must remain the definitive solution for ending child lead poisoning. Until that goal can be realized, protecting children's health necessarily depends on the adequacy of our methods for testing and detection. Current methods for testing and detection, however, are no longer suited to the demographics and magnitude of the problem. We discuss the potential deployment and feasibility of a three-pronged revision of current practices including: 1) acceptance of capillary samples for final determination of lead poisoning, with electronic documentation of "clean" collection methods submitted by workers who complete simple Centers for Disease Control and Prevention-endorsed online training and certification for capillary sample collection; 2) new guidance specifying the analysis of capillary samples by inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectrometry with documented limit of detection ≤0.2 μg/dL; and 3) adaptive "census tract-specific" universal testing and monitoring guidance for children from birth to 10 years of age. These testing modifications can bring child blood lead level (BLL) testing into homes and communities, immediately increasing our national capacity for inclusive and equitable detection and monitoring of dangerous lower-range BLLs in US children.