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Background: Few nutrition interventions in kindergarten classes have been evaluated, and none has been tested for program effectiveness, implementation, and dissemination. Building a Healthy Me (BHM) is a nutrition intervention for kindergarteners that is classroom-based and includes a family component. This study evaluated the public health impact of BHM in California kindergarten classrooms using the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework., Methods: A quasi-experimental design assessed pre-to-post changes in nutrition knowledge, dietary consumption, and parent behaviors of 25 intervention classrooms (414 students, 264 parents); and postintervention differences in nutrition knowledge between the intervention classrooms and 4 control classrooms measured at postintervention only (103 students)., Results: Intervention students improved in knowledge of food groups and healthy breakfast/snack options, and scored higher than control students in food group knowledge at postintervention (ps < .05). Parents of intervention group children increased their use of food labels, and intervention group children increased intake of several healthy foods and decreased intake of candy and fried potatoes (ps < .05). The BHM program reached 41% of kindergarteners attending public schools in California, and teachers implemented most lesson material., Conclusions: The BHM program was effective, implemented with fidelity, and broadly disseminated, highlighting its potential public health impact for kindergarteners., (© 2016, American School Health Association.)

Since 1964, smoking prevalence in the United States has declined because of nationwide intervention efforts. However, smoking interventions have not been implemented uniformly throughout all communities. Some of the highest smoking rates in the United States have been reported among Southeast Asian men, and socioeconomic status has been strongly associated with smoking. To compare the effect in reducing racial and ethnic disparities between men in Southeast Asian (Vietnamese and Cambodian) communities and men residing in the same states, CDC analyzed 2002-2006 data from The Racial and Ethnic Approaches to Community Health (REACH) project. The prevalence of current smoking significantly decreased and the quit ratio (percentage of ever smokers who have quit) significantly increased in REACH Vietnamese and Cambodian communities, but changes were minimal among all men in California or all men in Massachusetts (where these communities were located). The smoking rate also declined significantly, and the quit ratio showed an upward trend in U.S. men overall; however, the changes were significantly greater in REACH communities than in the nation. Stratified analyses showed decreasing trends of smoking and increasing trends of quit ratio in persons of both high and low education levels in Vietnamese REACH communities. The relative disparities in the prevalence of smoking and in the quit ratio decreased or were eliminated between less educated Vietnamese and less educated California men and between Cambodian and Massachusetts men regardless of education level. Eliminating health disparities related to tobacco use is a major public health challenge facing Asian communities. The decline in smoking prevalence at the population level in the three REACH Vietnamese and Cambodian communities as described in this report might serve as a model for promising interventions in these populations. The results highlight the potential effectiveness of community-level interventions, such as forming community coalitions, use of local media, and enhancing communities' capacity for systems change. The Office of Minority Health and Health Equity selected this intervention analysis and discussion to provide an example of a program that might be effective for reducing tobacco use-related health disparities in the United States.

Background: Oestrogen receptor (ER)- and progesterone receptor (PR)-negative (ER-PR-) breast cancer is associated with poorer prognosis compared with other breast cancer subtypes. High parity has been associated with an increased risk of ER-PR- cancer, but emerging evidence suggests that breastfeeding may reduce this risk. Whether this potential breastfeeding benefit extends to women at high risk of breast cancer remains critical to understand for prevention., Methods: Using population-based ascertained cases (n=4011) and controls (2997) from the Breast Cancer Family Registry, we examined reproductive risk factors in relation to ER and PR status., Results: High parity (≥3 live births) without breastfeeding was positively associated only with ER-PR- tumours (odds ratio (OR)=1.57, 95% confidence interval (CI), 1.10-2.24); there was no association with parity in women who breastfed (OR=0.93, 95% CI 0.71-1.22). Across all race/ethnicities, associations for ER-PR- cancer were higher among women who did not breastfeed than among women who did. Oral contraceptive (OC) use before 1975 was associated with an increased risk of ER-PR- cancer only (OR=1.32, 95% CI 1.04-1.67). For women who began OC use in 1975 or later there was no increased risk., Conclusions: Our findings support that there are modifiable factors for ER-PR- breast cancer and that breastfeeding in particular may mitigate the increased risk of ER-PR- cancers seen from multiparity.

The risk of obesity during childhood can be significantly reduced through increased physical activity and decreased sedentary behavior. Recent technological advances have created opportunities for the real-time measurement of these behaviors. Mobile phones are ubiquitous and easy to use, and thus have the capacity to collect data from large numbers of people. The present study tested the feasibility, acceptability, and validity of an electronic ecological momentary assessment (EMA) protocol using electronic surveys administered on the display screen of mobile phones to assess children's physical activity and sedentary behaviors. A total of 121 children (ages 9-13, 51% male, 38% at risk for overweight/overweight) participated in EMA monitoring from Friday afternoon to Monday evening during children's nonschool time, with 3-7 surveys/day. Items assessed current activity (e.g., watching TV/movies, playing video games, active play/sports/exercising). Children simultaneously wore an Actigraph GT2M accelerometer. EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity (MVPA) occurring in the 30 min before each EMA survey prompt. No significant differences between answered and unanswered EMA surveys were found for total steps or MVPA. Step counts and the likelihood of 5+ min of MVPA were significantly higher during EMA-reported physical activity (active play/sports/exercising) vs. sedentary behaviors (reading/computer/homework, watching TV/movies, playing video games, riding in a car) (P < 0.001). Findings generally support the acceptability and validity of a 4-day EMA protocol using mobile phones to measure physical activity and sedentary behavior in children during leisure time.

Background: Vaccination data for Asian Americans are comparable to those for whites, possibly because they are reported in aggregate rather than for subgroups. We compared influenza and pneumococcal vaccination rates among eligible Asian Americans and white Americans, and for Vietnamese Americans as a subgroup, and assessed factors associated with these vaccinations., Methods: Cross-sectional study of data collected from three ethnic groups over 4 years by telephone survey. Data were weighted for selection probability and population estimates and analyzed by multivariate logistic regression., Results: Vietnamese Americans had a higher rate of influenza vaccination (61%) than Asian Americans (45%) and white Americans (52%), and lower rate of pneumococcal vaccination (41%) than Asian Americans (56%), both lower than white Americans (67%)., Conclusion: When analyzed as a subgroup, Vietnamese Americans had a higher influenza vaccination rate, but a lower pneumococcal vaccination rate, compared to Asian Americans and white Americans, which may indicate that health behaviors and outcomes can differ widely among Asian subgroups. Analyses of preventive care measures in Asian Americans should focus on subgroups to ensure accuracy and quality of assessments.

Objectives: We examined trends in smoking prevalence from 2002 through 2006 in 4 Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) intervention., Methods: Annual survey data from 2002 through 2006 were gathered in 4 REACH Asian communities. Trends in the age-standardized prevalence of current smoking for men in 2 Vietnamese communities, 1 Cambodian community, and 1 Asian American/Pacific Islander (API) community were examined and compared with nationwide US and state-specific data from the Behavioral Risk Factor Surveillance System., Results: Prevalence of current smoking decreased dramatically among men in REACH communities. The reduction rate was significantly greater than that observed in the general US or API male population, and it was greater than reduction rates observed in the states in which REACH communities were located. There was little change in the quit ratio of men at the state and national levels, but there was a significant increase in quit ratios in the REACH communities, indicating increases in the proportions of smokers who had quit smoking., Conclusions: Smoking prevalence decreased in Asian communities served by the REACH project, and these decreases were larger than nationwide decreases in smoking prevalence observed for the same period. However, disparities in smoking prevalence remain a concern among Cambodian men and non-English-speaking Vietnamese men; these subgroups continue to smoke at a higher rate than do men nationwide.