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OBJECTIVES: As a replacement for traditional phone booths, LinkNYC kiosks provide the ability to make free calls, connect to WiFi, and to charge electronic devices. These structures, which are supported by advertising revenue, are found in growing numbers on the streets of New York City (NYC). The purpose of this study was to determine the prevalence of sugar-sweetened beverage advertisements on LinkNYC kiosks. STUDY DESIGN: Cross-sectional, observational. METHODS: A total of 100 kiosks from a sample of 507 kiosks were randomly selected and observed in Manhattan, NYC. RESULTS: A total of 2025 advertisements, including duplicates, were observed that included 347 (17.1%) viewed at 64 kiosks for non-alcoholic beverages. Over half (n = 206, 59.4%) featured beverages with added sugar. For the 206 beverages with sugar, the mean kilocalories and grams of sugar per serving were 149.90 (SD = 64.95, range = 90-300) and 35.04 (SD = 19.54, range = 17-81), respectively. Differences in the frequency of these 206 advertisements were examined by the median annual income quartile of the census tract where the kiosk was located, and no significant differences were observed, χ2 (3, N = 206) = 3.09, P = 0.38. CONCLUSIONS: As the NYC Department of Health and Mental Hygiene invests in efforts to reduce consumption of sugar-sweetened beverages, promoting these very products through new media controlled by the City does not seem well aligned with the goal of improving dietary intake of citizens.

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OBJECTIVE: To describe the most widely viewed English language videos related to celiac disease on YouTube. STUDY DESIGN: This is a cross-sectional study. METHODS: Videos sorted by number of views yielded the 100 most widely viewed. Number of views, source (consumer, professional, or news agency), and inclusion of specific content were recorded. RESULTS: Collectively, the 100 videos were viewed nearly 7 million times. Between 2007 and 2010, 28% were uploaded, while more than 70% were uploaded after 2010. Professionals uploaded almost half (48%), consumers posted 32%, and news sources posted the remaining 20%. While gluten-containing foods/drinks were presented in 57% of the videos, these videos garnered almost 78% of cumulative views. Comparatively few videos provided substantive information related to age at diagnosis, who is at risk for the disease, hereditary nature, or that the disease can inhibit growth and development among children. Most videos (56%) did not cover how celiac disease is diagnosed, and only 14% mentioned family members of diagnosed individuals should be screened for the disease (garnering only 9% of cumulative views). CONCLUSION: Given the popularity and potential reach of YouTube, medical professionals have an opportunity to use this medium to reach a large audience in providing accurate and useful information to the public about celiac disease.

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OBJECTIVES: The key to reducing mortality from skin cancer depends on early detection and treatment, which, in many cases, means a patient should be informed and possess the self-efficacy necessary to seek expert opinion. The purpose of this study was to determine the readability of skin cancer materials on the Internet using the commonly used readability tests. STUDY DESIGN: This is a cross-sectional study. METHODS: A search was conducted using the key words 'skin cancer.' The first 15 pages of websites that contained English language articles on skin cancer comprised the sample for this study. All English language articles appearing on these websites were analyzed using the Readable.io service to automate popular readability scores. For each article, it was determined if it was generated from a .org, .com, .gov, .net, .edu or other source. Five readability tests were conducted on the materials to determine the ease with which one can read each article. RESULTS: Of the 102 websites sampled, none received an acceptable score on all five assessments. In fact, more than 90% of the websites sampled received an unacceptable score on any one of the five assessments, and more than 78% of the websites sampled received an unacceptable level on all five assessments. All five readability assessments demonstrated statistically significant results; each P-value obtained from the t-tests was substantially below 0.01 and, hence, below the α = 0.05 threshold. These results indicate that it is unlikely that skin cancer websites are being written at the recommended level. Of the websites sampled, roughly 42% were .com, and slightly more than 36% were .org. Statistical evidence indicated that neither .com nor .org websites are likely to be written at the acceptable level. CONCLUSIONS: Both for-profit and non-profit agencies which aim to provide health information to consumers should be mindful of the readability levels of the materials they disperse.

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BACKGROUND: The unregulated social network YouTube TM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant. METHODS: Using the keywords 'vaccine safety' and 'vaccines and children', 87 of the most widely viewed YouTubeTM videos were identified and analyzed for content, author status and view count. RESULTS: The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTubeTM videos were consumers (27.6%), TV-based or Internet-based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines. CONCLUSION: Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

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The objective of this study was prospectively to investigate the health-related quality of life (HRQOL) of 80 pediatric recipients of allo-SCT for malignant and non-malignant diseases. The PedsQL 4.0 was used to assess self-reported physical, emotional and social functioning of children 5 years old once, pre-allo-SCT and on days +100, +180, +365 and +730. Emotional and social functioning was stable pre-to-post-allo-SCT and comparable to the normative sample (P>0.05), and physical functioning was 17 points lower pre-allo-SCT (P0.01) with improved scores equivalent to the norms by day +730. Lower physical scores were reflected by 50-54% of children reporting difficulties with movement, strength, pain and fatigue. At baseline, children ages 5-7 reported lower social functioning (P<0.05) and patients with non-malignant disease reported better physical functioning (P<0.05). Emotional functioning in ages 8-12 improved over time (P<0.05). More than 50% of the participants were minority and their HRQOL was similar to non-minority participants. Physical functioning significantly improved for recipients of reduced-toxicity conditioning (P0.01), significantly worsened for patients with chronic GVHD (cGVHD; P<0.05), and significantly decreased in recipients of matched-unrelated donor transplant who developed cGVHD (P<0.05). Multidisciplinary efforts are necessary to identify and support pediatric patients' physical needs to improve functional outcomes.

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A sample of 115 urban, working-class, predominantly minority men and women was interviewed by telephone to assess knowledge, beliefs, and barriers relevant to colorectal cancer (CRC) and CRC screening. More than half (53.9%) were unable to name a CRC screening test. Misconceptions were common. Dispelling inaccurate beliefs, establishing an individual's preference for fecal occult blood tests or flexible sigmoidoscopy, and helping individuals take a proactive role in the receipt of CRC screening are important goals for health education efforts aimed at increasing rates of CRC screening. Participants' willingness to engage in detailed telephone conversations about CRC and CRC screening was encouraging.

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BACKGROUND: There is a lack of published data on sources and quantity of calcium intake in preschool children. STUDY OBJECTIVES: To assess calcium intake compared with the Dietary Reference Intake (DRI), to identify major food sources of calcium, and to compare dietary patterns of healthy preschool children who do and do not meet the calcium DRI. DESIGN: Cross-sectional study. SETTING: Primary care pediatrics practice at a large urban medical center. SUBJECTS: A group of 228 children aged 44 to 60 months in a low socioeconomic community. METHODS: Diet was assessed using three or four 24-hour recalls administered approximately three months apart to the parents. Nutrient values were computed using a dietary analysis program based on USDA values. RESULTS: Mean daily calcium intake was 852 mg/day (S.D., 271) and 44% reported mean calcium intake less than the DRI of 800 mg/day. Milk consumption accounted for 64.3% and cheese for 6.7% of the daily calcium intake. Multiple linear regression analysis adjusting for age, sex, race, body mass index, and total caloric intake confirmed the main contribution of mainly milk and, to a much lesser extent, cheese consumption, as determinants of calcium intake. All of the children who consumed less than 1.2 servings of milk (288 ml) milk per day reported mean daily calcium intake below the DRI. CONCLUSIONS: Calcium intake below the DRI may be common in preschool children in low socioeconomic communities, and is associated primarily with lower milk intake. These findings indicate the need to promote the consumption of low-fat milk in preschool children.

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OBJECTIVES: This study evaluated a multicomponent educational intervention to increase ophthalmic examination rates among African Americans with diabetes. METHODS: A randomized trial was conducted with 280 African Americans with diabetes, enrolled from outpatient departments of 5 medical centers in the New York City metropolitan area, who had not had a dilated retinal examination within 14 months of randomization (65.7% female, mean age = 54.7 years [SD = 12.8 years]). RESULTS: After site differences were controlled, the odds ratio for receiving a retinal examination associated with the intervention was 4.3 (95% confidence interval = 2.4, 7.8). The examination rate pooled across sites was 54.7% in the intervention group and 27.3% in the control group. CONCLUSIONS: The intervention was associated with a rate of ophthalmic examination double the rate achieved with routine medical care.

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The term "horse-racing effect" refers to a positive correlation between the slope at which blood pressure increases with age and blood pressure level at a baseline. Previous studies have reported such an effect in adults, while studies in children have found a negative correlation (termed "the Jenss effect"). These studies used analytic methods in which it was assumed that the blood pressure slopes were constant or the blood pressure profiles were linear. In this study, the authors used a components-of-variance approach that did not require this assumption in order to model serial blood pressure measurements made in 216 US preschool children (mean age at first analyzable blood pressure observation, 58.9 months) at 6-13 visits over a 3-year period (1986-1989). Measurements were made using an automated blood pressure monitor. Values from the second and third measures at each visit were averaged to obtain each observation. Data from 2,203 blood pressure observations were available for analysis. For the full group, over the mean period of observation of 21.1 months, the mean rate of increase was 3.45 mmHg/year for systolic blood pressure and 0.06 mmHg/year for diastolic blood pressure. In the authors' model, 33 percent of the total marginal variability in systolic blood pressure was attributed to random error (visit-to-visit variability); average (constant) subject-specific difference from the population slope accounted for 42 percent, and a nonlinear component of variability around the subject-specific average accounted for the remaining 25 percent. All three components were statistically significant. Models which assumed that the slopes were constant did not fit these data, and fitting these models to the data led to an artifactual negative correlation between subject-specific slopes and intercepts. An implication of this is that the concepts of "horse-racing" and "the Jenss phenomenon," which have been operationalized by testing the covariance of the subject-specific slopes and intercepts using models which assume that the blood pressure slopes are constant over time, should not be applied to data that contain this nonlinear component of variance.

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OBJECTIVES: This study examined the effects of a school-based intervention designed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city, primarily Latino neighborhood. METHODS: A multifaceted intervention based on social marketing techniques was delivered at 3 randomly selected schools. The school was the unit of assignment and analysis; 6902 children were involved in the study. Milk selection and consumption were measured by sampling discarded milk and/or tallying milk carton disappearance at baseline, immediately postintervention, and at 3 to 4 months follow-up. RESULTS: Immediately postintervention, the mean proportion of sampled milk cartons that contained low-fat milk increased in the intervention schools, from 25% to 57%, but remained constant at 28% in the control schools. Differences between intervention and control schools remained significant at 3 to 4 months follow-up. The intervention was not associated with a decrease in overall milk consumption. CONCLUSIONS: A school-based intervention can lead to significant increases in student consumption of low-fat milk.

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The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.

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Medical students and physicians need to improve their understanding of the role of nutrition and the multidisciplinary team in diabetes care. To assist in this learning, an interactive computer program was developed that focused on prescribing diets for patients with diabetes. Parallel 10-item knowledge tests and an 8-item self-efficacy scale were used to evaluate the efficacy of the computer program among 41 third-year medical students. Mean knowledge scores increased significantly after using the computer program. Posttest knowledge scores for the medical students approached the level achieved by general practice dietitians with no diabetes specialty training. Mean self-efficacy scores increased significantly. The mean time spent on the educational component of the program was under 30 minutes. Computer-assisted diabetes nutrition education proved to be an efficient and effective method for teaching basic nutrition competencies to medical students. This program is available on the World Wide Web (http:/(/)medicine.aecom.yu.edu/diabetes/DEC.htm ) and may be a useful means for providing basic diabetes nutrition education to primary healthcare providers from a variety of disciplines as well as for medical students.

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Many patients with diabetes do not obtain the recommended annual dilated eye exam that is necessary for early detection of diabetic retinopathy. In this study, 150 suburban, low-income women with diabetes were interviewed using a structured telephone questionnaire that included subscales of ophthalmic knowledge and beliefs regarding barriers, benefits, concerns, and self-efficacy related to receiving recommended ophthalmic screening. The data revealed significant gaps in knowledge about diabetes-related eye complications. More than half of the subjects did not know that eye complications may be asymptomatic and that there are ways to lower the risk of eye problems. Over three quarters did not mention having drops put in their eyes as part of an eye exam, one fifth did not know what type of health provider should perform an eye exam, and 17% did not know that annual eye exams were recommended. Subjects were concerned about eye complications associated with diabetes, were aware of the benefits of eye exams, and reported high levels of self-efficacy for receiving an annual eye exam.

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African Americans with diabetes have a higher rate of lower-extremity amputation due to diabetic foot complications than the general public. Education about proper foot care can help prevent serious diabetic foot complications and assist in early detection of problems. The purpose of this project was to develop, formatively evaluate, and pilot test a self-care, take-home program for the prevention of foot problems in African Americans with diabetes. The program included a brief, one-on-one orientation session and a take-home foot self-care packet. Through telephone follow-up subjects reported the following: good to excellent overall rating of the program, favorable reactions to the patient instruction booklet, an overwhelming positive response to the large hand mirror, and a positive effect on their daily foot-care practices. The Afrocentricity of the patient education materials was preferred by younger subjects; older subjects found this approach too restrictive.

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Diabetes-related ophthalmic complications are the leading cause of newly diagnosed blindness among adults. These eye complications are often asymptomatic in the early stages, yet the majority of diabetes patients are not screened yearly. To develop a health promotion intervention to increase the rate of screening for diabetic retinopathy by dilated fundus exam (DFE), we assessed the knowledge and health beliefs related to preventing diabetic eye complications among a sample of African-Americans with diabetes. The study design was cross-sectional, using a telephone interview to collect data. From a random sample of 104 African-Americans with diabetes, 67 (64%) were completed: 54 women; mean age of 58 years. The telephone interview schedule contained items grouped into subscales for Perceived Incentives, Perceived Barriers to getting a DFE, Causes of Eye Problems, Risk of Eye Problems, and Effective Treatments for Eye Problems. Descriptive statistics were used to analyze the quantitative data. Transcribed qualitative responses to the open-ended questions were analyzed for themes. The incentives "having eye problems" and "doctor said it was important to go" each had 91% responding it was an incentive to go for a DFE. Only about one-third agreed that any particular item was a barrier to receiving a DFE (e.g., economic factors). In the subscale for Risk of Eye Problems, "retinopathy" had the lowest level of perceived risk (30%). Only 21% of the sample reported there were effective treatments for retinopathy. Eighty-seven percent reported the faulty belief that "diabetic eye problems have symptoms." Only 36% of the sample said they had heard of retinopathy and of those, only 8% could describe it correctly. Among general response themes were: fear, spirituality (faith and hope), priorities, economic or logistical factors, and external/internal motivation. Perceived incentives for receiving a DFE were acknowledged at far greater rates than perceived barriers. Having a yearly DFE in the absence of symptoms must be emphasized in health promotion materials. There are effective, early treatments for diabetic eye problems, and this information should be used to counter the fear of a dreaded diagnosis with the hope of treatment and cure. Ways of coping with fear of having the exam should be included in health education. DFEs must become a routine yearly exam and not just a reaction to recognized problems. Health education must address the specific needs of high-risk minority populations.

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OBJECTIVES: This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. METHODS: The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240,000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. RESULTS: Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. CONCLUSIONS: Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources.

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Substitution of low-fat for whole milk is an important strategy for reducing saturated fat consumption, but intake of whole milk remains high among Latinos. To assess whether this is related to the unavailability of low-fat milk, we surveyed 251 grocery stores (bodegas) and 25 supermarkets in a predominantly low-income, urban Latino community. Low-fat milk was available in 73% of bodegas and 96% of supermarkets, but it constituted only 15% of total milk volume in bodegas and 37% of that volume in supermarkets. Since lack of availability was not a major obstacle to increasing low-fat milk consumption, public health nutrition campaigns should focus on increasing consumer demand.

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