Kakoli Roy

Lower diet quality is a leading preventable risk factor for obesity and chronic diseases. This study assesses differences in the nutritional quality of at-home food purchases, using the Healthy Eating Index (HEI)-2015 and its components, among households with and without a member reporting type 2 diabetes (T2D), cardiovascular disease (CVD), obesity, and/or smoking. We use the 2015 IRI Consumer Network nationally representative household food purchase scanner data, combined with the IRI MedProfiler and the USDA’s Purchase-to-Plate Crosswalk datasets. For each/multiple condition(s), the difference in mean HEI score adjusted for covariates is tested for equivalence with the respective score against households without any member with the condition(s). The HEI score is higher for households without a member with reported T2D (2.4% higher), CVD (3.2%), obesity (3.3%), none of the three conditions (6.1%, vs. all three conditions), and smoking (10.5%) than for those with a member with the respective condition. Households with a member with T2D score better on the added sugar component than those with no member reporting T2D. We found that the average food purchase quality is lower than the recommended levels, especially for households with at least one member reporting a chronic condition(s).

Objectives.: From 2004 through 2005, as part of a major strategic planning process called the Futures Initiative, the Centers for Disease Control and Prevention (CDC) developed a set of Health Protection Goals to make the best use of agency resources to achieve health impact. These goals were framed in terms of people, places, preparedness, and global health. This article presents a goals framework and a set of health outcome measures with historical trends and forecasts to track progress toward the Healthy People goals by life stage (Infants and Toddlers, Children, Adolescents, Adults, and Older Adults and Seniors). Methods.: Measurable key health outcomes were chosen for each life stage to capture the multidimensional aspects of health, including mortality, morbidity, perceived health, and lifestyle factors. Analytic methods involved identifying nationally representative data sources, reviewing 20-year trends generally ranging from 1984 through 2005, and using time-series techniques to forecast measures by life stage until 2015. Results.: Improvements in measures of mortality and morbidity were noted among all life stages during the study period except Adults, who reported continued declining trends in perceived health status. Although certain behavioral indicators (e.g., prevalence of nonsmokers) revealed steady improvements among Adolescents, Adults, and Older Adults and Seniors, prevalence of the healthy weight indicator was declining steadily among Children and Adolescents and dramatically among Adults and Older Adults and Seniors. Conclusion.: The health indicators for the Healthy People goals established a baseline assessment of population health, which will be monitored on an ongoing basis to measure progress in maximizing health and achieving one component of CDC's Health Protection Goals.

The increasing prevalence of ciprofloxacin-resistant Neisseria gonorrhoeae has required replacing inexpensive oral ciprofloxacin treatment with more expensive injectable ceftriaxone. Further, monitoring antimicrobial resistance requires culture testing, but nonculture gonorrhea tests are rapidly replacing culture. Since the strategies were similar in effectiveness (>99%), we evaluated, from the healthcare system perspective, cost-minimizing strategies for both diagnosis (culture followed by antimicrobial susceptibility tests versus nonculture-based tests) and treatment (ciprofloxacin versus ceftriaxone) of gonorrhea in women. Our results indicate that switching from ciprofloxacin to ceftriaxone is cost-minimizing (i.e., optimal) when the prevalence of gonorrhea is >3% and prevalence of ciprofloxacin resistance is >5%. Similarly, culture-based testing and susceptibility surveillance are optimal when the prevalence of gonorrhea is <13%; nonculture-based testing is optimal (cost-minimizing) when gonorrhea prevalence is ≥13%.