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Background: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. Methods: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. Results: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. Conclusions: Our analysis supports the need for early skill-based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

A wide variety of school-based physical activity contexts have been recently associated with various measures of academic performance. Of these studies, a small number employing objective measures of student fitness have identified a relationship with academic achievements. However, even among these studies, the fitness-academic link has not been conclusively recognized or regularly assessed with regards to academic behaviors and socio-demographic variables. The purpose of this study was to explore the relationships among these variables by using objective measures of fitness, standardized Language Arts and Math test scores, attendance records, discipline actions, and socio-demographic information from a sample of 2,992 Mississippi (USA) public school children in grades 3-8. The sample consisted of students who were mostly male (52.4%), white (52.3%), in grades 3-5 (64.2%), within a healthy weight range (54.1%), and qualified for free/reduced price lunch (63.7%). The results indicated a statistically significant positive correlation between fitness and standardized test scores in Language Arts and Math and a statistically significant negative relationship with school absences. The relationships remained significant while controlling for gender, race, and socioeconomic status. Given that students who were more fit had higher test scores and fewer absences, these findings warrant consideration in the educational policy making process. (Contains 4 tables and 1 figure.)

Purpose/Objective: The Child Nutrition and WIC Reauthorization Act of 2004 required all schools receiving funding for school meals to implement a Local Wellness Policy. However, there is little to no accountability related to the implementation of the policy. Therefore, the purpose of this study was to evaluate the degree of implementation of nutrition components of the Local School Wellness policies in Mississippi in 2008. Methods: Data were collected through the 2008 Local School Wellness Policy Principal Survey which was sent to principals of all public schools in Mississippi. The survey was sent out through email; the survey content was based on the Local School Wellness Policy: "Guide for Development" and the Mississippi Healthy Students Act. Responses to each survey item related to implementation of the policy were tabulated and percentages were calculated. For items asked in both the 2006 and 2008 surveys, statistical significance of difference was determined through the calculation and comparison of confidence intervals (CIs). Results: Significant improvements have been made in the implementation of Local School Wellness Policies from 2006 to 2008. In 2008, 96.0% of the respondents reported that the Local School Wellness Policy was being partially or fully implemented in their school (significantly higher than 78.2% in 2006). The majority of schools (96.7%) reported implementing the minimum nutrition components of local wellness policy requirements. In 2008, 72.3% of the principals reported that 75-100% of the students were receiving nutrition education as compared to 35.2% in 2006. Applications to Child Nutrition Professionals: It is encouraging to see that schools are actively moving to stronger implementation of the local wellness policy, with significant improvements in nutrition-related activities. Child nutrition professionals are key in the development, implementation, and evaluation of the wellness policy. (Contains 2 tables.)

Background: Previous investigations have shown that low academic achievers are more likely to smoke cigarettes, drink alcohol, and use marijuana and other illicit drugs. This study investigated the relationship between academic performance and substance use among public high school students in Mississippi. Methods: The sampling frame for the 2003 Mississippi Youth Risk Behavior Survey was obtained from the Mississippi Department of Education. A 2-stage cluster sample design produced a representative sample of Mississippi students in grades 9-12 who attended public schools. During the spring 2003, 34 of the 45 sampled schools (75.6%) participated. Results: A total of 1488 from the 1672 sampled students (89.0%) completed an 87-item questionnaire (overall response rate 67.3%). Low academic performance (students with mostly Cs or below) during the 12 months preceding the survey was more prevalent among males, non-Hispanic blacks, frequent smokers, binge drinkers, and marijuana users. Logistic regression identified gender, race, frequent smoking, and marijuana use as statistically significant factors associated with increased odds for low academic performance. Adjusted odds ratios were 1.2 for binge drinkers versus other students to 2.6 for non-Hispanic black students versus non-Hispanic white students. Conclusions: The present findings highlight the extensive use of cigarettes, alcohol, and marijuana among Mississippi public high school students. Because poor academic achievers are more prevalent among students who participate in these substance-use behaviors, multifaceted approaches that encourage high levels of academic performance, while dissuading student involvement in risky/problem behaviors, may both improve low levels of academic achievement and reduce behaviors that contribute to poor health in adulthood.

Researchers examined trends and compared subgroup differences in violence-related behaviors on school property among Mississippi public high school students from 1993 to 2003. Findings are based on data from the Mississippi Youth Risk Behavior Surveillance System (YRBSS), a representative sample (N = 9,058) of Mississippi high school students. Males, non-Hispanic Whites, heavy smokers, and binge drinkers reported violence-related behaviors on school property more frequently than their counterparts. A statistically significant linear decrease occurred during 1993-2003 in the percent of students carrying a weapon (p < 0.0001) and having a physical fight (p < 0.0001). The percent of students threatened or injured with a weapon on school grounds did not decrease significantly (p = 0.2800). Violence-related behaviors were reported somewhat less frequently among 12th graders but overall, grade was not a statistically significant factor. Trends observed in Mississippi appear to be occurring throughout the United States and perhaps globally. Parents, school officials, and community administrators are committed to reducing violence-related behavior on school property. Although the decreases are encouraging, the percent of students who reported violence-related behaviors remains at a level that causes serious concern. Efforts must continue and perhaps increase to curb behaviors that may lead to school violence. Future studies should elucidate mechanisms associated with the self-reported decreasing behaviors so intervention programs can be properly focused.

Introduction: Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID‐19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID‐19 pandemic and explore relevant policy implications. Design: Researchers used a cross‐sectional, non‐experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. Methods: As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID‐19 pandemic has made me more open to using telehealth" on a 5‐point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t‐test and one‐way ANOVA with Bonferroni post‐hoc multiple comparisons. Results: Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID‐19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post‐hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). Conclusion: As access to telehealth increased due to the COVID‐19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. Clinical Relevance: Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID‐19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions. [ABSTRACT FROM AUTHOR]

Background: Mississippi (MS) has among the highest rates of cervical cancer incidence and mortality in the United States, with disproportionately higher rates among Blacks compared to Whites. Here, we evaluate the prevalence of high‐risk human papillomavirus (HPV) and abnormal cytology in a representative baseline sample from a diverse statewide cohort of individuals attending cervical screening in MS from the STRIDES Study (STudying Risk to Improve DisparitiES in cervical cancer). Methods: We included individuals aged 21–65 years undergoing screening at the University of Mississippi Medical Center (UMMC) and the Mississippi State Department of Health (MSDH) from May to November 2018. We calculated age‐specific HPV prevalence, overall and by partial HPV16/18 genotyping, and abnormal cytology by race. Results: A total of 6871 individuals (mean age 35.7 years) were included. HPV prevalence was 25.6% and higher in Blacks (28.0%) compared to Whites (22.4%). HPV prevalence was significantly higher in Blacks aged 21–24 years (50.2%) and 30–34 years (30.2%) compared to Whites in the same age groups (32.1% and 20.7%; p < 0.0001, respectively). The prevalence of high‐grade cytologic abnormalities, a cytologic sign of cervical precancer, peaked earlier in Blacks (ages 25–29) compared to Whites (35–39). For comparison, we also analyzed HPV prevalence data from the National Health and Nutrition Examination Survey (NHANES, 2013–2016) and observed similar racial differences in HPV prevalence among women aged 21–24 years. Conclusions: Our findings suggest that Blacks undergoing cervical cancer screening in MS have higher prevalence of other high‐risk 12 HPV types at younger ages and experience an earlier peak of high‐grade cytologic abnormalities compared to Whites. [ABSTRACT FROM AUTHOR]

BACKGROUND In Mississippi, hypertension as a leading cause of death moved from 15th in 2000 to 11th in 2018, but research on temporal trends is limited. We examined temporal trends in hypertension-related mortality among Mississippi adults by age, sex, and race. METHODS We extracted data on the number of deaths due to hypertension among adults aged 45 or older annually from 2000 to 2018 from Mississippi Vital Statistics. We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision to identify hypertension deaths. We calculated the annual percentage change (trend segment) and average annual percentage change (AAPC) in age-adjusted hypertension death rates from 2000 to 2018 and examined differences in the AAPC by age, sex, and race. RESULTS From 2000 through 2018, the age-adjusted hypertension death rate increased annually by 3.0% (AAPC 3.0%, 95% confidence interval, 1.9%–4.0%) with 3 distinct time periods. There was an average annual increase in age-adjusted hypertension death rates for all subgroups, i.e. men, women, Blacks, Whites, White females, Black males, and White males. The highest magnitude of increase was among those aged 45–64 years (AAPC 6.0%), men (AAPC 4.5%), Whites (AAPC 3.5%), and White men (AAPC 6.2%) compared with other age groups, women, Blacks, and Black men, respectively. CONCLUSIONS For nearly 2 decades, there was an increase in age-adjusted hypertension death rates among Mississippi adults aged 45 years or older. Blood pressure lowering interventions that target hypertensive adults are needed. [ABSTRACT FROM AUTHOR]

Purpose: Examine association of health literacy (HL) and menu-labeling (ML) usage with sugar-sweetened beverage (SSB) intake among adults in Mississippi. Design: Quantitative, cross-sectional study. Setting: 2016 Mississippi Behavioral Risk Factor Surveillance System data. Participants: Adults living in Mississippi (n = 4549). Measures: Outcome variable was SSB intake (regular soda, fruit drinks, sweet tea, and sports/energy drinks). Exposure variables were 3 HL questions (find information, understand oral information, and understand written information) and ML usage among adults who eat at fast-food/chain restaurants (user, nonuser, and do not notice ML). Analysis: Multinomial logistic regressions were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for SSB intake ≥1 time/d (reference: 0 times/d) associated with HL and ML. Results: In Mississippi, 46.8% of adults consumed SSB ≥1 time/d, and 26.9% consumed ≥2 times/d. The odds of consuming SSBs ≥1 time/d were higher among adults with lower HL (aOR = 1.7; 95% CI = 1.3-2.2) than those with higher HL. Among adults who ate at fast-food/chain restaurants, the odds of consuming SSBs ≥1 time/d were higher among nonusers of ML (aOR = 2.3; 95% CI = 1.7-3.1) and adults who did not notice ML (aOR = 1.8; 95% CI = 1.3-2.6) than ML users. Conclusion: Adults with lower HL and adults who do not use or notice ML consumed more SSBs in Mississippi. Understanding why lower HL and no ML usage are linked to SSB intake could guide the design of interventions to reduce SSB intake in this population. [ABSTRACT FROM AUTHOR]

In 2017, Mississippi had the third highest age-adjusted prevalence of hypertension in the United States. We estimated the prevalence of hypertension by sociodemographic characteristics and occupation and examined the association between hypertension with occupation and sociodemographic characteristics among Mississippi workers. We calculated adjusted prevalence and adjusted prevalence ratios (APRs) by sociodemographic characteristics and occupation among Mississippi adult workers. We analyzed combined 2013, 2015, and 2017 data from the Mississippi Behavioral Risk Factor Surveillance System for 6,965 workers in ten Standard Occupational Classification System major groups. Of the estimated 1.1 million Mississippi workers during the three survey years, 31.4% (95% confidence interval (CI), 30.0–32.8) had hypertension. The likelihood of having hypertension was significantly higher among workers aged 30–44 years, 45–64 years, blacks, and those classified as overweight and obese workers compared to their counterparts. The likelihood of having hypertension among workers in the fields of installation, repair and maintenance, and production were 26% higher (APR, 1.26; 95% CI, 1.03–1.55) and 33% higher (APR, 1.33; 95% CI, 1.11–1.58), respectively, than workers in all other occupational groups. Among Mississippi workers, hypertension prevalence varied by sociodemographic characteristics and occupational groups. Age, race, obesity status, installation, repair, maintenance, and production occupation groups are associated with an increased likelihood of hypertension. Novel and/or community-based or linked programs are needed that could target workers at risk of hypertension that are outside of a single-site workplace. [ABSTRACT FROM AUTHOR]

Obesity remains a serious public health issue in adolescents, who may be subjected to weight stigma leading to increased stress and poor health outcomes. Stigma can be detrimental to adolescents during self-identity formation. The purpose of this study was to examine weight stigma in adolescents in light of the Identity Threat Model of Stigma. A cross-sectional correlational design was used to examine the relationships among the variables of weight stigma, psychosocial stress, coping styles, disordered eating, and physical inactivity. Regression modeling and path analysis were used to analyze the data. Over 90% of the sample had scores indicating weight stigma or antifat bias. Avoidant coping style and psychosocial stress predicted disordered eating. The strongest path in the model was from avoidant coping to disordered eating. The Identity Threat Model of Stigma partially explained adolescents’ weight stigma. Nursing practice implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives To determine the prevalence of postpartum depression (PPD) among new mothers in Mississippi during 2009-2011 and evaluate the effects of different stressful life events in the year before delivery on the likelihood of PPD. Methods We used Mississippi Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011 data (n = 3695) to evaluate the effects of different stressful life events on PPD. We categorized 13 stressors into 4 groups: financial, relational, trauma-related, and emotional. A composite score of the mothers' responses (≥10) to the three items: 'I felt down, depressed, or sad', 'I felt hopeless', and 'I felt slowed down' was used to measure PPD. The items were rated on a Likert scale from (1) never to 5 (always). Descriptive statistics, Chi square tests, t tests, and logistic regression analyses were conducted using SAS 9.3 Proc Survey procedure (SAS Institute, Cary, NC, USA). Results The overall prevalence of self-reported PPD was 14.8 %. Mothers who experienced high relational with low financial and high trauma related stresses had the highest likelihood of PPD diagnosis after adjusting for confounders (OR = 8.6; 95 % CI, 3.5-21.3), followed by those who reported high relational stress with low financial and low trauma stresses (OR = 5.9; 95 % CI, 3.5-10.2). Those with high financial, low relational, and low trauma had the least likelihood of PPD (OR = 2.2; 95 % CI, 1.6-3.0) compared to women with low stress in all three categories. Conclusion Our findings showed that the likelihood of PPD was higher among women who had high relational stress, indicating that efforts to effectively prevent PPD need to focus on healthy relationships between partners during pregnancy. [ABSTRACT FROM AUTHOR]

Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been associated with lower rates of breastfeeding; studies have suggested this relationship may be modified by race. The purpose of this study is to examine the association between WIC participation and breastfeeding behaviors among white and black women in Mississippi. Using data from the 2004–2008 Mississippi Pregnancy Risk Assessment Monitoring System, we calculated multivariable prevalence and hazard ratios to assess the relationships among WIC participation during pregnancy and breastfeeding initiation and duration through 10 weeks postpartum. Stratified analyses were performed for white and black women. 52.2 % of white and 82.1 % of black women participated in WIC. 60.4 % of white and 39.7 % of black women initiated breastfeeding, and 26.5 % and 21.9 %, respectively, were breastfeeding at 10 weeks postpartum. WIC participation was negatively associated with breastfeeding initiation among whites (APR: 0.87; 95 % CI 0.77–0.99), but not blacks (APR: 0.99; 95 % CI 0.28–1.21). WIC participation was not associated with breastfeeding duration for women of either race (white: AHR: 1.05, 95 % CI 0.80–1.38; black: AHR: 0.91, 95 % CI 0.65–1.26). The results among white women suggest that Mississippi WIC might benefit from an in depth evaluation of the program’s breastfeeding promotional activities to determine if aspects of the program are undermining breastfeeding initiation. High rates of participation in the WIC program among black women, and the overall low rates of breastfeeding in this population point to the potential the program has to increase breastfeeding rates among blacks. [ABSTRACT FROM AUTHOR]

Objectives. We examined the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the southeastern United States. Methods. We investigated cross-sectional associations of FFR availability with dietary intake and body mass index (BMI) and waist circumference in 4740 African American Jackson Heart Study participants (55.2 612.6 years, 63.3% women). We estimated FFR availability using circular buffers with differing radii centered at each participant's geocoded residential location. Results. We observed no consistent associations between FFR availability and BMI or waist circumference. Greater FFR availability was associated with higher energy intake among men and women younger than 55 years, even after adjustment for individual socioeconomic status. For each standard deviation increase in 5-mile FFR availability, the energy intake increased by 138 kilocalories (confidence interval [CI]=70.53, 204.75) for men and 58 kilocalories (CI=8.55, 105.97) for women. We observed similar associations for the 2-mile FFR availability, especially in men. FFR availability was also unexpectedly positively associated with total fiber intake. Conclusions. FFR availability may contribute to greater energy intake in younger African Americans who are also more likely to consume fast food. [ABSTRACT FROM AUTHOR]

This study aimed to identify factors contributing to high rates of preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi while considering both traditional risk factors and maternal medical conditions. The retrospective cohort study used 1996-2003 Mississippi linked birth and infant death files. Multiple logistic regression was used to investigate association between maternal medical conditions and unfavorable birth outcomes. Along with traditional risk factors, hypertension was significantly associated with PTB and LBW. Women with hypertension were about 2.2 and 3.2 times as likely to have PTB and LBW, respectively. Hydramnios/oligohydramnios increased 1.8-4.4 folds of risk for PTB, LBW and infant death and was significantly associated with the unfavorable birth outcomes. Non-Hispanic black women were about 1.5-2.0 times as likely to have an unfavorable birth outcome compared to non-Hispanic white women. Maternal education and prenatal care effect appeared to be modified by maternal race. Certain maternal medical conditions may be contributing to PTB, LBW and infant mortality rates identifying preconception and prenatal healthcare as possible strategies for reducing unfavorable outcomes. Results suggest that different risk profiles for unfavorable outcomes may exist according to maternal race highlighting the need to consider racial groups separately when further exploring the sociodemographic and/or health-related factors that contribute to unfavorable birth outcomes. [ABSTRACT FROM AUTHOR]

The objective of the study is to identify racial disparities in prenatal care (PNC) utilization and to examine the relationship between PNC and preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi. Retrospective cohort from 1996 to 2003 linked Mississippi birth and infant death files was used. Analysis was limited to live-born singleton infants born to non-Hispanic white and black women ( n = 292,776). PNC was classified by Kotelchuck's Adequacy of Prenatal Care Utilization Index. Factors associated with PTB, LBW and infant death were identified using multiple logistic regression after controlling for maternal age, education, marital status, place of residence, tobacco use and medical risk. About one in five Mississippi women had less than adequate PNC, and racial disparities in PNC utilization were observed. Black women delayed PNC, received too few visits, and were more likely to have either 'inadequate PNC' ( P < 0.0001) or 'no care' ( P < 0.0001) compared to white women. Furthermore, among women with medical conditions, black women were twice as likely to receive inadequate PNC compared to white women. Regardless of race, 'no care' and 'inadequate PNC' were strong risk factors for PTB, LBW and infant death. We provide empirical evidence to support the existence of racial disparities in PNC utilization and infant birth outcomes in Mississippi. Further study is needed to explain racial differences in PNC utilization. However, this study suggests that public health interventions designed to improve PNC utilization among women might reduce unfavorable birth outcomes especially infant mortality. [ABSTRACT FROM AUTHOR]

Background: In the United States, asthma hospitalization rates are disproportionately high among blacks compared with other racial/ethnic groups and vary by geographic region. These disparities among asthma hospitalizations might be affected by social, environmental, and health-care access factors. Objective: To determine demographic risk factors for asthma hospitalizations in urban versus rural areas of Mississippi. Methods: A cross-sectional study using data from the Mississippi Asthma Surveillance System was conducted to compare asthma hospitalizations in the urban Jackson metropolitan statistical area and rural Delta regions of Mississippi from 2003 to 2005. Factors including race, sex, age, and household income that might be associated with multiple hospitalizations for asthma (3 or more during the study period) were assessed using logistic regression. Results: Asthma hospitalization rates were significantly higher among all demographic groups in the rural Delta region compared with the urban Jackson Metropolitan Statistical Area (P < .001). In both regions, hospitalization rates were higher among blacks and females (P < .001). Asthma hospitalization rates were highest among children (0-17 years) and older adults (≥65 years). In both regions, blacks were more likely to have 3 or more asthma hospitalizations (P < .001). Residents of the Delta had higher odds for multiple hospitalizations controlling for race, sex, age, and household income (P < .05). Conclusion: Blacks with asthma are more likely to have multiple asthma hospitalizations in Mississippi. Higher odds of multiple asthma discharges for Delta residents were not explained by race, sex, age, or income, indicating that other contributing factors (eg, environmental, social, and access to care factors) need further investigation. [Copyright &y& Elsevier]

Introduction. Cardiovascular disease (CVD), accounting for one in every four U.S. deaths, has had a devastating impact on Mississippi's African American population. 1 Seeking innovative mitigation models, this study assesses CVD prevalence and reach via barbershops to rural Mississippi African Americans. Methods. Data was collected from barbershop clientele who consented to be screened and contacted for referral to clinical care if blood pressure was found to be elevated. Results. Most participants were African American (97.7%, n=2,756) and male (54.4%). Descriptive findings revealed more than one-third of participants (34.2%) had elevated blood pressure at screening. Factoring in those with hypertension in control, we found lower rates of hypertension in the male population (males 51.4% vs. females 57.8%), a sharp contrast to national rates. Conclusion. Evaluation findings suggest CVD prevalence in rural Mississippi is comparatively high but that barbershop partners were able to successfully reach and screen the target population. [ABSTRACT FROM AUTHOR]

In order to examine associations between asthma morbidity and local ambient air pollution in an area with relatively low levels of pollution, we conducted a time-series analysis of asthma hospital admissions and fine particulate matter pollution (PM2.5) in and around Jackson, MS, for the period 2003 to 2011. Daily patient-level records were obtained from the Mississippi State Department of Health (MSDH) Asthma Surveillance System. Patient geolocations were aggregated into a grid with 0.1° × 0.1° resolution within the Jackson Metropolitan Statistical Area. Daily PM2.5 concentrations were estimated via machine-learning algorithms with remotely sensed aerosol optical depth and other associated parameters as inputs. Controlling for long-term temporal trends and meteorology, we estimated a 7.2% (95% confidence interval 1.7–13.1%) increase in daily all-age asthma emergency room admissions per 10 μg/m3 increase in the 3-day average of PM2.5 levels (current day and two prior days). Stratified analyses reveal significant associations between asthma and 3-day average PM2.5 for males and blacks. Our results contribute to the current epidemiologic evidence on the association between acute ambient air pollution exposure and asthma morbidity, even in an area characterized by relatively good air quality. [ABSTRACT FROM AUTHOR]

Objectives: Mississippi has one of the highest mortality rates in colorectal cancer (CRC) and one of the lowest rates of CRC screening in the United States. The purpose of the study was to assess the characteristics of Mississippians who met the US Preventive Services Task Force (USPSTF) recommendation on CRC screening and type of the test they used.Methods: We analyzed the data from the 2018 Mississippi Behavioral Risk Factor Surveillance System (N = 5843), which included a CRC screening module for participants who were 50 years old or older. Respondents in this module were asked when, if ever, they had last undergone a colonoscopy, sigmoidoscopy, or stool occult test. Their responses were then categorized according to their compliance with the USPSTF recommendations on CRC screening. We compared the compliance with responders' sociodemographic and risk factors. Data analysis accounted for the complex sampling design.Results: The majority of the CRC screening tests are colonoscopies: 60.1% of Mississippians aged 50 to 75 years had received one within 10 years. In addition, 7.8% had taken a stool test within the last year, and 1.9% had undergone sigmoidoscopy within 5 years. The prevalence of individuals aged 50 to 75 in Mississippi who met the USPSTF recommendation for CRC screening in 2018 was 62.6%. Women (65.5%), married (67.5%), those with health insurance (66.5%) or annual household income of ≥$75,000 (71.6%), those with a regular healthcare provider (68.0%), or those who quit smoking (70.4%) had higher compliance than their counterparts. After controlling for the covariates, the adults aged 50 to 75 who had health insurance or had a personal healthcare provider were 2.52 and 2.95 times more likely to be compliant, respectively (P < 0.001). Those who had quit smoking were 2.27 times more likely to be compliant with the USPSTF than current smokers (P < 0.001). Weight status, binge drinking, or physical inactivity was not associated with the CRC screening rates.Conclusions: Mississippi adults aged 50 to 75 were more likely to be compliant with the CRC screening standards if they had insurance coverage or access to care. To further increase the overall CRC screening rate and for the benefit of the 70 × 2020 state initiative, certain screenings such as stool test need to be promoted and recommended by family practitioners, and certain subgroups of the population such as smokers need to be targeted and educated. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of using glacial acetic acid (GAA) to convert unsatisfactory bloody ThinPrep (TP) cervical smear test to satisfactory, and identify associated missed diagnoses and high-risk HPV (hrHPV) genotypes.Methods: In a retrospective descriptive cross-sectional analysis, all TP tests performed in Mississippi, USA, 2012-2016, were evaluated for unsatisfactory results owing to blood. Tests that were converted to satisfactory by GAA treatment, and corresponding anomalies and HPV genotypes were identified.Results: Among 106 384 TP tests, there were 1460 (1.37%) unsatisfactory results, of which 1442 (98.77%) were converted to satisfactory after GAA treatment. Laboratory preprocessing with GAA increased costs minimally. Precancerous lesions were detected in 166 (11.51%) of 1442 GAA-treated samples, of which 12 (7.2%) were high-grade lesions, 110 (66.3%) were atypical squamous cells of undetermined significance, and 63 (57.3%) tested positive for hrHPV. Of 60 genotyped samples, 39 (65%) had non-HPV16 and non-HPV18. Including mixed infections, 48 (80%) contained less-common hrHPV types, reflecting an unexpected distribution in bloody specimens.Conclusions: GAA pretreatment of bloody TP tests would reduce the incidence of unsatisfactory results and missed high-grade lesions, and prevent the cost of repeat tests and delayed treatment. Clinicians without access to GAA should consider HPV testing. [ABSTRACT FROM AUTHOR]

Cervical cancer rates in Mississippi are disproportionately high, particularly among Black individuals; yet, research in this population is lacking. We designed a statewide, racially diverse cohort of individuals undergoing cervical screening in Mississippi. Here, we report the baseline findings from this study. We included individuals aged 21 years and older undergoing cervical screening with cytology or cytology-human papillomavirus (HPV) co-testing at the Mississippi State Health Department (MSDH) and the University of Mississippi Medical Center (UMMC) (December 2017-May 2020). We collected discarded cytology specimens for future biomarker testing. Demographics and clinical results were abstracted from electronic medical records and evaluated using descriptive statistics and chi-square tests. A total of 24,796 individuals were included, with a median age of 34.8 years. The distribution of race in our cohort was 60.2% Black, 26.4% White, 7.5% other, and 5.9% missing. Approximately 15% had abnormal cytology and, among those who underwent co-testing at MSDH (n = 6,377), HPV positivity was 17.4% and did not vary significantly by race. Among HPV positives, Black individuals were significantly less likely to be HPV16/18 positive and more likely to be positive for other high-risk 12 HPV types compared to White individuals (20.5% vs. 27.9%, and 79.5% and 72.1%, respectively, p = 0.011). Our statewide cohort represents one of the largest racially diverse studies of cervical screening in the U.S. We show a high burden of abnormal cytology and HPV positivity, with significant racial differences in HPV genotype prevalence. Future studies will evaluate cervical precancer risk, HPV genotyping, and novel biomarkers in this population. [ABSTRACT FROM AUTHOR]

Mississippi youth are demographically unique compared to those of the nation. The aim of the study was to examine the drug use among adolescents in Mississippi compared to that in the US, which included determining prevalence and trends in drug use as well as drugs on school property and estimating the differences in drug use prevalence by gender and by race. National and Mississippi Youth Risk Behavior Surveillance System (YRBSS) data from 2001 to 2021 were obtained for analysis. Summary statistics, prevalence ratio, and survey Chi-squared tests of independence statistics were generated for the comparison for all students, and by gender and race separately. Trend analysis was conducted using logistic regression combined with joinpoint regression. The six survey questions being studied were the following: have you ever used marijuana, an inhalant, heroin, methamphetamines, or injected drugs, and were you offered, sold, or given an illegal drug on school property during the last 12 months. Survey packages in R were used to account for the complex sampling design of YRBSS data. On the national level, all six drug-related risk behaviors being studied showed a significant decrease from 2001 to 2021. In Mississippi, however, only "ever used marijuana" showed a decrease trend, while three remain unchanged, and two increased. The 2021 YRBSS data show that Mississippi adolescents exhibited a significantly higher prevalence of drug use, and are more likely to be offered, sold or given an illegal drug on school property. This research showed detailed findings on drug use-related issues in Mississippi, which is alarming. This poses an important challenge for public health in Mississippi and sounds an urgent call for drug use intervention among Mississippi adolescents. More concerted actions at the community, school and government level are needed for reducing youth drug use and controlling the drug traffic on school property.

Introduction: Cardiovascular disease (CVD) is the leading of cause of death in Mississippi. We explored trends in CVD death rates among adults in Mississippi aged 35 years or older to assess changes from 2000 through 2018., Methods: We extracted data from Mississippi Vital Statistics from 2000 through 2018. We used underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10) to identify CVD deaths; we included all cases with codes I00-I09, I11, I13, I20-I51, I60-I69, and I70. We calculated age-adjusted CVD death rates for the overall population by age, race, sex, and race-by-sex groups., Results: Overall, the age-adjusted CVD death rate declined from 832.3 deaths per 100,000 population in 2000 to 550.5 deaths per 100,000 in 2018, a relative decline of 33.9% and an average annual decline of -2.3% (95% CI, -2.7% to -1.8%). Age-adjusted CVD death rates declined from 2000 through 2018 for all groups, but the magnitude of decline varied by subgroup (men, -2.0%; women, -2.6%; non-Hispanic Black, -2.4%; non-Hispanic White, -2.2%; non-Hispanic Black women, -3.0%; non-Hispanic White women, -2.5%; non-Hispanic Black men -2.1%; non-Hispanic White men -2.0%). Age-specific analysis indicated a significant average annual increase of 1.7% (95% CI, 0.6%-2.9%) from 2011 through 2018 for the group aged 55 to 64 years., Conclusion: From 2000 through 2018, age-adjusted CVD death rates in Mississippi declined for all age/race/sex groups. However, the magnitude of decline varied by subgroup. Targeted interventions for CVD risk reduction are needed for adults aged 55 to 64 years in Mississippi, the only age group in which we observed a significant annual increase in CVD death rates.

Background: Long-standing racial disparities exist in reproductive healthcare and have been associated with negative health outcomes among minority women. This study aimed to analyze the racial disparities in reproductive healthcare among Mississippi women, particularly as it related to contraception access, usage, setting, provider type, and payer., Methods: A two-stage stratified probability design was employed - 95 of the 1500 licensed childcare facilities across the state were randomly selected, and then two to three classrooms were randomly selected within each facility. The children were the means to obtaining a weighted sample of parous women of childbearing age (15-44). Once a parous woman completed the study, she could invite a nulliparous friend of similar age, race, and socioeconomic background to also participate in the study., Results: Racial disparities were found in the reproductive healthcare of both the parous and nulliparous groups. Overall, black women were less likely to receive services from an obstetrics and gynecology. Parous and nulliparous black women were more likely to receive their reproductive healthcare at the health department and less likely to use the most effective methods of contraception., Conclusion: Low use of the most effective methods of contraception, despite high levels of general contraceptive use and high insurance coverage, hints at additional barriers to full access for black women in Mississippi. More equitable access to effective family planning counseling and contraception can have meaningful impact on the lives of black women in our state.

Introduction: On average, more than 1,700 people in Mississippi die from stroke annually, but data on trends by age, sex, and race in Mississippi are limited. We examined trends in the stroke death rate among adults in Mississippi aged 35 or older by age, sex, and race., Methods: We used Mississippi Vital Statistics data to calculate age-specific death rates for stroke among people in Mississippi aged 35 or older from 2000 to 2016. We identified cases according to underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10). We used Joinpoint software to calculate annual percentage change (APC) and the average annual percentage change (AAPC) in death rates for stroke by age, sex, and race (non-Hispanic black and non-Hispanic white)., Results: Among adults aged 35 or older, the age-adjusted stroke death rate declined 30.7% from 141.3 per 100,000 population in 2000 to 97.9 per 100,000 population in 2016, with an AAPC of -2.4% (95% confidence interval, -3.1% to -1.6%). Stroke death rates declined significantly among both men and women in the first trend segment (2000-2009 for men and 2000-2007 for women) but did not decline in the second trend segment (2009-2016 for men and 2007-2016 for women). Non-Hispanic black men had the smallest decline in stroke death rates during the full study period. Among people aged 55 to 64 and non-Hispanic white men, rates shifted from a significant annual decline during the first segment to a significant annual increase during the second segment., Conclusion: Age-adjusted stroke death rates among adults in Mississippi aged 35 or older declined significantly between 2000 and 2016, but trends differed by age, race, and sex. Clinical and community interventions aimed at reducing stroke risk factors, particularly for adults aged 55 to 64, are needed in Mississippi.

Background : Food insecurity is a public health problem. There is limited data on food insecurity in Mississippi. Methods : We analyzed data from the 2015 Mississippi Behavioral Risk Factor Surveillance System, which included the Social Context Module for 5870 respondents. Respondents who indicated that in the past 12 months they were "always", "usually", or "sometimes" "worried or stressed about having enough money to buy nutritious meals" were considered food insecure. Food insecurity was compared across sociodemographic and health characteristics using chi-square tests, and the association between food insecurity and select cardiovascular disease risk factors was assessed using logistic regression. Results : The prevalence of food insecurity was 42.9%. Compared to the referent group, Mississippi adults with high blood pressure had 51% higher odds, those with diabetes had 30% higher odds, those who were not physically active had 36% higher odds, and those who consumed fewer than five fruits and vegetables daily had 50% higher odds of being food insecure. Conclusion : Among Mississippi adults, food insecurity is associated with high blood pressure, diabetes, obesity, fruit and vegetable consumption, physical inactivity, and smoking.

This study estimated. the prevalence of overweight and obesity in Mississippi public school students in grades K-12 and examined changes between 2005 and 2015. In 2015, the prevalence of overweight, obesity, and both combined remained higher than national averages, yet the rates have neither increased nor decreased significantly since 2005 (p = 0.6904). In 2015, as with all previous years, there was no difference between boys and girls (p=0.570). As in all previous years, the prevalence of obesity in 2015 was significantly higher among black students (p < 0.001) than among white students. Similar to 2011 and 2013, there was a significant difference by grade level in 2015 (p=0.0029), with the lowest prevalence again among the elementary students. The significant linear decrease in obesity prevalence among elementary school students observed during 2013 continued to 2015 (p = 0.0209). Trends are discussed in the context of state policy and recent research.

This study estimated the prevalence of overweight and obesity in Mississippi public school students in grades K-12 and assessed changes in the prevalence between 2005 and 2013. In 2013, Body Mass Index was calculated using measured height and weight data for a weighted representative sample of 4,402 public school students. Additional analyses compared 2013 prevalence estimates by gender, race, and grade levels and for changes between 2005 and 2013. The prevalence of overweight and obesity among public school students no longer appears to be increasing although no significant downward trend was observed (p = 0.0862), and rates remain higher than national averages. In 2013, the combined prevalence of overweight and obesity for all students in grades K-12 was 41.8%, as compared to 40.9% in 2011, 42.4% in 2009, 42.1% in 2007 and 43.9% in 2005. Significant decreases in overweight and obesity were found among white students and elementary school students from 2005 to 2013. White students' combined rates fell from 40.6% in 2005 to 36.8% in 2013 (p = 0.0007). Similarly, combined rates in elementary school students dropped from 43.0% in 2005 to 38.0% in 2013 (p = 0.0002). Additionally, 2013 marked the first year that a significant decline in obesity prevalence was noted among elementary school students, from 25.0% in 2005 to 22.0% in 2013 (p = 0.0163). In 2013, the prevalence of obesity was significantly higher among black students (p < 0.001) and middle school students (p = 0.048). These findings are discussed in light of recent state-wide educational and policy initiatives and on health disparities. Implications for future practice, policy and research are presented.

This study estimated the prevalence of overweight and obesity in Mississippi public school students in grades K - 12 and assessed changes in the prevalence between 2005 and 2011. In 2011, Body Mass Index was calculated using measured height and weight data for a weighted representative sample of 4,235 public school students. Additional analyses compared 2011 prevalence estimates by gender, race, and grade levels and for changes between 2005 and 2011. The prevalence of overweight and obesity among public school students no longer appears to be increasing although a significant downward trend was not observed (p = 0.0845), and rates remain higher than national averages. In 2011, the combined prevalence of overweight and obesity for all students in grades K - 12 was 40.9% as compared to 42.4% in 2009, 42.1% in 2007 and 43.9% in 2005. Significant decreases in overweight and obesity were found among white students and elementary school student groups from 2005 to 2011. White students' combined rates fell from 40.6% in 2005 to 34.8% in 2011 (p = 0.0006). Similarly, combined rates in elementary school students dropped from 43.0% in 2005 to 37.3% in 2011 (p = 0.0045). In 2011, the prevalence of overweight and obesity was significantly lower among white students than black students (p < 0.001) and significantly lower among white female students than black female students at all three grade levels. These findings are discussed in light of recent statewide educational initiatives and health disparities. Implications for future practice, policy, and research are presented.

Introduction: Obesity is one of Mississippi's pressing public health problems. Since 2005, the state has ranked first in the nation in adult obesity prevalence. For authorities to take targeted action against the obesity epidemic, counties, regions, and subpopulations that are most affected by obesity need to be identified. The objective of this study was to assess the scope, socioeconomic and geographic characteristics, and temporal trends of the obesity epidemic in Mississippi., Methods: Using 2007-2009 Mississippi Behavioral Risk Factor Surveillance System data and auxiliary data, we applied a small-area estimation method to estimate county-level obesity prevalence in 2007 through 2009, to assess the association between obesity and socioeconomic factors and to evaluate temporal trends. We determined geographic patterns by mapping obesity prevalence. We appraised the precision of estimates by the width of 95% confidence intervals, and we validated our small-area estimates by comparing them with direct estimates., Results: In 2009, the county prevalence of obesity ranged from 30.5% to 44.2%. Counties with the highest prevalence of obesity were in the Delta region and along the Mississippi River. The obesity prevalence increased from 2007 through 2009. Age, sex, race, education, and employment status were associated with obesity., Conclusion: The 2009 obesity prevalence in all Mississippi counties was substantially higher than the national average and differed by geography and race. Although urgent intervention measures are needed in the entire state, policies and programs giving higher priority to higher-risk areas and subpopulations identified by this study may be better strategies.

This study investigates trends in tobacco use based on gender, race, and grade level among Mississippi public high school students during 1993-2009. Data were obtained by combining eight weighted Mississippi Youth Risk Behavior Surveys (YRBS). Current tobacco use (cigarette, smokeless, and cigar) was selected for investigation. During 1993-2009, the prevalence of current cigarette and cigar use among Mississippi public high school students showed a significant linear decrease (p < 0.0001). A quadratic trend was also detected for current cigarette use (p = 0.0038) indicating that it increased during 1993-1995 and then decreased over the remaining period of the study. Neither linear nor quadratic trends were observed for current smokeless tobacco use. Male students were more likely to be current tobacco users. White students were more likely to use cigarettes and smokeless tobacco. Programs that target male and white students on certain products such as smokeless tobacco are needed to further decrease overall tobacco use in the state.

The purpose of this research was to determine the prevalence of overweight and obesity in Mississippi children and youth in grades K-12, and to assess any changes in the prevalence during 2005, 2007, and 2009. Body Mass Index was calculated using measured height and weight data for 3,703 public school students, and the prevalence of overweight and obesity was estimated. Additional analysis compared prevalence estimates by gender, race, and grade for the 2009 data, and comparisons were made between the 2005, 2007, and 2009 data. In 2009, the prevalence of obesity for all students in grades K-12 was 23.9%, as compared to 23.5% in 2007 and 25.5% in 2005. However, no statistically significant differences were found over the three time periods. The disparity between races appears to be increasing over time with the prevalence remaining level for Nonwhite students while dropping each year for White students.

This study estimates prevalence of overweight and at risk of overweight among low-income predominately non-Hispanic Black Head Start Mississippi preschoolers. A two-stage stratified probability design produced a representative sample of 1,250 preschoolers aged 3 to 5 years. Height, weight, age, gender, and race data were obtained. The prevalence of overweight (20.6%) and at risk of overweight (17.9%) combined was 38.5%. Moreover, highest rates were found in boys, non-Hispanic Blacks, and 5-year-olds. The prevalence of overweight in Mississippi Head Start children exceeds national averages, reinforcing the need for early-childhood health promotion and prevention.

Background: We investigated the relationship between Body Mass Index (BMI) and health-related quality of life (HRQOL) indicated by baseline health status in elementary school children., Methods: Data were obtained via parents whose children enrolled in an elementary school, kindergarten to fourth grade, in southern Mississippi in spring 2004. Parents completed the SF-10 for Children, a brief 10-item questionnaire designed to measure children's HRQOL on a voluntary basis., Results: A total of 279 parents completed the questionnaires for their children. On average, physical and psychosocial summary scores, major indicators for HRQOL, were significantly higher among the elementary school children in our study relative to those from U.S. children overall (p < 0.0001 and p = 0.0007, respectively). Males tended to have better physical functioning than their female classmates, whereas females had better psychosocial health. Overall, except for third graders, the physical summary scores increased as grade level increased. The means for psychosocial score fluctuated without a clear pattern over the five grade levels. High level of BMI was significantly associated with children's physical summary scores below 50, a norm used for U.S. children (p = 0.003). Gender and grade were not significant predictors of children's physical and psychosocial scores., Discussion: This study can be used as baseline information to track changes over time, in BMI and health status among the elementary school children. In addition, this study can be used to investigate relationships between BMI, health status, intellectual ability, and performance in school., Conclusion: The findings suggest that programs designed to encourage children to lose weight in a healthy manner, thus reducing their BMI, could improve the physical and psychosocial health, and subsequently increase HRQOL.

The purpose of this research was to estimate the 2007 prevalence of obesity and overweight among children and youth and to compare these data with previous prevalence data to determine current trends in weight status in Mississippi. Measured height and weight data were collected on a weighted sample of 3,837 public school students in grades K-12. Prevalence estimates of obesity and overweight, as indicated by Body Mass Index, were calculated. Analyses were made by gender, race, and grade level for 2007 data, and these data were compared to the 2005 findings. In 2007, 23.5% of the students were obese. The prevalence was highest among elementary school students, males and nonwhite students. The prevalence of obesity in 2007 was lower than in 2005, and the decline occurred primarily among middle and high school students. While the 2007 prevalence was still high, the decline suggests that recent obesity initiatives may be having a positive impact.

Introduction: The purpose of this study was to analyze 2003 Mississippi Behavioral Risk Factor Surveillance System (BRFSS) data to describe the health of Mississippians with arthritis or chronic joint pain. For this study, we made statistical estimates of the extent of arthritis burden among the respondents and delineated measurable differences in sociodemographic factors, health status, and the prevalence of associated risk factors. Our findings compare health-related quality of life, physical activity, and key demographic characteristics and obesity rates, controlling for differences among the subgroups by age, sex, educational attainment, income, and race/ethnicity., Methods: Respondents to Mississippi's 2003 BRFSS were assigned to 1 of 5 distinct and mutually exclusive subgroups: 1) those with intermittent joint symptoms (IJS), 2) those with chronic joint symptoms (CJS), 3) those with doctor-diagnosed arthritis without CJS (DDA-CJS), 4) those with doctor-diagnosed arthritis with chronic joint symptoms (DDA+CJS), and 5) those with no joint symptoms (NJS). To determine the prevalence of arthritis and the continuum of disease progression, we compared the health-related quality of life, physical activity, and obesity of the respondents., Results: Respondents with DDA+CJS were older than those with NJS (mean age, 57.1 years vs 38.7 years); they were more likely to be female (60.5% vs 51.7%), to have a high school diploma or less education (59.3% vs 45.4%), to be in fair to poor health (odds ratio [OR], 10.0), to be physically inactive (OR, 2.7), and to be overweight or obese (OR, 2.5)., Conclusion: Health status, physical disability, and weight control may be substantially improved through heightened levels of physical activity. However, in spite of the potential for marked improvement, adult Mississippians, especially those clients with DDA+CJS, remain reluctant to commit to exercise regimens. Findings from this study suggest a need to encourage Mississippians with DDA+CJS to engage in some regular physical activity, which could reduce the damaging effects of disease and improve their health. Increasing the health care resources earmarked for arthritis self-help and physical activity programs is one potential avenue to address the problem.

Objective: To investigate the impact of selected maternal chronic medical conditions, race, and age on preterm birth (PTB), low birth weight (LBW), and infant mortality among Mississippi mothers from 1999 to 2003., Design: A retrospective cohort analysis of linked birth and death certificates., Sample: The 1999-2003 Mississippi birth cohort comprising 202,931 singleton infants born to African American and White women., Measurements: The relationship between maternal chronic conditions and the dependent variables of PTB, LBW, and infant mortality were investigated using logistic regression analysis., Results: PTB, LBW, and infant mortality were more prevalent among African American women, very young women (< or =15 years), and women with certain chronic medical conditions. Among White mothers, maternal chronic hypertension was significantly associated with PTB and LBW, and maternal diabetes with PTB and infant mortality. Among African American mothers, maternal cardiac disease was significantly associated with PTB and LBW; maternal chronic hypertension was significantly associated with LBW and infant mortality; and maternal diabetes with PTB., Conclusions: Maternal chronic hypertension and diabetes were significantly associated with negative birth outcomes regardless of maternal race. Maternal cardiac disease was only significantly associated with PTB and LBW among African Americans.

Introduction: The purpose of the Child and Youth Prevalence of Overweight Survey was to estimate the prevalence of overweight and at risk for becoming overweight among children in Mississippi (grades 1-8) using height and weight measures instead of self-report and to compare the findings for grades 6 through 8 with data from the Youth Risk Behavior Surveillance System for middle school students (grades 6-8)., Methods: Students in randomly selected classes from 37 sampled elementary and middle schools throughout Mississippi participated in the study. School staff were trained to collect height and weight data using a standardized procedure., Results: Overall, 24.0% of students in grades 1 through 8 were found to be overweight, and another 14.7% were at risk for becoming overweight. With the exception of sixth grade, there was a trend of increasing prevalence of overweight by grade (17.5% in grade 1 compared with 31.3% in grade 8). In the Child and Youth Prevalence of Overweight Survey, 25.2% of students in grades 6 through 8 were found to be overweight, compared with 18.5% in the Youth Risk Behavior Surveillance System., Conclusion: A high percentage of students in Mississippi are already overweight in first grade, and the prevalence tends to increase by grade. Data collected from middle school students through measured heights and weights in the Child and Youth Prevalence of Overweight Survey were higher than self-reported data from the Youth Risk Behavior Surveillance System. Our data suggest that self-reported data underestimate the prevalence of overweight among middle school students. Efforts to monitor students' body mass index and assess effectiveness of interventions should include all grades and use measured heights and weights rather than self-reports.

Objectives: We examined longitudinal trends in relative frequency of influenza vaccination in the state of Mississippi., Methods: An influenza vaccination questionnaire was used to assess status among 20,078 adults who were sampled in random-digit-dialed telephone surveys administered in 1992, 1993, 1995, 1997, 1999, 2001, 2002, and 2003. Time trends were evaluated using logistic regression models in which the status of influenza vaccination was regressed on the respondents' gender, race, education, and household income., Results: In Mississippi, influenza vaccination rates increased substantially during 1992-2003 irrespective of gender, race/ethnicity, age, education, and household income. The increases showed a significant linear trend. Non-Hispanic blacks were significantly less likely to have been vaccinated for influenza compared to non-Hispanic whites without accounting for gender, age, education, and household income. Having a college degree was associated with higher vaccination rates among older Mississippians after adjusting for other factors., Conclusions: Although vaccination coverage is increasing, the national goal for 2010 does not appear achievable without new initiatives. Meanwhile, we should continue to provide funding for the immunization program and to educate the population regarding their compliance.