CONTACT: For copies of articles or full table of contents of issue, call Daniel Greenberg, 202-777-3913, or email

Newswise — The articles below will be published online August 16, 2012, at 4 p.m. (EDT) by the American Journal of Public Health® under “First Look” at, and they are currently scheduled to appear in the October 2012 print issue of the Journal. “First Look” articles have undergone peer review, copy editing and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association,, and is available at .

American Journal of Public Health Highlights:

1) Beverage industry self-regulation helps reduce distribution of high-caloric, sugary beverages to U.S. schoolchildren

2) Fetal death rates vary by racial/ethnic group

3) School-based health services may help to lower incidence of pregnancy among high school students

4) Greater awareness is needed on prevention measures against carbon monoxide poisoning

1) Beverage industry self-regulation helps reduce distribution of high-caloric, sugary beverages to U.S. schoolchildren

Given the growing concern over childhood obesity in the United States, a new study from the American Journal of Public Health found that there was a significant reduction of sugar-sweetened beverages shipped to U.S. schools between 2004 and 2010, in part due to self-regulation by the beverage industry.

Researchers monitored the progress of this self-regulatory effort to reduce the number of beverage calories available to children during the regular and extended school day. They used a consistent methodology over a period of more than five years to measure the total volume of beverage shipments to elementary, middle and high schools, monitoring changes in beverage volumes, the composition of products and portion sizes. They found that between 2004 and the 2009-2010 school year, the beverage industry reduced calories shipped to schools by 90 percent and shipments of full-calorie soft drinks by 97 percent, on a total ounces basis. The authors compared these results with findings from existing research of the school beverage landscape and a separate data set based on contracts between schools and beverage bottling companies.

The study’s authors concluded, “Industry self-regulation, with the assistance of a transparent and independent monitoring process, can be a valuable tool in improving public health outcomes.” [From: “Industry Self-Regulation to Improve Student Health: Quantifying Changes in Beverage Shipments to Schools.” Contact: Robert F. Wescott, PhD, President, Keybridge Research LLC, Washington, D.C.,].

2) Fetal death rates vary by racial/ethnic groups

Racial and ethnic variables contribute to disparities in fetal death rates among racial/ethnic groups, according to a new analysis from the American Journal of Public Health.

Researchers sought to determine the importance of socioeconomic factors, maternal comorbid conditions, antepartum and intrapartum complications of pregnancy, and fetal factors (such as gestational age at delivery) in mediating racial disparities in fetal deaths. They formed a retrospective cohort study of hospital-based deliveries with a gestational age between 23 and 44 weeks in California, Missouri and Pennsylvania from 1993 to 2005.

Of the 7,104,674 deliveries included in this cohort, 23,471 were fetal deaths, averaging 3.3 per 1,000 deliveries. Black women had the highest rate of fetal death at 5.9 fetal deaths per 1,000 deliveries, compared with 2.6 per 1,000 deliveries for non-Hispanic white women, 3.2 per 1,000 deliveries for Asian women, and 3.6 fetal deaths per 1,000 deliveries for Hispanic women.

For black women, fetal factors mediated the largest percentage (49.6 percent) of the disparity in fetal deaths, whereas antepartum and intrapartum factors mediated some of the difference in fetal deaths for both black and Asian women. Among Hispanic women, socioeconomic factors mediated 35.8 percent of the disparity in fetal deaths.

In univariable analysis, the researchers reported that fetal deaths were more prevalent in women older than 35 years and women with chronic comorbid conditions such as chronic hypertension and diabetes mellitus. Fetal deaths were more prevalent in women with intrapartum complications of pregnancy, such as placental abruption or when the fetuses were of lower birth weight or had a congenital anomaly.

The study’s authors suggest, “Interventions targeting mediating factors specific to racial/ethnic groups, such as improved access to care, may help reduce U.S. fetal death disparities.”

[From: “Factors that mediate racial/ethnic disparities in U.S. fetal death rates.” Contact: Scott A. Lorch, MD, MSCE, The Children’s Hospital of Philadelphia, Center for Outcomes Research, Philadelphia, Pa.,].

3) School-based health services may help to lower incidence of pregnancy among high school students

Fewer pregnancies occurred among high school teens in schools with more than 10 hours of nursing and doctor time per 100 students, finds a new study published in the American Journal of Public Health.

Researchers aimed to determine whether school-based health services are associated with better sexual and reproductive health among students, using nationally representative data from 9,107 students from 96 New Zealand high schools. Students self-reported whether they were sexually active, how often they used condoms or contraception, and their involvement in pregnancy. In addition, school administrators completed questionnaires on their school-based health services, including doctor and nursing hours per week, team-based services and health screening. Researchers found that there were fewer pregnancies among students in schools with more than 10 hours of nursing and doctor time per 100 students.

The study’s authors stated, “Our findings suggest that school-based health services may be able to lower the incidence of pregnancy by providing access to comprehensive health services, including contraceptive care that is easily available and appropriate for the student population.”

[From: “Association between availability and quality of health services in schools and reproductive health outcomes among students: a multilevel observational study.” Contact: Simon Denny, PhD, MPH, University of Auckland, Auckland, New Zealand,].

(4) Greater awareness is needed on prevention measures against carbon monoxide poisoning

A new study published today in the American Journal of Public Health sheds light on the problem of disaster-related carbon monoxide (CO) poisoning in the United States and identified areas needed for education and awareness.

Over 19 years, 75 deaths and nearly 2,000 nonfatal disaster-related CO poisoning cases were identified by the study’s researchers after a widespread literature review. These numbers are believed to be grossly underestimated due to misdiagnosis and under-reporting of cases, restrictions in population and geographic areas under study, and short case ascertainment periods. In the United States, unintentional and non-fire-related CO poisoning result in nearly 450 deaths, more than 2,000 hospitalizations and more than 20,000 emergency department visits annually. Female individuals and children younger than 18 constituted the majority of nonfatal cases, whereas 79 percent of individuals who died were male. The study’s authors note that these findings are consistent with previous reports, as higher mortality among men has been assumed a result of engaging in high-risk behaviors such as using fuel-burning tools or appliances.

Generator use was implicated in most of the fatal and nonfatal cases and was the primary source of CO exposure for all posthurricane studies. Approximately two-thirds of the fatal cases resulted from using the generator indoors or in a basement. Indoor placement is particularly dangerous because the CO emitted from a typical portable generator is equal to that of six idling automobiles. Placing a generator outside in an attached garage, near open doors or windows, or near the air conditioning vent can still put residents at risk for CO poisoning, warned the study’s authors. Currently, the Centers for Disease Control and Prevention (CDC) recommends placing generators at least 20 feet away from home and also away from nearby dwellings.

“Predisaster risk communication might result in better public health effectiveness in reducing disaster-related CO exposures, because most cases occur within days of event onset, and most natural disasters and subsequent high-risk behaviors . . . are quite predictable,” suggested the study’s authors. Post-disaster power outages can also make the distribution of prevention messaging a challenge.

“Indoor use of charcoal grills was also a major source of disaster-related CO exposures, particularly for winter storms. It has been suggested that persons of Asian, Middle Eastern or African origins or persons from warmer climates where solid fuel burning indoors for cooking or heating purposes is common might be inclined to use charcoal briquettes or grills indoors,” reported the study’s authors. “Multilingual education or warning materials distributed with the sales of generators and charcoal bags may be helpful in targeting minority populations and reducing the risk of CO poisoning,” urged the study’s authors.

The study’s authors concluded, “These findings emphasize the continued need for communicating CO-related health information and surveillance of CO poisoning cases as a central component of public health emergency preparedness, response and prevention efforts during natural disasters.”

[From: “A review of disaster-related carbon monoxide poisoning: surveillance, epidemiology, and opportunities for prevention.” Contact: Shahed Iqbal, PhD, Centers for Disease Control and Prevention, Atlanta, Ga.,]

The American Journal of Public Health is the monthly journal of the American Public Health Association® (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at

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American Journal of Public Health (October 2012)