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Lin G, Werner K, Alqunaiebet A, Hamza MM, Alkanhal N, Alsukait RF, Alruwaily A, Rakic S, Cetinkaya V, Herbst CH, Lin TK. The cost-effectiveness of school-based interventions for chronic diseases: a systematic review. Cost Eff Resour Alloc 2024; 22:26. [PMID: 38605333 PMCID: PMC11008027 DOI: 10.1186/s12962-024-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.
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Affiliation(s)
- George Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Mariam M Hamza
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Norah Alkanhal
- Saudi Public Health Authority, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Severin Rakic
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Volkan Cetinkaya
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
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Shin S, Alqunaibet AM, Alsukait RF, Alruwaily A, Alfawaz RA, Algwizani A, Herbst CH, Shekar M, Finkelstein EA. A Randomized Controlled Study to Test Front-of-Pack (FOP) Nutrition Labels in the Kingdom of Saudi Arabia. Nutrients 2023; 15:2904. [PMID: 37447230 DOI: 10.3390/nu15132904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
One common strategy for governments to tackle the non-communicable disease (NCD) epidemic is front-of-package (FOP) nutrition labeling. The Kingdom of Saudi Arabia (KSA) is considering implementing a new FOP label that is based on either France's Nutri-Score (NS), which labels all foods (A = healthiest to E = least healthy) based on overall nutritional quality, or the Chilean warning label (WL) approach, which identifies foods to avoid based on select nutritional characteristics. Using a fully functional online grocery store, this study aimed to test these two promising FOP strategies by randomizing 656 KSA adults into one of the three versions of the store to complete a hypothetical grocery shop: no-label (control), NS, and WL. The NS was modified with a sugar percentage tag given that reducing sugar consumption is one of KSA's public health goals. We found that both modified NS labels and Chilean warning labels positively influenced food and beverage choices among KSA participants, but there were differential effects across the two labels. Relative to the control, NS improved the overall diet quality of the shopping baskets, measured by the weighted (by the number of servings) average NS point (ranging from 0, least healthy, to 55, healthiest), by 2.5 points [95% CI: 1.7, 3.4; p < 0.001], whereas results for WL were not statistically significant (0.6 points [95% CI: -0.2,1.5]). With respect to each nutritional attribute, we found that NS reduced sugar intake per serving, whereas WL was effective at decreasing energy and saturated fat intake per serving from food and beverages purchased. Our results suggest that the NS approach that identifies the healthiness of all foods using a holistic approach appears preferable if the purpose of the label is to improve overall diet quality as opposed to addressing select nutrients to avoid.
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Affiliation(s)
- Soye Shin
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Riyadh 11362, Saudi Arabia
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | | | | | | | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Meera Shekar
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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Almudarra S, Kamel S, Saleh E, Alaswad R, Alruwaily A, Almowald S, Alqunaibet AM, Almudiaheem A, Almutlaq H, Alserehi H, Almalki S, Bahlaq MA, Alsahafi AJ, Alsaif F, Khojah AT, Al-Tawfiq JA, Asiri SI, Assiri A, Jokhdar H. High seroprevalence of SARS-CoV-2 among high-density communities in Saudi Arabia. Infection 2021; 50:643-649. [PMID: 34881415 PMCID: PMC8653801 DOI: 10.1007/s15010-021-01726-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
Background The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) infection had been investigated utilizing serology. Materials and methods This community-based sero-survey was carried out in the neighborhoods of three cities in Saudi Arabia. Results Of 5629 participants, 2766 (49.1%) were women; and 2148 (38.1%) were 18–34 years of age, and 3645 (64.7%) were from South East Asia. Positive serology was seen in 2825 (50.2% (95% CI: 48.8–51.5%) for SARS-CoV-2 anti-S1 IgG antibodies by ECLIA. Being in the age category of 18–34 years and being from Eastern Mediterranean Region (country A) were associated with higher COVID-19 seropositivity with estimated odds ratio of 1.3 [95% CI 1.1–1.8] and 2.5 [95% CI 1.1.5–4.2] respectively. Gender, social status, education, nationality, symptoms, presence of comorbidities and activity style were positively associated with increased seropositivity. Factors associated negatively with the rate of seropositivity were higher education and having outdoor activity with estimated OR of 0.92 [95% CI 0.46–0.95] and 0.59 [95% CI 0.47–0.74], respectively. Conclusion The study showed high seroprevalence of SARS-CoV-2 among high density population. Health education campaigns should target middle-aged, those with low education, those living in lower standards and indoor workers.
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Affiliation(s)
- Sami Almudarra
- Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Shady Kamel
- Field Epidemiology Training Program, Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Eman Saleh
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rehab Alaswad
- Saudi Center of Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Amaal Alruwaily
- Saudi Center of Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Shaza Almowald
- Saudi Center of Disease Prevention and Control, Riyadh, Saudi Arabia
| | | | | | - Hind Almutlaq
- Saudi Center of Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Haleema Alserehi
- Saudi Center of Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Safar Almalki
- Ministry of Health Laboratories, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Mohannad Abdulhafiz Bahlaq
- Public Health Deputy, Madinah Directorate of Health Affairs, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Jaber Alsahafi
- Public Health Deputy, Jeddah Directorate of Health Affairs, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Alsaif
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah T Khojah
- Faculty of Medicine, Al Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Infectious Disease Division, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Abdullah Assiri
- Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
| | - Hani Jokhdar
- Public Health Agency, Saudi Ministry of Health, Riyadh, Saudi Arabia
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Banjar A, Al-Tawfiq JA, Alruwaily A, Alserehi H, Al-Qunaibet A, Alaswad R, Almutlaq H, Almudaiheem A, Khojah AT, Alsaif F, Almolad SK, Alqahtani S, AlJurayyan A, Alotaibi A, Almalki S, Abuhaimed Y, Alkhashan A, Alfaifi A, Alabdulkareem K, Jokhdar H, Assiri A, Almudarra S. Seroprevalence of antibodies to SARS-CoV-2 among blood donors in the early months of the pandemic in Saudi Arabia. Int J Infect Dis 2021; 104:452-457. [PMID: 33465488 PMCID: PMC7816871 DOI: 10.1016/j.ijid.2021.01.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Serologic testing provides better understanding of SARS-CoV-2 prevalence and its transmission. This study was an investigation of the prevalence of antibodies to SARS-CoV-2 among blood donors in Saudi Arabia. OBJECTIVE To estimate the seroprevalence of anti-SARS-CoV-2 antibodies among blood donors in Saudi Arabia during the early phase of the COVID-19 pandemic. METHODS Serology results and epidemiological data were analyzed for 837 adult blood donors, with no confirmed SARS-CoV-2 infection, in Saudi Arabia from 20th to 25th May 2020. Seroprevalence was determined using electrochemical immunoassay to detect anti-SARS-CoV-2 antibodies. RESULTS The overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% (12/837). Non-citizens had higher seroprevalence compared with citizens (OR 13.6, p = 0.001). Secondary education was significantly associated with higher seroprevalence compared with higher education (OR 6.8, p = 0.005). The data showed that the highest seroprevalence was in Makkah (8.1%). Uisng Makkah seroprevalence as the reference, the seroprevalence in other areas was: Madinah 4.1% (OR 0.48, 95% CI 0.12-1.94), Jeddah 2.3% (OR 0.27, 95% CI 0.31-2.25), and Qassim 2.9 % (OR 0.34, 95% CI 0.04-2.89) and these were not statistically different from seroprevalence in the Makkah region. CONCLUSIONS At the early months of the COVID-19 pandemic in Saudi Arabia, the seroprevalence of antibodies to SARS-CoV-2 among blood donors was low, but was higher among non-citizens. These findings may indicate that non-citizens and less educated individuals may be less attentive to preventive measures. Monitoring seroprevalence trends over time require repeated sampling.
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Affiliation(s)
- Ayman Banjar
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Amaal Alruwaily
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Haleema Alserehi
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Ada Al-Qunaibet
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Rehab Alaswad
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Hind Almutlaq
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | | | - Abdullah T Khojah
- Faculty of Medicine, Al Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Faisal Alsaif
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saeed Alqahtani
- Deputy Ministry for Laboratories and Blood Banks, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Abdullah Alotaibi
- Dammam Regional Laboratory, Ministry of Health, Dammam, Saudi Arabia
| | - Safar Almalki
- Jeddah Regional Laboratory, Ministry of Health, Jeddah, Saudi Arabia
| | - Yousef Abuhaimed
- King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Abdullah Alkhashan
- Deputy Ministry for Laboratories and Blood Banks, Ministry of Health, Riyadh, Saudi Arabia
| | - Amal Alfaifi
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Khaled Alabdulkareem
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia; Faculty of Medicine, Al Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Hani Jokhdar
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Assiri
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Sami Almudarra
- Deputy Ministry for Public Health, Ministry of Health, Riyadh, Saudi Arabia; Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia.
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Millar JA, Dao HDN, Stefopulos ME, Estevam CG, Fagan-Garcia K, Taft DH, Park C, Alruwaily A, Desai AN, Majumder MS. Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave. medRxiv 2021:2021.02.24.21252135. [PMID: 33655256 PMCID: PMC7924276 DOI: 10.1101/2021.02.24.21252135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.
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Affiliation(s)
- Jess A. Millar
- University of Michigan - Department of Epidemiology, Department of Computational Medicine and Bioinformatics (Ann Arbor, MI, United States)
| | - Hanh Dung N. Dao
- University of Oklahoma Health Sciences Center - Department of Biostatistics and Epidemiology (Oklahoma City, OK, United States)
| | | | - Camila G. Estevam
- State University of Campinas - Department of Public Health (Campinas, SP, Brazil)
| | | | - Diana H. Taft
- University of California Davis - Department of Food Science and Technology (Davis, CA, United States)
| | - Christopher Park
- New York University - College of Global Public Health (New York, NY, United States)
| | - Amaal Alruwaily
- Saudi Center for Disease Prevention and Control - Department of Non-Communicable Disease (Riyadh, Saudi Arabia)
| | - Angel N. Desai
- Department of Internal Medicine, Division of Infectious Disease, University of California Davis Medical Center (Sacramento, CA, United States)
| | - Maimuna S. Majumder
- Harvard Medical School and Boston Children’s Hospital (Boston, MA, United States)
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Alruwaily A, Mangold C, Greene T, Arshonsky J, Cassidy O, Pomeranz JL, Bragg M. Child Social Media Influencers and Unhealthy Food Product Placement. Pediatrics 2020; 146:peds.2019-4057. [PMID: 33106342 PMCID: PMC7786816 DOI: 10.1542/peds.2019-4057] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We aimed to determine the frequency with which kid influencers promote branded and unbranded food and drinks during their YouTube videos and assess the nutritional quality of food and drinks shown. METHODS Researchers used Socialbakers data to identify the 5 most-watched kid influencers (ages 3 to 14 years) on YouTube in 2019. We searched for 50 of their most-watched videos and 50 of their videos that featured food and/or drinks on the thumbnail image of the video. We coded whether kid influencers consumed or played with food or toys, quantified the number of minutes food and/or drinks appeared, and recorded names of branded food and/or drinks. We assessed the nutritional quality of foods using the Nutrient Profile Model and identified the number of drinks with added sugar. RESULTS A sample of 418 YouTube videos met the search criteria, and 179 of those videos featured food and/or drinks. Food and/or drinks were featured in those videos 291 times. Kid influencers' YouTube videos were collectively viewed >48 billion times, and videos featuring food and/or drinks were viewed 1 billion times. Most food and/or drinks were unhealthy branded items (n = 263; 90.34%; eg, McDonald's), followed by unhealthy unbranded items (n = 12; 4.1%; eg, hot dogs), healthy unbranded items (n = 9; 3.1%; eg, fruit), and healthy branded items (n = 7; 2.4%; eg, Yoplait yogurt). CONCLUSIONS Kid influencers generate millions of impressions for unhealthy food and drink brands through product placement. The Federal Trade Commission should strengthen regulations regarding product placement on YouTube videos featuring young children.
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Affiliation(s)
| | | | - Tenay Greene
- Department of Population Health, School of Medicine and
| | | | - Omni Cassidy
- Department of Population Health, School of Medicine and
| | | | - Marie Bragg
- Department of Population Health, School of Medicine and .,School of Global Public Health, New York University, New York, New York
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