Background In the U.S., where coronary heart disease (CHD) is the leading cause of mortality, CHD risk assessment is a priority and accurate blood pressure (BP) measurement is essential. Methods Hypertension estimates in the National Longitudinal Study of Adolescent Health (Add Health), Wave IV (2008)—a nationally-representative field study of 15,701 participants aged 24–32—was referenced against NHANES (2007–2008) participants of the same age. We examined discordances in hypertension, and estimated the accuracy and reliability of blood pressure in the Add Health study. Results Hypertension rates (BP ≥ 140/90 mm Hg) were higher in Add Health compared with NHANES (19% versus 4%), but self-reported history was similar (11% versus 9%) among adults aged 24–32. Survey weights and adjustments for differences in participant characteristics, examination time, use of anti-hypertensive medications, and consumption of food/caffeine/cigarettes before blood pressure measurement had little effect on between-study differences in hypertension estimates. Among Add Health participants interviewed and examined twice (full and abbreviated interviews), blood pressure was similar, as was blood pressure at the in-home and in-clinic exams conducted by NHANES III (1988–1994). In Add Health, there was minimal digit preference in blood pressure measurements; mean bias never exceeded 2 mm Hg; and reliability (estimated as intra-class correlation coefficients) was 0.81 and 0.68 for systolic and diastolic BPs, respectively. Conclusions The proportion of young adults in NHANES reporting a history of hypertension was twice that with measured hypertension, whereas the reverse was found in Add Health. Between-survey differences were not explained by digit preference, low validity, or reliability of Add Health blood pressure data, or by salient differences in participant selection, measurement context, or interview content. The prevalence of hypertension among Add Health Wave IV participants suggests an unexpectedly high risk of cardiovascular disease among U.S. young adults and warrants further scrutiny.

Extramural programs may increase uptake of vaccines and decrease absenteeism due to noncompliance with vaccine requirements for school entry. Until extramural programs in the US receive better access to billing private insurers and Medicaid, sustainability of these programs relies on grant funding. Better integration of extramural school-located vaccine programs with existing local healthcare and other programs at schools is an area for growth.

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Background With the emergence of obesity as a global health issue an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. Objectives We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES) and, using both sources, provide a detailed anthropometric description of young adults in the United States. Methods The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. Results Short-term reliabilities of in-home measures of height, weight, waist and arm circumference—as well as derived body mass index (BMI, kg/m2)—were excellent. Prevalence of obesity (37% vs. 29%) and central obesity (47% vs. 38%) was higher in Add Health than in NHANES while socio-demographic patterns of obesity and central obesity were comparable in the two studies. Conclusions Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.

Background Uptake of HPV vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions. Methods We conducted structured interviews in Fall 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine. Results Centers had heterogeneous policies and procedures. Out-of-pocket costs for children to receive privately-purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately-purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all p < .05). Conclusions While school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low-cost interventions to increase HPV vaccine uptake among adolescent students.