1 Department of Health Promotion & Community Health Sciences (Dr Spengler and Ms Stasi) and Office of the Dean (Dr Maddock), School of Public Health, and Department of Environmental and Occupational Health (Dr Maddock), Texas A&M University, College Station, Texas; and Department of Orthopedics, Sidney Kimmel Medical College at Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Dr Smith).