Food deserts and cardiovascular health among young adults

Community Engagement to Inform Multilevel Analyses of the Role of Neighborhood Factors in Cancer Control Behaviors in African Americans

BACKGROUND

Although community engagement has had a substantial presence in public health research, community input to inform geospatial and health analyses remains underutilized and novel. This article reports on community engagement activities to solicit stakeholder perspectives on the role of neighborhood conditions in health and cancer. We discuss how this community input refined an a priori conceptual model to be tested in the larger Families, Friends, and Neighborhoods Study.

METHODS

We conducted semistructured virtual interviews with 82 stakeholders (e.g., community and faith leaders, educators, and healthcare workers) across four states (Maryland, Connecticut, Alabama, and Missouri). Participants discussed the impact where a person lives can have on their health and cancer risk. We subsequently convened a virtual group discussion with 17 randomly selected interviewees. Our study team individually reviewed discussion notes, which were synthesized into a consensus document.

RESULTS

In addition to constructs from the original conceptual model, participants identified neighborhood-level factors not present in the original model, including K-12 educational quality, local property investment, homelessness, public transportation infrastructure, proximity to healthcare facilities, environmental toxin exposures, access to healthy foods, and cost of living. These factors will be incorporated into the Families, Friends, and Neighborhoods Study analytic models.

CONCLUSIONS

Although geospatial analyses in health research have not traditionally employed community engagement techniques, this study illustrates the value of informing multilevel analytic models with the lived experiences of those negatively affected by neighborhood conditions that underlie the risk, prevention, and screening behaviors driving cancer incidence and mortality.

IMPACT

Future social epidemiology research can be enriched through community engagement.

Making the Healthy Choice the Easy Choice: Examining the Food Environments Surrounding South Carolina's Historically Black Colleges and Universities (HBCUs)

PURPOSE

To understand the distribution of healthy and unhealthy food stores and restaurants around historically Black colleges and universities (HBCUs) in South Carolina.

DESIGN

DatabaseUSA and ArcGIS Pro were used to identify, classify, and map food stores and restaurants near each HBCU.

SETTING

The study area included a 3-mile buffer radius around the eight South Carolina HBCUs.

SUBJECTS

A total of 654 food stores and restaurants were identified within a 3-mile radius of the HBCUs.

MEASURES

Demographic data for each HBCU was collected from the National Center for Education Statistics. The food stores and restaurants were identified using Standard Industrial Classification (SIC) codes and descriptions, and they were classified using previous research methodologies.

RESULTS

Based on the analysis, 19 (2.9%), 237 (36.2%), and 398 locations (60.9%) were classified as healthy, intermediate, and unhealthy, respectively. Within a 0.5-mile radius of the HBCUs, there were no retail food stores classified as healthy, followed by 14 (2.1%) and 23 (3.5%) retail food stores and restaurants that were classified as intermediate and unhealthy, respectively.

CONCLUSIONS

This study shows that most food options around South Carolina HBCUs are unhealthy and that few places are available to purchase healthy food. Eating well will be difficult in the current food environment. Increasing healthy options should be part of a comprehensive approach to promoting good nutrition.

Social, Racial, and Economic Disparities Affecting Outcomes of Hypertensive Adolescents

Essential hypertension is one of the most common conditions managed in pediatric cardiology and can result in lasting deleterious effects on the cardiovascular system. Pediatric hypertension is so prevalent in the United States that it is often referred to as a public health challenge. Social determinants of health (SDH) are the cultural, economic, educational, healthcare accessibility, and political influences in the environment in which an individual is born or lives, all of which can affect that individual's overall health. This study investigated the impact of social determinants such as rurality, food insecurity, transportation challenges, minority status, income, and race on cardiovascular outcomes in adolescent patients with essential hypertension. This study utilizes multiple validated tools including those from the United States Census and the United States Department of Agriculture (USDA). Using these tools, the patients were scored on their social vulnerability based on home address. These scores were then compared with their echocardiographic data, focusing on measures of end-organ damage known to occur in the setting of hypertension, including but not limited to indexed left ventricular (LV) mass. LV mass is an independent risk factor for future adverse cardiovascular events. In this study, more social vulnerability and low income were associated with a greater indexed LV mass (r = 0.18, p = 0.008). African American race was associated with a higher left atrial (LA) volume (p = 0.03). These findings substantiate that adolescents with essential hypertension are not only impacted by biological factors but also a combination of intersecting social constructs. The results of this study provide both a deeper understanding of the challenges these patients face and the opportunity to develop real-life interventions that can optimize clinical outcomes.

Identifying Nutritional Inequities of Patients with Cancer Residing in Food Deserts

Purpose

Nutrition is essential for cancer care, and patients who reside in food priority areas (FPAs) may experience limited access to healthy meals. There are few data evaluating the consequence of residing in FPAs because it relates to perceived food insecurity, psychosocial needs, or nutritional status of patients with cancer. This study aimed to determine the nutritional and psychosocial needs of patients with cancer who do and do not reside in FPAs.

Methods and Materials

From May 2019 to December 2022, a cross-sectional analysis was conducted using a validated questionnaire, offered at various time points before and after therapy, evaluating the psychosocial needs of patients with curable cancers. Groups were compared using X2 and Mann-Whitney U tests as appropriate. Binary logistic regression was used to identify predictors of food insecurity.

Results

Survey compliance was 74% (n = 320 of 434 patients). Patients who resided in FPAs (26%; n = 114) were more likely to self-identify as Black (60.5% vs 39.5%; P < .001), single (70% vs 37%; P < .001), and have a lower median income ($47,225 vs $91,305; P < .001) when compared with non-FPA residents. Residents of FPAs had a higher unmet nutritional needs index (median nutritional unmet needs score: 2.42 vs 2.00; P = .003), which included higher demands for healthier food choices (67.6% vs 54.4; P = .047) and greater food insecurity (44.4% vs 19.9%; P = .002). FPA residence was associated with a 3-fold increased risk of food insecurity (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.59-6.57; P < .001). On multivariate analysis, predictors for food insecurity included Black race (OR, 9.46; 95% CI, 3.93-22.76; P < .001), stage (stage IV vs l OR, 4.27; 95% CI, 1.12-16.34; P = .034), and recurrent disease (OR, 10.26; 95% CI, 2.29-46.09; P = .002).

Conclusions

Inequities were identified in patients residing in FPAs, where race and higher stage were important predictors of food insecurity. Demographics can be readily used by clinicians to identify high-risk patients early in their cancer care in order to provide continuous nutritional resources to improve food insecurity perceptions. Future prospective studies are needed to confirm if such interventions improve cancer outcomes.

Next generation brain health: transforming global research and public health to promote prevention of dementia and reduce its risk in young adult populations

Efforts to prevent dementia can benefit from precision interventions delivered to the right population at the right time; that is, when the potential to reduce risk is the highest. Young adults (aged 18-39 years) are a neglected population in dementia research and policy making despite being highly exposed to several known modifiable risk factors. The risk and protective factors that have the biggest effect on dementia outcomes in young adulthood, and how these associations differ across regions and groups, still remain unclear. To address these uncertainties, the Next Generation Brain Health team convened a multidisciplinary expert group representing 15 nations across six continents. We identified several high-priority modifiable factors in young adulthood and devised five key recommendations for promoting brain health, ranging from individual to policy levels. Increasing research and policy focus on brain health across the life course, inclusive of younger populations, is the next crucial step in the efforts to prevent dementia at the global level.

WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions

The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.

The effect of food deserts on gynecologic cancer survival

Objective

Living in a food desert is a known negative health risk, with recent literature finding an associated higher mortality in patients with cancers. Gynecologic cancers have not specifically been studied. We aimed to describe patients with gynecologic cancers who live in a food desert and determine if there is an association between living in a food desert and gynecologic cancer mortality.

Methods

The 2013-2019 California Cancer Registry (CCR) was used to identify patients with endometrial, ovarian, or cervical cancers. Patient residential census tract was linked to food desert census tracts identified by the 2015 United States Department of Agriculture Food Access Research Atlas. Comorbidity data were obtained from the California Office of Statewide Health Planning and Development database (OSHPD). Treatment, diagnosis, and survival outcomes were obtained from the CCR's variables and compared by food desert status. Five-year disease-specific survival was analyzed by applying Cox proportional hazards analysis.

Results

40,340 gynecologic cancer cases were identified. 60.1 % had endometrial cancer, 23.2 % had ovarian cancer, and 15.9 % had cervical cancer. The average age of the cohort was 59.4 years, 48.0 % was non-Hispanic White, 50.3 % was privately insured, and 6.8 % of lived in a food desert. Living in a food desert was associated with higher disease-specific mortality for patients with gynecologic cancers (endometrial cancer HR 1.43p < 0.001 95 % CI 1.22-1.68; ovarian cancer HR 1.47p < 0.001 95 % CI 1.27-1.69; cervical cancer HR 1.24p = 0.045 95 % CI 1.01-1.54).

Conclusion

Patients living in food deserts had worse disease-specific survival, making access to food a modifiable risk factor that may result in mitigating gynecologic cancer disparities.

Neighborhood physical environments and change in cardiometabolic risk factors over 14 years in the study of Women's health across the nation

BACKGROUND

Neighborhood physical environments may influence cardiometabolic health, but prior studies have been inconsistent, and few included long follow-up periods.

METHODS

Changes in cardiometabolic risk factors were measured for up to 14 years in 2830 midlife women in the Study of Women's Health Across the Nation, a multi-ethnic/racial cohort of women from seven U.S. sites. Data on neighborhood food retail environments (modified Retail Food Environment Index) and walkability (National Walkability Index) were obtained for each woman's residence at each follow-up. Data on neighborhood access to green space, parks, and supermarkets were available for subsets (32-42%) of women. Models tested whether rates of change in cardiometabolic outcomes differed based on neighborhood characteristics, independent of sociodemographic and health-related covariates.

RESULTS

Living in more (vs. less) walkable neighborhoods was associated with favorable changes in blood pressure outcomes (SBP: -0.27 mmHg/year, p = 0.002; DBP: -0.22 mmHg/year, p < 0.0001; hypertension status: ratio of ORs = 0.79, p < 0.0001), and small declines in waist circumference (-0.09 cm/year, p = 0.03). Small-magnitude associations were also observed between low park access and greater increases in blood pressure outcomes (SBP: 0.37 mmHg/year, p = 0.003; DBP: 0.15 mmHg/year, p = 0.04; hypertension status: ratio of ORs = 1.16, p = .04), though associations involving DBP and hypertension were only present after adjustment for sociodemographic variables. Other associations were statistically unreliable or contrary to hypotheses.

CONCLUSION

Neighborhood walkability may have a meaningful influence on trajectories of blood pressure outcomes in women from midlife to early older adulthood, suggesting the need to better understand how individuals interact with their neighborhood environments in pursuit of cardiometabolic health.

The role of place-based factors and other social determinants of health on adverse post-sepsis outcomes: a review of the literature

Sepsis remains a common and costly disease. With early recognition and guideline-based treatment, more patients are surviving to hospital discharge. Many survivors experience adverse health events in the months following discharge, while others suffer long-term physical and cognitive decline. Social, biological, and environmental factors affect all aspects of the disease process, from what pathogens one is exposed to, how/if disease develops, what avenues are available for treatment, as well as short- and long-term sequelae of survival. Disparities in sepsis care exist at all stages of a patient's clinical course, but increased survivorship has highlighted the extent to which Social Determinants of Health (SDoH) influence post-discharge adverse events. Despite increased interest in the last decade, a nuanced understanding of causal relationships remains elusive. This is due to several factors: the narrow range of social determinants of health (SDoH) variables typically studied, the inconsistent and non-standardized methods of documenting and reporting SDoH, and the inadequate acknowledgment of how social, environmental, and biological factors interact. Lack of clear understanding of how SDoH influence post- discharge outcomes is an obstacle to development and testing of strategies to mitigate their harms. This paper reviews the literature pertaining to the effects of SDoH on post-discharge outcomes in sepsis, highlights gaps therein, and identifies areas of greatest need for improving the quality and impact of future investigations.

Integrating human activity into food environments can better predict cardiometabolic diseases in the United States

The prevalence of cardiometabolic diseases in the United States is presumably linked to an obesogenic retail food environment that promotes unhealthy dietary habits. Past studies, however, have reported inconsistent findings about the relationship between the two. One underexplored area is how humans interact with food environments and how to integrate human activity into scalable measures. In this paper, we develop the retail food activity index (RFAI) at the census tract level by utilizing Global Positioning System tracking data covering over 94 million aggregated visit records to approximately 359,000 food retailers across the United States over two years. Here we show that the RFAI has significant associations with the prevalence of multiple cardiometabolic diseases. Our study indicates that the RFAI is a promising index with the potential for guiding the development of policies and health interventions aimed at curtailing the burden of cardiometabolic diseases, especially in communities characterized by obesogenic dietary behaviors.

Food deserts and dental care utilization in the United States

OBJECTIVES

Although food deserts are known to impact health and healthcare utilization, no research has investigated the relationship between food deserts and dental care utilization. This study aimed to fill this gap by assessing the relationship between living in a food desert and self-reported dental care utilization in the past year.

METHODS

Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 10,495). The association between food deserts and dental care utilization was assessed using covariate-adjusted multiple logistic regression.

RESULTS

Living in a food desert was associated with higher odds of not utilizing dental care in the past year. This association was concentrated among high-poverty areas (≥20% poverty rate).

CONCLUSIONS

The current study is the first to assess the relationship between living in a food desert and dental care utilization. The findings demonstrate that individuals living in low-income urban food deserts may be at increased risk for not utilizing dental care.

The Association Between Census Tract Healthy Food Accessibility and Life Expectancy in the United States

Accessibility of healthy food is an important predictor for several health outcomes, but its association with life expectancy is unclear. We evaluated the association between U.S. Department of Agriculture's Food Research Atlas measures of healthy food accessibility and life expectancy at birth across contiguous U.S. census tracts using spatial modeling analysis. Both income and healthy food accessibility were associated with life expectancy at birth, as indicated by shorter life expectancy in low-income census tracts when comparing tracts with similar healthy food accessibility level, and in low-access tracts when comparing tracts with similar income level. Compared to high-income/high-access census tracts, life expectancy at birth was lower in high-income/low-access (- 0.33 years; 95% confidence interval - 0.42, - 0.28), low-income/high-access (- 1.45 years; - 1.52, - 1.38), and low-income/low-access (- 2.29 years; - 2.38, - 2.21) tracts after adjusting for socio-demographic characteristics and incorporating vehicle availability. Effective interventions to increase healthy food accessibility may improve life expectancy.

Association of Joint Genetic and Social Environmental Risks With Incident Myocardial Infarction: Results From the Health and Retirement Study

Background Myocardial infarction (MI) is a significant clinical and public health problem worldwide. However, little research has assessed the interplay between genetic susceptibility and social environment in the development of MI. Methods and Results Data were from the HRS (Health and Retirement Study). The polygenic risk score and polysocial score for MI were classified as low, intermediate, and high. Using Cox regression models, we assessed the race-specific association of polygenic score and polysocial score with MI and examined the association between polysocial score and MI in each polygenic risk score category. We also examined the joint effect of genetic (low, intermediate, and high) and social environmental risks (low/intermediate, high) on MI. A total of 612 Black and 4795 White adults aged ≥65 years initially free of MI were included. We found a risk gradient of MI across the polygenic risk score and polysocial score among White participants; no significant risk gradient across the polygenic risk score was found among Black participants. A disadvantaged social environment was associated with a higher risk of incident MI among older White adults with intermediate and high genetic risk but not those with low genetic risk. We revealed the joint effect of genetics and social environment in the development of MI among White participants. Conclusions Living in a favorable social environment is particularly important for people with intermediate and high genetic risk for MI. It is critical to developing tailored interventions to improve social environment for disease prevention, especially among adults with a relatively high genetic risk.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Influence of Unhealthy Food Environment on Premature Cardiovascular Disease Mortality in Brazil: An Ecologic Approach

INTRODUCTION

Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population.

METHODS

This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest.

RESULTS

After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]).

CONCLUSIONS

This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.

Assessment of Doubly Disadvantaged Neighborhoods by Healthy Living Environment Exposure

Good access to greenspace and healthy food has commonly been found to be positively associated with health outcomes, despite some studies finding no significant relationship between them. Examining inequalities in accessing greenspace and healthy food among different disadvantaged neighborhoods can help reveal the disadvantaged races/ethnicities in cities with a high level of residential segregation (i.e., population of the same race/ethnicity concentrated in the same neighborhoods). However, existing studies have mostly focused on measuring the inequalities in accessing either greenspace or healthy food alone, which can lead to the inaccurate depiction of disadvantaged neighborhoods in healthy living environments. Therefore, this paper aims at improving the assessment of doubly disadvantaged neighborhoods by considering accessibility to both greenspace and healthy food in the City of Chicago. Our results show that black-majority neighborhoods are the most doubly disadvantaged in terms of exposure to healthy living environments. This study can help guide policymakers to divert more resources towards the improvement of the urban environment for the most doubly disadvantaged neighborhoods.

Adverse Childhood Experiences, health insurance status, and health care utilization in middle adulthood

RATIONALE

Adverse childhood experiences (ACEs) negatively impact health over the life-course. Yet, compared to the robust literature on the consequences for ACEs for health, substantially fewer studies assess the implications of exposure to ACEs for health insurance status and health care utilization in adulthood.

OBJECTIVE

To assess the association between accumulating ACEs and (1) an individual's health insurance status, and (2) usual source of care, as well as examine the mediating role of adult socioeconomic status.

METHODS

Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8,757). Multinomial logistic regression is used to assess the relationship between ACEs and health insurance status and the usual source of care.

RESULTS

Net of control and mediating variables, accumulating exposure to ACEs -particularly four or more ACEs- is associated with a higher likelihood of being uninsured and utilizing the emergency room as the usual source of care. Adult socioeconomic status including educational attainment, household income, employment status, and being uninsured-in the case of usual source of care-substantially mediates these associations.

CONCLUSION

ACEs carry negative repercussions for health insurance and patterns of healthcare utilization that spans into adulthood, and this is largely driven by poor adult socioeconomic status.

The Changing Landscape of Food Deserts and Swamps over More than a Decade in Flanders, Belgium

Food deserts and swamps have previously been mostly studied in Anglo-Saxon countries such as the USA and Great Britain. This research is one of the first studies to map food deserts and swamps in a mainland European, densely populated but heavily fragmented region such as Flanders. The evolution of food deserts and swamps between 2008 and 2020 was assessed. Special focus was given to areas where high numbers of elderly, young people and/or families with low income live. Food deserts were calculated based on supermarket access within 1000 m and bus stop availability, while food swamps were calculated using the Modified Food Environment Retail Index. The main cause behind the formation of food deserts in Flanders is its rapidly aging population. Food deserts with a higher number of older people increased from 2.5% to 3.1% of the residential area between 2008 and 2020, housing 2.2% and 2.8% of the population, respectively. Although the area that could become a food desert in the future due to these sociospatial and demographic evolutions is large, food deserts are currently a relatively small problem in Flanders in comparison to the widespread existence of food swamps. Unhealthy retailers outnumbered healthy retailers in 74% of residential areas in 2020, housing 88.2% of the population. These food swamps create an environment where unhealthy food choices predominate. Residential areas with a higher number of elderly people, young people and families with low incomes had healthier food environments than Flanders as a whole, because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher. This research showed that food deserts and swamps could be a growing problem in European regions with a high population density that experience the high pressures of competing land uses.

Adverse Childhood Experiences and Cardiovascular Risk among Young Adults: Findings from the 2019 Behavioral Risk Factor Surveillance System

Background: Heart disease is the fourth leading cause of death for young adults aged 18-34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a contemporary, national sample to examine the association between ACEs and cardiovascular health among young adults in the United States, as well as potential mediating pathways. Methods: The present study uses data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine associations between ACEs and cardiovascular risk, as well as the role of cumulative disadvantage and poor mental health in these associations. Results: Findings indicate that young adults who have experienced a greater number of ACEs have a higher likelihood of having moderate to high cardiovascular risk compared to those who have zero or few reported ACEs. Moreover, both poor mental health and cumulative disadvantage explain a significant proportion of this association. Conclusions: The present findings suggest that young adulthood is an appropriate age for deploying prevention efforts related to cardiovascular risk, particularly for young adults reporting high levels of ACEs.

Health Disparities Across the Continuum of ASCVD Risk

PURPOSE OF THE REVIEW

Despite marked progress in cardiovascular disease management in the last several decades, there remain significant, persistent disparities in cardiovascular health in historically marginalized racial and ethnic groups. Here, we outline current state of health disparities in cardiovascular disease, discuss the interplay between social determinants of health, structural racism, and cardiovascular outcomes, and highlight strategies to address these issues.

RECENT FINDINGS

Across the continuum of atherosclerotic cardiovascular disease (ASCVD) prevention, there remain significant disparities in outcomes including morbidity and mortality by race, ethnicity, and socioeconomic status (SES). These disparities begin early in childhood (primordial prevention) and continue with a higher prevalence of cardiovascular risk factors (primary prevention), and in the uptake of evidence-based therapies (secondary prevention). These disparities are driven by social determinants of health and structural racism that disproportionately disadvantage historically marginalized populations. Structural racism and social determinants of health contribute to significant disparities in cardiovascular morbidity and mortality.

Prospects of ultrasonically extracted food bioactives in the field of non-invasive biomedical applications - A review

Foods incorporated with bioactive compounds, called nutraceuticals, can fight or prevent or alleviate diseases. The contribution of nutraceuticals or phytochemicals to non-invasive biomedical applications is increasing. Although there are many traditional methods for extracting bioactive compounds or secondary metabolites, these processes come with many disadvantages like lower yield, longer process time, high energy consumption, more usage of solvent, yielding low active principles with low efficacy against diseases, poor quality, poor mass transfer, higher extraction temperature, etc. However, nullifying all these disadvantages of a non-thermal technology, ultrasound has played a significant role in delivering them with higher yield and improved bio-efficacy. The physical and chemical effects of acoustic cavitation are the crux of the output. This review paper primarily discusses the ultrasound-assisted extraction (USAE) of bioactives in providing non-invasive prevention and cure to diseases and bodily dysfunctions in human and animal models. The outputs of non-invasive bioactive components in terms of yield and the clinical efficacy in either in vitro or in vitro conditions are discussed in detail. The non-invasive biomedical applications of USAE bioactives providing anticancer, antioxidant, cardiovascular health, antidiabetic, and antimicrobial benefits are analyzed in-depth and appraised. This review additionally highlights the improved performance of USAE compounds against conventionally extracted compounds. In addition, an exhaustive analysis is performed on the role and application of the food bioactives in vivo and in vitro systems, mainly for promoting these efficient USAE bioactives in non-invasive biomedical applications. Also, the review explores the recovery of bioactives from the less explored food sources like cactus pear fruit, ash gourd, sweet granadilla, basil, kokum, baobab, and the food processing industrial wastes like peel, pomace, propolis, wine residues, bran, etc., which is rare in literature.

COVID's Impact on Non-communicable Diseases: What We Do Not Know May Hurt Us

PURPOSE OF REVIEW

In this review, we outline the impacts of the COVID-19 pandemic on non-communicable diseases around the world.

RECENT FINDINGS

The mechanisms of COVID-19's impact on non-communicable diseases are both direct and indirect. The direct mechanisms include direct vascular and myocardial injury as well as pancreatic injury increasing incidence of new-onset diabetes. Indirect effects of the pandemic on non-communicable disease include delayed presentation for acute illness including STEMI and the impact of social distancing and quarantine policies on socialization, mental health, physical activity, and the downstream health impacts of inactivity and deconditioning. International focus has been on disease variants, infection control and management, healthcare system, and resource utilization and infection incidence. However, the impact of this pandemic on non-communicable diseases has been largely overlooked but will manifest itself in the coming years to decades.

Disparities in SNAP online grocery delivery and implementation: Lessons learned from California during the 2020-21 COVID pandemic

During the COVID-19 pandemic in 2020, the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) was rapidly expanded across the US. This program, enabling direct-to-home grocery delivery, could be a transformative step towards improving fresh-food access. However, lack of information on which areas are serviced by SNAP OPP hinders the identification of potential demographic and regional disparities in access. Lessons from the initial implementation period are critical for understanding continuing inequities and informing the implementation of future programs. In California, SNAP OPP expanded food access for 85.9% of the state's SNAP households in 2020–21. Coverage was significantly greater in urban areas, covering 87.2% of CalFresh households in urban limited food access areas as compared with 29.9% of CalFresh households in rural limited food access areas. County-level COVID-19 rates did not have a meaningful association with SNAP OPP coverage.

Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease

Health care in the United States has seen many great innovations and successes in the past decades. However, to this day, the color of a person's skin determines-to a considerable degree-his/her prospects of wellness; risk of disease, and death; and the quality of care received. Disparities in cardiovascular disease (CVD)-the leading cause of morbidity and mortality globally-are one of the starkest reminders of social injustices, and racial inequities, which continue to plague our society. People of color-including Black, Hispanic, American Indian, Asian, and others-experience varying degrees of social disadvantage that puts these groups at increased risk of CVD and poor disease outcomes, including mortality. Racial/ethnic disparities in CVD, while documented extensively, have not been examined from a broad, upstream, social determinants of health lens. In this review, we apply a comprehensive social determinants of health framework to better understand how structural racism increases individual and cumulative social determinants of health burden for historically underserved racial and ethnic groups, and increases their risk of CVD. We analyze the link between race, racism, and CVD, including major pathways and structural barriers to cardiovascular health, using 5 distinct social determinants of health domains: economic stability; neighborhood and physical environment; education; community and social context; and healthcare system. We conclude with a set of research and policy recommendations to inform future work in the field, and move a step closer to health equity.

Safety and Quality of Romaine Lettuce Accessible to Low Socioeconomic Populations Living in Houston, TX

ABSTRACT

Previous empirical evidence has demonstrated that low-socioeconomic status (SES) communities have higher rates of gastroenteritis; however, there is a paucity of literature on the safety and quality of food (fresh produce) accessible to these communities. The overarching goal of this study was to investigate the microbial safety and quality of romaine lettuce from low- and high-SES neighborhoods in the Houston, TX, area. Loose-leaf romaine lettuce was purchased from low- and high-SES neighborhood retailers, and aerobic plate count, coliform, Escherichia coli, yeast, and mold assays were conducted. In addition, enrichment was performed on all samples for Listeria monocytogenes, Staphylococcus aureus, Salmonella spp., and E. coli O157:H7, and reverse transcriptase PCR analysis was carried out. The results showed that E. coli, coliform, yeast, and mold were present in significantly higher counts (P < 0.05) in produce obtained from low-SES neighborhoods compared with high-SES neighborhoods. The reverse transcriptase PCR results showed that 38% of samples from high-SES areas were positive for S. aureus versus 87% of samples from low-SES areas. None of the samples from high-SES areas were positive for the other pathogens. The samples from low-SES areas were positive for E. coli O157:H7 (4%), Salmonella spp. (53%), L. monocytogenes (13%), and S. aureus (87%). These results demonstrate a significant disparity in the quality and safety of romaine lettuce accessible to low- versus high-SES populations. Future studies can be designed to identify the specific cause of this challenge by investigating the food supply chain.

HIGHLIGHTS

Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity

PURPOSE OF REVIEW

We sought to examine the role of social and environmental conditions that determine an individual's behaviors and risk of disease-collectively known as social determinants of health (SDOH)-in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US).

RECENT FINDINGS

Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. We examined existing evidence of the association between SDOH-organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context-and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.

Effects of Advertising: A Qualitative Analysis of Young Adults' Engagement with Social Media About Food

Young adults are constantly exposed to energy-dense, nutrient-poor food and beverages, particularly through advertising. Exposure can influence poor food choices and negatively impact health. This study aimed to understand young adults' attitudes and experiences associated with food-related advertisements, particularly on social media. This qualitative analysis involved n = 166 Australian 18 to 24-year-olds who were involved in a four-week online conversation on different areas relating to health, social media, and eating. Inductive thematic analysis was utilised on two forums on the recall and perceptions of food-related advertisements. Young adults commonly mentioned aspects of the marketing mix (promotion, product, price, and place) in food advertisements. Participants were more readily able to recall energy-dense, nutrient-poor food advertisements compared to healthy food-related advertisements. Digital advertisements were often discussed alongside the use of ad-blockers and algorithms which tailored their social media viewing to what they like. Participants felt constant exposure to unhealthy food advertisements hindered their ability to realise healthy eating behaviours and created feelings of guilt. This current analysis highlights the need to provide an advertising environment that appropriately motivates healthy eating and a food environment that allows healthy food to be the affordable and convenient option.