1
|
Jones EJ, Miller P, Gibson-Davis CM, Hanson JL, Votruba-Drzal E. Family wealth and adolescent physical health. Health Psychol Rev 2025; 19:315-343. [PMID: 39801320 PMCID: PMC12116244 DOI: 10.1080/17437199.2025.2451232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 01/03/2025] [Indexed: 05/28/2025]
Abstract
Inequalities in the distribution of wealth among families with children may have deleterious health consequences, especially for adolescent children. Marked by significant psychosocial and physiological changes, adolescence is a period when socioeconomic differences in chronic disease risk factors are observed. Unfortunately, research on socioeconomic inequalities in adolescent health has overlooked wealth, focusing instead on differences in health based on household income and parental educational attainment. Expanding our knowledge of wealth's role in shaping adolescents' current and long-term health is of critical public health concern, especially as wealth is more unequally distributed than income. This review discusses what is known about wealth-related inequalities in adolescent physical health and proposes four psychosocial mechanisms that may explain how wealth shapes adolescent physical health including (1) serving as a stress-buffer; (2) enabling parents to invest in opportunities to support adolescent healthy development; (3) increasing families' access to social and cultural capital resources that may promote salutary health behaviours while mitigating experiences of social-class discrimination; (4) and supporting adolescents' future expectations. We end with a discussion of existing questions and suggestions for future research to add to our understanding of wealth-related inequalities in adolescent physical health, which could be used to inform health equity interventions.
Collapse
Affiliation(s)
- Emily J. Jones
- University of Pittsburgh, 3420 Forbes Avenue, Pittsburgh, PA, 15260
| | - Portia Miller
- University of Pittsburgh, 3420 Forbes Avenue, Pittsburgh, PA, 15260
| | | | - Jamie L. Hanson
- University of Pittsburgh, 3420 Forbes Avenue, Pittsburgh, PA, 15260
| | | |
Collapse
|
2
|
Wiafe MA, Ayensu J, Yeboah GB, Eli-Cophie D, Benewaa A. Management of adolescent obesity in developing countries: A systematic review. Nutr Health 2025:2601060251330027. [PMID: 40129404 DOI: 10.1177/02601060251330027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
Background: Adolescent obesity is a menace that demands a multi-factorial approach to its management and prevention. Aim: The purpose of this review was to assess interventions used in the management of adolescent obesity in developing countries. Methods: Electronic search were conducted between January 2000 and December 2022 on six databases: Pubmed, GoogleScholar, CINAHL, SCOPUS, Cochrane Library and Science Direct and three clinical trial registries: Pan African Clinical Trial, World Health Organization and clinicalTrial.gov. The quality of the included studies was assessed using the Effective Public Health Practice Project. Results: Eighteen studies met the inclusion criteria. The studies were conducted in Africa (N = 7), Asia (N = 6) and South America (N = 5). The sample size ranged from 10 to 4003 at baseline. The studies were carried out in schools (N = 13) and hospitals (N = 5) with four main varied designs: controlled trial (N = 7), quasi-experimental (N = 3), cohort (N = 3) and longitudinal (N = 4). The duration of the interventions ranged from six weeks to three years. The interventions were nutrition education (NE) and physical education (PE) (N = 11), PE only (N = 3), Surgery/NE (N = 1), Surgery/NE/PE (N = 1) and psychotherapy/NE/PE (N = 2). Three studies that used NE and PE and five studies that used same reported significant differences in body mass index for-age z score (zBMI) and waist circumference, respectively. Studies that included surgeries in the interventions reported significant differences in weight, zBMI and waist-to-hip ratio. Conclusions: Few intervention studies have been done on management of adolescent obesity in developing countries and largely effective. All interventions prioritized nutrition and/or PE. The studies were largely school-based.
Collapse
Affiliation(s)
| | - Jessica Ayensu
- Department of Clinical Nutrition and Dietetics, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Georgina Benewaa Yeboah
- School of Food and Health Sciences, Anglican University College of Technology, Nkoranza, Ghana
| | - Divine Eli-Cophie
- Department of Sport Nutrition, School of Sports and Exercise Medicine University of Health and Allied Sciences, Ho, Ghana
| | - Anita Benewaa
- Department of Nursing and Midwifery, Christian Service University, Kumasi, Ghana
| |
Collapse
|
3
|
Ignatow G, Gutin I. Elite class self-interest, socioeconomic inequality and U.S. population health. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:1749-1771. [PMID: 38923915 DOI: 10.1111/1467-9566.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Class-based perspectives on the persistent social gradients in health within modern welfare states largely focus on the adverse consequences of unfettered neoliberalism and entrenched meritocratic socioeconomic selection. Namely, neoliberal-driven economic inequality has fuelled resentment and stress among lower-status groups, while these groups have become more homogeneous with regard to health behaviours and outcomes. We synthesise several sociological and historical literatures to argue that, in addition to these class-based explanations, socioeconomic inequality may contribute to persistent social gradients in health due to elite class self-interest-in particular elites' preferences for overdiagnosis, overprescription and costly high-technology medical treatments over disease prevention, and for increased tolerance for regulatory capture. We demonstrate that this self-interest provides parsimonious explanations for several contemporary trends in U.S. health inequality including (A) supply-side factors in drug-related deaths, (B) longitudinal trends in the social gradients of obesity and chronic disease mortality and (C) the immigrant health advantage. We conclude that sociological theories of elite class self-interest usefully complement theories of the psychosocial effects of neoliberalism and of meritocratic social selection while answering recent calls for research on the role advantaged groups play in generating inequalities in health, and for research that moves beyond technological determinism in health sociology.
Collapse
Affiliation(s)
- Gabe Ignatow
- Department of Sociology, The University of North Texas, Denton, Texas, USA
| | - Iliya Gutin
- Maxwell School of Citizenship & Public Affairs, Syracuse University, Syracuse, New York, USA
| |
Collapse
|
4
|
Kallestrup-Lamb M, Marin AOK. Lifetime healthcare expenditures across socioeconomic groups. BMC Public Health 2024; 24:2751. [PMID: 39385138 PMCID: PMC11463145 DOI: 10.1186/s12889-024-20209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/26/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND A socioeconomic gradient affects healthcare expenditures and longevity in opposite directions as less affluent individuals have higher current healthcare expenditures but simultaneously enjoy shorter lives. Yet, it is unclear whether this cross-sectional healthcare expenditure gradient persists from a lifetime perspective. This paper analyzes lifetime healthcare expenditures across socioeconomic groups using detailed individual-level healthcare expenditure data for the entire Danish population. METHOD Using full population healthcare expenditures from Danish registries, we estimate lifetime healthcare expenditures as age-specific mean healthcare expenditures times the probability of being alive at each age. Our data enables the estimation of lifetime healthcare expenditures by sex, socioeconomic status, and by various types of healthcare expenditure. RESULTS Once we account for mortality differences and all types of healthcare expenditures, all socioeconomic groups spend an almost equal amount on healthcare throughout a lifetime. Lower socioeconomic groups incur the lowest lifetime hospital expenditures, whereas higher socioeconomic groups experience the highest lifetime expenditures on long-term care services. Our findings remain robust across various socioeconomic measures and alternative estimation methodologies. CONCLUSION Improving the health status of lower socioeconomic groups to align with that of higher socioeconomic groups is costly but may ultimately reduce current healthcare expenditures. Enhanced health outcomes likely increase lifespan, leading to extended periods of healthcare consumption. However, since all socioeconomic groups tend to have similar lifetime healthcare expenditures, this prolonged consumption has limited impact on overall lifetime healthcare costs. Additionally, a significant benefit is the deferment of healthcare expenditures into the future. Overall, our results diminish concerns about socially inequitable utilization of healthcare resources while socioeconomic differences in health and longevity persist, even in a universal healthcare system.
Collapse
Affiliation(s)
| | - Alexander O K Marin
- Present Address: University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Aarhus University, Aarhus, Denmark.
| |
Collapse
|
5
|
Deng Y, Yli-Piipari S, El-Shahawy O, Tamura K. Trends and key disparities of obesity among US adolescents: The NHANES from 2007 to 2020. PLoS One 2024; 19:e0290211. [PMID: 39383131 PMCID: PMC11463737 DOI: 10.1371/journal.pone.0290211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 06/25/2024] [Indexed: 10/11/2024] Open
Abstract
This study aimed to estimate the trends in the body mass index (BMI) and prevalence of obesity among United States (U.S.) adolescents (10-19 years) and to examine the associations between sociodemographic factors and both BMI and obesity prevalence. The 2007-2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative repeated cross-sectional survey data (n = 9,826) were used. Outcomes included: 1) Mean BMI and 2) obesity (yes/no; defined as BMI ≥95% percentile). Sociodemographic variables included age, sex, race/ethnicity, and poverty income ratio (PIR; low-income <1.3, middle-income ≥1.3 and <3.5, high-income ≥3.5). By accounting for the complex survey design, weighted generalized linear/Poisson models were used to conduct the analyses. Girls constituted 49% of the sample. From 2007-2008 to 2017-2020, there was an increase in BMI and obesity prevalence, particularly among Black and Hispanic adolescents, and those from low- and middle-income families. Additionally, there was an increase in obesity prevalence among both boys and girls. However, there were no significant changes in BMI and obesity prevalence in the other race and ethnic adolescents. Girls had a 12% (Adjusted Prevalence Ratio [APR] = 0.88; 95% CI, 0.81-0.96) lower likelihood of being obese than boys. Compared to White adolescents, Black and Hispanic adolescents had 22% (APR = 1.22; 95% CI, 1.06-1.40) and 19% (APR = 1.19; 95% CI, 1.05-1.36) greater risk of being obese. Compared to high-income families, adolescents from low- and middle-income families had 62% (APR = 1.62; 95% CI, 1.39-1.90) and 47% (APR = 1.47; 95% CI, 1.24-1.76) greater risk of being obese, respectively. The results indicated persistent disparities in obesity prevalence among different race/ethnic and sociodemographic groups. Future obesity intervention should address key disparities by targeting specific race/ethnic adolescents from low-income families and promoting health equality.
Collapse
Affiliation(s)
- Yangyang Deng
- Division of Intramural Research, Socio-Spatial Determinants of Health (SSDH) Laboratory, National Institute on Minority Health and Health Disparities, National Institutes of Health, Population and Community Health Sciences Branch, Bethesda, MD, United States of America
| | - Sami Yli-Piipari
- Department of Kinesiology, Mary Frances Early College Education, University of Georgia, Athens, GA, United States of America
| | - Omar El-Shahawy
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
- Division of Global Health, New York University School of Global Public Health, New York, NY, United States of America
| | - Kosuke Tamura
- Division of Intramural Research, Socio-Spatial Determinants of Health (SSDH) Laboratory, National Institute on Minority Health and Health Disparities, National Institutes of Health, Population and Community Health Sciences Branch, Bethesda, MD, United States of America
| |
Collapse
|
6
|
Surachman A, Hamlat E, Zannas AS, Horvath S, Laraia B, Epel E. Grandparents' educational attainment is associated with grandchildren's epigenetic-based age acceleration in the National Growth and Health Study. Soc Sci Med 2024; 355:117142. [PMID: 39106784 PMCID: PMC11703522 DOI: 10.1016/j.socscimed.2024.117142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/03/2024] [Accepted: 07/12/2024] [Indexed: 08/09/2024]
Abstract
We examined three generations (grandparents, mothers, and grandchildren) to assess the association between grandparents' educational attainment and their grandchildren's epigenetic-based age acceleration and whether the association was mediated by parental educational attainment and mothers' life course health-related factors. Mothers were recruited to the NHLBI Growth and Health Study at 9-10 years and followed for 10 years (1987-1998). Mothers were then re-contacted three decades later (ages 37-42) to participate in the National Growth and Health Study (NGHS), and health information from their youngest child (i.e., grandchildren; N = 241, ages 2-17) was collected, including their saliva samples to calculate epigenetic age. Five epigenetic-based age acceleration measures were included in this analysis, including four epigenetic clock age accelerations (Horvath, Hannum, GrimAge, and PhenoAge) and DunedinPACE. Grandparents reported their highest education during the initial enrollment interviews. Parental educational attainment and mothers' life course health-related factors (childhood BMI trajectories, adult cardiovascular health behavioral risk score, and adult c-reactive protein) are included as mediators. Grandparents' education was significantly associated with Horvath age acceleration (b = -0.32, SE = 0.14, p = 0.021). Grandchildren with college-degree grandparents showed significantly slower Horvath age accelerations than those without college degrees. This association was partially mediated by parental education and mothers' health-related factors, especially adult cardiovascular health behavioral risk score and CRP, but not mothers' childhood BMI trajectory. This ability to conserve the speed of biological aging may have considerable consequences in shaping health trajectories across the lifespan.
Collapse
Affiliation(s)
- Agus Surachman
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, USA; College of Nursing and Health Profession, Drexel University, USA.
| | - Elissa Hamlat
- Center for Health and Community, School of Medicine, University of California, San Francisco, USA
| | - Anthony S Zannas
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA; Department of Genetics, University of North Carolina at Chapel Hill, USA
| | - Steve Horvath
- Department of Human Genetics, University of California, Los Angeles, USA; The Altos Institutes of Science, San Diego, USA
| | - Barbara Laraia
- School of Public Health, University of California, Berkeley, USA
| | - Elissa Epel
- Center for Health and Community, School of Medicine, University of California, San Francisco, USA; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA.
| |
Collapse
|
7
|
Dakin M, Omorou AY, Guillemin F. Effectiveness of interventions to reduce social inequalities of weight status in adolescents: A systematic review and meta-analysis. Obes Rev 2024; 25:e13752. [PMID: 38644206 DOI: 10.1111/obr.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Abstract
Many interventions are implemented in the public health context to overcome social inequalities of weight status in adolescents, but their effectiveness is challenged. This study aimed to examine the effectiveness of these interventions with a systematic review and meta-analysis. We systematically searched for reports of randomized control trials and quasi-experimental studies aiming to reduce social inequalities of weight status in adolescents in five electronic databases. The primary outcomes were social inequalities in weight-related outcomes (body mass index [BMI], BMI z score, waist circumference, percent body fat, prevalence of overweight/obesity). Interventions were effective when they reduced social inequalities in at least one weight-related outcome. Meta-analyses involved using random-effects models. The review included 38 publications (33 studies) with interventions mostly targeting disadvantaged adolescents (n = 29 studies), showing effectiveness in half of the studies (n = 19/33, 57.6%). The meta-analysis (27 studies) revealed that targeted interventions significantly reduced BMI z score (β = -0.04 [95% CI -0.08, -0.01]), BMI (β = -0.32 [-0.47, -0.18]), and waist circumference (β = -0.84 [-1.48, -0.21]) but not percent body fat (β = -0.27 [-0.71, 0.17]) or prevalence of overweight/obesity (odds ratio = 1.06 [0.85, 1.31]). This review shows moderate effectiveness of interventions targeting disadvantaged adolescents to reduce social inequalities of weight status. High-quality research with better implementation to reach their full potential is required to strengthen their effectiveness.
Collapse
Affiliation(s)
- Mohamed Dakin
- Inserm, UMR 1319 INSPIIRE, Université de Lorraine, Nancy, Metz, France
| | - Abdou Yacoubou Omorou
- Inserm, UMR 1319 INSPIIRE, Université de Lorraine, Nancy, Metz, France
- Inserm, CHRU Nancy, Université de Lorraine, CIC-Clinical Epidemiology, Nancy, France
| | - Francis Guillemin
- Inserm, UMR 1319 INSPIIRE, Université de Lorraine, Nancy, Metz, France
- Inserm, CHRU Nancy, Université de Lorraine, CIC-Clinical Epidemiology, Nancy, France
| |
Collapse
|
8
|
Fielding-Singh P, Fan JX. Dietary Patterns Among US Children: A Cluster Analysis. J Acad Nutr Diet 2024; 124:700-712. [PMID: 38081384 DOI: 10.1016/j.jand.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions. OBJECTIVE This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics. DESIGN Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns. PARTICIPANTS AND SETTING Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall. MAIN OUTCOME MEASURES The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores. STATISTICAL ANALYSES PERFORMED A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership. RESULTS Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster. CONCLUSIONS Children in this study displayed different dietary patterns, with key sociodemographic variation.
Collapse
Affiliation(s)
| | - Jessie X Fan
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah
| |
Collapse
|
9
|
Kiss O, Baker FC, Palovics R, Dooley EE, Pettee Gabriel K, Nagata JM. Using explainable machine learning and fitbit data to investigate predictors of adolescent obesity. Sci Rep 2024; 14:12563. [PMID: 38821981 PMCID: PMC11143310 DOI: 10.1038/s41598-024-60811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/26/2024] [Indexed: 06/02/2024] Open
Abstract
Sociodemographic and lifestyle factors (sleep, physical activity, and sedentary behavior) may predict obesity risk in early adolescence; a critical period during the life course. Analyzing data from 2971 participants (M = 11.94, SD = 0.64 years) wearing Fitbit Charge HR 2 devices in the Adolescent Brain Cognitive Development (ABCD) Study, glass box machine learning models identified obesity predictors from Fitbit-derived measures of sleep, cardiovascular fitness, and sociodemographic status. Key predictors of obesity include identifying as Non-White race, low household income, later bedtime, short sleep duration, variable sleep timing, low daily step counts, and high heart rates (AUCMean = 0.726). Findings highlight the importance of inadequate sleep, physical inactivity, and socioeconomic disparities, for obesity risk. Results also show the clinical applicability of wearables for continuous monitoring of sleep and cardiovascular fitness in adolescents. Identifying the tipping points in the predictors of obesity risk can inform interventions and treatment strategies to reduce obesity rates in adolescents.
Collapse
Affiliation(s)
- Orsolya Kiss
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA.
| | - Fiona C Baker
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
- School of Physiology, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Robert Palovics
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35233, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
Sezer FE, Alpat Yavaş İ, Saleki N, Bakırhan H, Pehlivan M. Diet quality and snack preferences of Turkish adolescents in private and public schools. Front Public Health 2024; 12:1365355. [PMID: 38496396 PMCID: PMC10940538 DOI: 10.3389/fpubh.2024.1365355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Socioeconomic level is one of the important factors determining diet quality. Snack preferences are affected by socioeconomic level. The objective of this research was to determine the effect of socioeconomic levels on diet quality and snack preferences among adolescents from different socioeconomic backgrounds. Methods The study involved 118 adolescents aged between 10-18 years residing in Istanbul. A questionnaire prepared by the researchers was used to obtain information on the adolescents' dietary habits, consumption of main meals and snacks, habits, and food consumption records. The participants' food consumption was assessed using the retrospective 24-hour recall method, and diet quality was evaluated using the calculated nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR). Results The mean age of the adolescents was 16.42±0.89 years. The number of snacks consumed in private schools was found to be higher than in public schools (p < 0.05). The NAR score for vitamin C consumption was significantly higher in private schools compared to public schools (p < 0.05). Although the MAR scores of adolescents in private schools were higher than those in public schools, this difference was not statistically significant. The majority of adolescents in private schools regularly consumed fresh fruit (67.2%), milk (60.3%), yogurt (60.3%), and nuts (56.9%) as snacks. In contrast, 45% of adolescents in public schools regularly consumed pastries (p < 0.05). Discussion It was observed that adolescents studying in public schools had a lower tendency to prefer healthy foods for snacks compared to those in private schools. Socioeconomic level was identified as an important factor influencing eating habits during adolescence. Considering that the level of income is significantly different between the adolescents studying at private and public schools, the higher consumption of snacks by the adolescents studying at private school may be associated with higher income.
Collapse
Affiliation(s)
- Fatma Elif Sezer
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
| | - İdil Alpat Yavaş
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
| | - Neda Saleki
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
| | - Hande Bakırhan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Kahramanmaraş Istiklal University, Kahramanmaraş, Türkiye
| | - Merve Pehlivan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Türkiye
| |
Collapse
|
11
|
Olds T, Singh B, Miatke A, Eglitis E, Maher C, Dumuid D. The Association Between Socioeconomic Status and Use of Time in Australian Children and Adolescents. J Adolesc Health 2023; 73:1068-1076. [PMID: 37665307 DOI: 10.1016/j.jadohealth.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE There are well-known socioeconomic status (SES) gradients in children and adolescents' health which may be associated with time use. Our aim was to evaluate the association between Australian children's 24-hour time use and SES using four separate surveys from 2005 to 2021. METHODS Time use was assessed in 4526 8-19-year-olds from the 2005 Health of Young Victorians, 2007 National Children's Nutrition and Physical Activity, 2015 Child Health CheckPoint, and 2019-21 Life on Holidays study. Each survey used the same reliable, valid, 24-hour recall instrument. SES was quantified using tertiles of household income, education, and postcode-level measures. Compositional data analysis was used to compare 24-hour time use between SES categories, adjusting for age, sex, and puberty. RESULTS Time-use compositions differed significantly by SES in each survey. Relative to the lowest SES, children from the highest SES accumulated on average 31 min/day more School-related time, 6 min/day more Passive Transport and 6 min/day more Self-care. Conversely, they accumulated 30 min/day less Screen Time (which included computer time), 11 min/day less sleep, and spent 7 min/day less in Domestic/Social activities. There were only small differences in Quiet Time and Physical Activity. DISCUSSION SES-related differences in time use were robust across ages 8-19, a 16-year timespan, diverse Australian geographical regions, and using different SES metrics. The exchange of about 30 min/day between School-related activities and Screen Time amounts to >180 hours extra exposure to School-related activities annually in the highest SES category relative to the lowest, equivalent to >6 weeks of school time per year.
Collapse
Affiliation(s)
- Timothy Olds
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Ben Singh
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia.
| | - Aaron Miatke
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Emily Eglitis
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Allied Health & Human Performance, Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Abbasifard M, Bazmandegan G, Ostadebrahimi H, Amiri M, Kamiab Z. General and central obesity prevalence in young adult: a study based on the Rafsanjan youth cohort study. Sci Rep 2023; 13:17259. [PMID: 37828357 PMCID: PMC10570321 DOI: 10.1038/s41598-023-44579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
Growing prevalence of obesity among youth would have adverse consequences and increased risk of developing chronic diseases at older ages. This study explored the prevalence of obesity and its association with relevant risk factors in the Rafsanjan youth cohort population. This cross-sectional study was done on 3006 individuals from the 15-35-year-old population included in the Rafsanjan youth cohort study. The data were extracted from the youth cohort databases, which had been collected through in-person interview and standard questionnaires. Definition of general obesity was considered as body mass index ≤ 30 and that of central obesity as waist to hip ratio (WHR) ≥ 0.9 for men and ≥ 0.85 for women. Multivariate stepwise proportional odds model and multivariable stepwise logistic regression models were done to explore the factors associated with general obesity and central obesity. The mean age was 25.78 ± 6.06 years with 56% (n = 1683) female. The prevalence of general obesity was 15.80% (95% CI 14.50-17.11) and central obesity was 28.41% (95% CI 26.80-30.02). The risk of general obesity increased with increasing age (OR = 1.053, P < 0.0001), being married (OR = 1.658, P < 0.0001), history of diabetes (OR = 1.609, P = 0.0185), history of hypertension (OR = 1.609, P < 0.0001), elevated triglyceride (OR = 1.007, P < 0.0001) and LDL (OR = 1.015, P < 0.0001), while decreasing with being employed (OR = 0.748, P = 0.0002) and elevated HDL (OR = 0.975, P < 0.0001). Prevalence of obesity was high in study population. Marital status, increasing age, and history of chronic diseases were associated with obesity. Preventing programs should be developed against obesity and for promoting healthy habits in young adult especially during education at schools.
Collapse
Affiliation(s)
- Mitra Abbasifard
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Gholamreza Bazmandegan
- Department of Physiology and Pharmacology Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamid Ostadebrahimi
- Department of Pediatrics, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahsa Amiri
- General Physician, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Kamiab
- Department of Community Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| |
Collapse
|
13
|
Mohamud MA, Campbell DJT, Wick J, Leung AA, Fabreau GE, Tonelli M, Ronksley PE. 20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States. Int J Equity Health 2023; 22:137. [PMID: 37488549 PMCID: PMC10367428 DOI: 10.1186/s12939-023-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States. METHODS This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups. RESULTS There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%). CONCLUSIONS From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States. PRIOR PRESENTATIONS Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
Collapse
Affiliation(s)
- Mursal A Mohamud
- Cumming School of Medicine, Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
14
|
Widome R, Erickson DJ, Laska MN, Berger AT, Lenk KM, Iber C, Kilian G, Lammert S, Wahlstrom KL. Impact of delaying high school start times on weight and related behaviors - the START study. Prev Med 2023; 172:107548. [PMID: 37201593 PMCID: PMC10319406 DOI: 10.1016/j.ypmed.2023.107548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016-2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50-65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors - for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.
Collapse
Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA.
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Aaron T Berger
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kathleen M Lenk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Gudrun Kilian
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
15
|
Johnson-Jennings MD, Reid M, Jiang L, Huyser KR, Brega AG, Steine JF, Manson SM, Chang J, Fyfe-Johnson AL, Hiratsuka V, Conway C, O'Connell J. American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use. Int J Obes (Lond) 2023; 47:297-305. [PMID: 36750690 PMCID: PMC10121828 DOI: 10.1038/s41366-022-01236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12-19 years in association with social determinants of health (SDOH), and mental health and substance use disorders. METHODS Guided by the World Health Organization's Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12-19 years. We described obesity prevalence in relationship to SDOH and adolescents' mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics. RESULTS We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001). CONCLUSIONS Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.
Collapse
Affiliation(s)
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, BC, Canada
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John F Steine
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenny Chang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, Seattle, WA, USA
| | | | - Cheryl Conway
- Charles George Veterans Medical Center, Ashville, NC, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
16
|
Kim E, Lee GB, Yon DK, Kim HC. Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020. Epidemiol Health 2023; 45:e2023033. [PMID: 36915269 PMCID: PMC10586920 DOI: 10.4178/epih.e2023033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity. METHODS This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father's educational attainment, mother's educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII). RESULTS The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father's education, and 1.45 for the mother's education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively. CONCLUSIONS These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.
Collapse
Affiliation(s)
- Eunji Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ga Bin Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Matsuzaki M, Sanchez‐Vaznaugh EV, Alexovitz K, Acosta ME, Sánchez BN. Trends in school-neighbourhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California. Pediatr Obes 2023; 18:e12991. [PMID: 36517944 PMCID: PMC10078445 DOI: 10.1111/ijpo.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States. METHODS We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models. RESULTS Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients. CONCLUSIONS The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.
Collapse
Affiliation(s)
- Mika Matsuzaki
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Emma V. Sanchez‐Vaznaugh
- Department of Public HealthSan Francisco State UniversitySan FranciscoCaliforniaUSA
- Health Equity InstituteSan Francisco State UniversitySan FranciscoCaliforniaUSA
- Center for Health EquityUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kelsey Alexovitz
- Department of Epidemiology and BiostatisticsDrexel Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Maria E. Acosta
- Department of Public HealthSan Francisco State UniversitySan FranciscoCaliforniaUSA
| | - Brisa N. Sánchez
- Department of Epidemiology and BiostatisticsDrexel Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
18
|
Kim Y, Vazquez C, Cubbin C. Socioeconomic disparities in health outcomes in the United States in the late 2010s: results from four national population-based studies. Arch Public Health 2023; 81:15. [PMID: 36739440 PMCID: PMC9899106 DOI: 10.1186/s13690-023-01026-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/09/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the importance of monitoring health disparities by multiple socioeconomic categories, there have been no recent updates on the prevalence of general health indicators by socioeconomic categories. The present study aims to update the prevalence estimates of health indicators by education and income categories across three age groups (children, young and middle-aged adults, and older adults) in the late 2010s by using four nationally representative data sources. We also examine socioeconomic differences in health by race/ethnicity subgroups. METHODS Data were obtained from four nationally representative data sources from the U.S.: The National Health Interview Survey (2015-2018); the National Health and Nutrition Examination Survey, NHANES (2017-2020); the Behavioral Risk Factor Surveillance System (2016-2020); and the Health & Retirement Study (2016). Respondent-rated health and obesity were selected as the health indicators of interest. Socioeconomic factors included percentages of the federal poverty level and years of educational attainment. We conducted logistic regression analyses to calculate adjusted prevalence rates of respondent-rated (or measured, in the case of obesity in NHANES) poor health and obesity by income and education categories after controlling for sociodemographic characteristics. The complex sampling designs were accounted for in all analyses. RESULTS Prevalence rates across racial/ethnic groups and age groups demonstrated clear and consistent socioeconomic gradients in respondent-rated poor health, with the highest rates among those in the lowest income and education categories, and decreased rates as income and education levels increased. On the other hand, there were less evident socioeconomic differences in obesity rates across all data sources, racial/ethnic groups, and age groups. CONCLUSIONS Our results confirmed earlier, persistent evidence indicating socioeconomic disparities in respondent-rated poor health across all age and race/ethnicity groups by using four nationally representative datasets. In comparison to a decade earlier, socioeconomic disparities in poor health appeared to shrink while they emerged or increased for obesity. The results suggest an urgent need for action to alleviate pervasive health disparities by socioeconomic status. Further research is needed to investigate potentially modifiable factors underlying socioeconomic disparities in health, which may help design targeted health promotion programs.
Collapse
Affiliation(s)
- Yeonwoo Kim
- grid.267315.40000 0001 2181 9515Department of Kinesiology, University of Texas at Arlington, Arlington, TX USA ,grid.267315.40000 0001 2181 9515School of Social Work, University of Texas at Arlington, Arlington, TX USA
| | - Christian Vazquez
- grid.267315.40000 0001 2181 9515School of Social Work, University of Texas at Arlington, Arlington, TX USA
| | - Catherine Cubbin
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX USA
| |
Collapse
|
19
|
Kim Y, Colabianchi N. The Longitudinal Effect of Area Socioeconomic Changes on Obesity: a Longitudinal Cohort Study in the USA from 2003 to 2017. J Urban Health 2022; 99:1068-1079. [PMID: 36121565 PMCID: PMC9727040 DOI: 10.1007/s11524-022-00681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 12/31/2022]
Abstract
Despite several dimensions of area socioeconomic status (SES), past literature has been dominated by the use of area socioeconomic position. We examined the longitudinal effect of three area SES measures (i.e., socioeconomic position, inequality, and segregation) on obesity. Using longitudinal data from the Fragile Families & Child Wellbeing Study (N = 1493), we estimated a linear mixed model to examine the effect of three time-varying area SES measures on time-varying measures of objectively measured body mass index z-score (BMIz) from ages 5 years to 15 years. Findings showed that BMIz increased steadily over time (B = 0.02, 95% CI = 0.02, 0.03). A significant interaction between time and area socioeconomic position indicates that children in areas with higher socioeconomic position had a smaller increase in BMIz than those in low socioeconomic areas (B = - 0.02, 95% CI = - 0.02, - 0.01). A non-linear relationship of area income inequality with BMIz such that BMIz was higher as area income inequality was greater, but the effect diminishes in magnitude with a higher level of area income inequality (linear term: B = 0.07; quadratic term: B = - 0.03). Area income segregation was associated with greater BMIz (B = 0.08, 95% CI = 0.03, 0.12). No time interaction effect was found for area income inequality and segregation. Results highlight a need for community health policy efforts and evidence-based interventions to address childhood obesity issues in low-SES areas.
Collapse
Affiliation(s)
- Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX USA
| | | |
Collapse
|
20
|
Delbosq S, Velasco V, Vercesi C, Gruppo Regionale HBSC Lombardia 2018, Vecchio LP. Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15719. [PMID: 36497794 PMCID: PMC9736019 DOI: 10.3390/ijerph192315719] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.
Collapse
Affiliation(s)
- Stefano Delbosq
- Psychology Department, Milano-Bicocca University, 20126 Milan, Italy
| | - Veronica Velasco
- Psychology Department, Milano-Bicocca University, 20126 Milan, Italy
| | - Cecilia Vercesi
- Psychology Department, Milano-Bicocca University, 20126 Milan, Italy
| | | | | |
Collapse
|
21
|
Lee DS, Nitsche N, Barclay K. Body mass index in early adulthood and transition to first birth: Racial/ethnic and sex differences in the United States NLSY79 Cohort. POPULATION STUDIES 2022:1-21. [DOI: 10.1080/00324728.2022.2128396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Kieron Barclay
- Max Planck Institute for Demographic Research
- Swedish Collegium for Advanced Study
- Stockholm University
| |
Collapse
|
22
|
Kobayashi MA, Benzo RM, Lee TK, George SMS. Intergenerational Determinants of Weight Status Concordance and Discordance in Parent/Adolescent Dyads from the Family Life, Activity, Sun, Health, and Eating Study. Child Obes 2022; 18:454-465. [PMID: 35049335 DOI: 10.1089/chi.2021.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Studies have shown that obesity (OB) has strong intergenerational linkages and tends to cluster in families, but there is a dearth of research examining the socioecological factors predictive of weight status concordance and discordance among parents and adolescents. Methods: We ran a stepwise multinomial logistic regression to assess for sociodemographic, individual-, and family-level predictors of four dyadic weight status groups using data from 1516 parent/adolescent dyads from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Study. We categorized parent/adolescent dyads into one of four groups based on their BMI: (1) Healthy Weight Concordance (i.e., both parent and adolescent in the normal weight range); (2) overweight (OW)/OB Concordance (i.e., both parent and adolescent with OW or OB); (3) Discordance-Parent OW/OB (i.e., parent with OW/OB and adolescent in the normal weight range); or (4) Discordance-Adolescent OW/OB (i.e., adolescent with OW/OB and parent in the normal weight range). Results: There were 475 parent/adolescent dyads (31.3%) in the Healthy Weight Concordance group, 351 (23.2%) in the OW/OB Concordance group, 604 (39.8%) in the Discordance-Parent OW/OB group, and 86 (5.7%) in the Discordance-Adolescent OW/OB group. Being from a low socioeconomic family, identifying as a minority, and identifying as a male parent were associated with an OW/OB dyadic BMI. Higher levels of adolescent and parent emotional eating were significantly associated with parent/adolescent dyads being in the OW/OB Concordance group. Parent emotional eating was also associated with Discordance-Parent OW/OB. In contrast, parents' and adolescents' physical activity self-efficacy was associated with a Healthy Weight dyadic BMI vs. OW/OB Concordance or Discordance-Parent OW/OB. Conclusions: Our findings highlight the strength of OW/OB concordance in families, especially among lower socioeconomic and ethnic minority families and the significance of emotional eating and physical activity self-efficacy in contributing to BMI patterns among parents and adolescents.
Collapse
Affiliation(s)
- Marissa A Kobayashi
- Department of Psychology, University of Miami, Miami, FL, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roberto M Benzo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Tae Kyoung Lee
- Convergence for Social Innovation/Child Psychology and Education, Sungkyunkwan University, Seoul, Korea
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
23
|
The Association Between Racial Discrimination, Race, and Social Class With Health Among US Children. Acad Pediatr 2022; 22:1228-1236. [PMID: 35644370 DOI: 10.1016/j.acap.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the association between racial discrimination, race and ethnicity, and social class with child health and unmet health care needs among children in the United States (US). METHODS We used a nationally representative sample of children aged 0 to 17 from the 2018-2019 National Survey of Children's Health. Bivariate and multivariable logistic regression were used to test associations between measures of discrimination, social class (income, employment, and education), and race and ethnicity with overall child health and unmet health care needs controlling for covariates identified a priori. RESULTS Overall, 90.3% of children (n = 59,964) had excellent/very good overall health; 3.1% had unmet health care needs. Black, non-Hispanic children had 8.9 times the odds of having experienced racial discrimination compared to White, non-Hispanic children (95% confidence interval [CI], 7.0-11.4). Having special health care needs was significantly associated with greater odds of racial discrimination (OR 2.3; 95% CI, 1.9-2.8). In multivariable models, underrepresented race and ethnicity groups, lower household income level, and lower caregiver education were significantly associated with poorer overall child health. Conversely, experiencing discrimination was not significantly associated with excellent/good overall child health (adjusted odds ratios [aORs], 0.8; 95% CI, 0.6-1.1) Racial discrimination (aOR 2.7; 95% CI, 1.9-4.0) and lower household income (aOR 2.6; 95% CI, 1.8-3.5) were associated with significantly greater odds of unmet health care needs. CONCLUSION Race and ethnicity and low social class were significantly associated with worse overall health while racial discrimination and low-income were associated with more unmet health care needs. These findings underscore the importance of policy and health care system innovations that address the effects of racism and poverty on child health.
Collapse
|
24
|
Socio-economic inequality in prevalence of type 2 diabetes among adults in north-west of Iran: a Blinder-Oaxaca decomposition. J Diabetes Metab Disord 2022. [PMID: 36404827 PMCID: PMC9672171 DOI: 10.1007/s40200-022-01093-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background The aim of this study was to estimate the socio-economic inequality in prevalence of type 2 diabetes among adults in north-west of Iran. Methods A cross-sectional study was conducted in Ardabil with data from the PERSIAN Cohort Study. Diabetes has been measured by combining self-reported and clinical records. Based on the socio-economic status score, households divided into five quintiles. A multiple logistic regression model was used to examine the association between having diabetes and independent variables and the Blinder-Oaxaca (BO) method was used to decompose the socioeconomic inequality, respectively. Results The Overall age-adjusted prevalence of diabetes among 20,419 Ardabil's adults was 14.3% (95% CI: 13.6 to 14.9). The prevalence of type 2 diabetes for the poorest and richest groups was 16.07% and 7.60%, the gap between the poorest and richest groups was 8.47%. The prevalence type 2 diabetes was significantly increasing with increasing in age (OR = 4.05, 95% CI = 3.27-5.02), BMI (OR: 3.10, 95%CI = 1.25-7.68), blood pressure (OR: 2.61, 95% CI = 2.37-2.88), and decreases with higher education level (OR = 0.78, 95% CI = 0.63-0.97). The richest-economic group has lower prevalence of diabetes (OR = 0.73, 95% CI = 0.60-0.88). The decomposition showed that most important factors affecting the difference between poorest and richest group in the prevalence of type 2 diabetes were age (86.1%), years of schooling (46.9%) and having chronic diseases such as hypertension (26.9%). Conclusions The present study showed that the prevalence of type 2 diabetes was significantly higher among the elderly, women, uneducated, obese, and poor populations. Policies that address people poverty such as increasing job opportunities, increasing the minimum income etc. could reduce diabetes risk for poor people.
Collapse
|
25
|
Homere A, Reddy S, Haller L, Richey J, Gefter L. How do underserved adolescents want to learn about health? An exploration of health concerns, preferences, and resources utilized. J Natl Med Assoc 2022; 114:518-524. [PMID: 35764430 PMCID: PMC9510699 DOI: 10.1016/j.jnma.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
Understanding health concerns and preferences of underserved adolescents has potential to shape health interventions. The objective of this study is to better understand these adolescents' current and preferred health resources, prior to the COVID-19 pandemic. High school students from underrepresented communities in six US cities completed a pre-pipeline program survey in which they reported level of personal concern, as well as current and preferred sources of information about 1) depression/anxiety, 2) nutrition, 3) sexual health, 4) trauma/violence, and 5) alcohol/drugs. 259 participants completed the survey (avg. age 15.7, 79% female, 58.3% Hispanic, and 36.0% Black). At least a moderate level of concern and some degree of prior knowledge (>3 on 5-point Likert scale) were reported across all health topics. Participants reported the lowest level of knowledge on the topic of trauma/violence. Students reported family (24%) and teachers (21%) as the most utilized current sources of information. Students reported doctors as the preferred source of information across all health topics. The difference between students' current source of information and preferred source of information was significant across four topics: depression/anxiety, sexual health, trauma, and alcohol/drugs (p <0.01). These results underscore the important role of physicians as educators and suggest a need for improved education on trauma/violence. These results also establish a pre-COVID-19 baseline for adolescent health concerns, current, and preference health resources. This baseline understanding may shift because of pandemic changes.
Collapse
Affiliation(s)
- Andrew Homere
- Keck School of Medicine at the University of Southern California USA.
| | - Surabhi Reddy
- Keck School of Medicine at the University of Southern California USA
| | - Leonard Haller
- Keck School of Medicine at the University of Southern California USA
| | - Joyce Richey
- Department of Clinical Physiology and Neuroscience, Keck School of Medicine at the University of Southern California USA; Office of Diversity and Inclusion, Keck School of Medicine at the University of Southern California USA
| | - Liana Gefter
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine USA; Health Career Collaborative, American College of Surgeons USA
| |
Collapse
|
26
|
Gong S, Wang L, Zhou Z, Wang K, Alamian A. Income Disparities in Obesity Trends among U.S. Adults: An Analysis of the 2011-2014 California Health Interview Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7188. [PMID: 35742437 PMCID: PMC9222810 DOI: 10.3390/ijerph19127188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/17/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine income disparities in obesity trends among California adults. Data were obtained from the 2011−2014 California Health Interview Survey (n = 83,175 adults). Obesity for adults was defined as a body mass index of 30 kg/m2 or above. Family income was categorized as below 100%, 100% to 299%, or 300% and above of the federal poverty level (FPL). Weighted multiple logistic regression analyses were used to examine the association between family income and obesity across survey years after controlling for age, sex, race/ethnicity, smoking status, marital status, education, physical activity, and healthy diet. Obesity prevalence among California adults increased slightly from 25.1% in 2011 to 27.0% in 2014. Compared to 300% FPL or above, <100% FPL and 100−299% FPL were associated with increased odds of obesity, respectively (OR = 1.35, 95% CI = 1.22−1.50, for 100−299% FPL; OR = 1.18, 95% CI = 1.10−1.27, for 300% FPL or above). Each year, lower FPL was associated with higher odds of obesity, except for the year 2014. An inverse association between obesity and family income in each survey year was observed, with the magnitude of the income disparity decreasing from 2011 to 2014. The findings of this study show that family income was negatively associated with obesity among adults in California from 2011−2014, and the magnitude of the income disparity in obesity prevalence decreased over this period. Future studies need to examine potential risk factors associated with the decreasing trend.
Collapse
Affiliation(s)
- Shaoqing Gong
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Science, Baylor University, Waco, TX 76789, USA;
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China;
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, West Virginia University, Morgantown, WV 26506, USA;
| | - Arsham Alamian
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA;
| |
Collapse
|
27
|
Using structural equation modeling to understand family and psychological factors of childhood obesity: from socioeconomic disadvantage to loss of control eating. Eat Weight Disord 2022; 27:1809-1819. [PMID: 34731454 DOI: 10.1007/s40519-021-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Current study aimed to empirically test the Hemmingsson's theoretical model of childhood obesity which emphasizing the importance of family environment and the emotional distress of parents as influential variables in the emotional distress of the child and subsequent weight gain. This study also tested the hypothesis that the emotional distress of the child triggers a weight gain-inducing behavior (loss of control eating) to suppress negative emotions. METHODS Families of 220 Spanish children participated in the study (28.2% normal, 35.1% overweight and 32.2% obesity), aged between 8 and 12. The evaluation included a clinical interview and a battery of questionnaires. RESULTS Structural equation models were computed according to the steps proposed by theoretical model. Fit indices were acceptable suggesting that the data adequately fit the hypothesized model. Path coefficients in the final model were statistically significant showing a relationship between socioeconomic status, the emotional distress of parents, family environment, the emotional distress of children, loss of control eating and child's BMI Z-score. CONCLUSION Considering this relation between emotional distress and child weight status, childhood obesity intervention programs may benefit from targeting family environment and the potential role that food is playing in the regulation of children's distress. LEVEL OF EVIDENCE Level III: Cohort analytic study.
Collapse
|
28
|
Browne VR, Bruno DM, Dhuper S, Afable A. Insights into the challenges and facilitators to physical activity among brooklyn teens enroled in a weight management programme. Health Expect 2022; 25:1832-1843. [PMID: 35633048 PMCID: PMC9327863 DOI: 10.1111/hex.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose A qualitative study was carried out to explore obese adolescents' understanding of physical activity, perceptions of the ideal body type and to identify facilitators of and barriers to physical activity. Methods Twenty‐two adolescents 12–18 years of age and 14 of their parents were recruited from an obesity intervention programme in Brooklyn, New York, from June to November 2017. Data were collected using focus groups and individual semi‐structured interviews, followed by interpretative phenomenological analysis of the transcripts. Results The adolescents wanted to ‘lose some weight’, but not to be ‘thin’ or ‘look hungry’. Most females desired a ‘slim‐thick’ figure, which was ‘a flat stomach with big thighs, and curvy’. Fun and support from parents, peers and programme staff facilitated achieving their physical activity goals. Barriers included low self‐efficacy, inactive families, fear of neighbourhood gangs and crime and perceptions that the parks were small and overcrowded, with limited physical activity options for adolescents. Conclusion These findings highlight the need to consider local norms concerning body image when designing obesity interventions. To effectively reduce childhood obesity in New York City, policy should prioritize the promotion of public safety, improvement of neighbourhood parks and increase options for physical activity. Patient or Public Contribution The voices and narratives of patients and their families informed this study.
Collapse
Affiliation(s)
- Viola R Browne
- School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York, USA
| | - Denise M Bruno
- School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sarita Dhuper
- Department of Pediatrics, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York, USA
| | - Aimee Afable
- School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York, USA
| |
Collapse
|
29
|
Lee AM, Huo T, Miller D, Gurka MJ, Thompson LA, Modave FP, Hong YR, Pavela G, Cardel MI. The effects of experimentally manipulated social status and subjective social status on physical activity among Hispanic adolescents: An RCT. Pediatr Obes 2022; 17:e12877. [PMID: 34859604 PMCID: PMC9010353 DOI: 10.1111/ijpo.12877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low objective socioeconomic status (SES) and subjective social status (SSS), one's perceived social rank, are associated with obesity. This association may be due, in part, to social status-related differences in energy expenditure. Experimental studies are needed to assess the extent to which SES and SSS relate to energy expenditure. OBJECTIVE Assess the effects of experimentally manipulated social status and SSS on moderate-to-vigorous physical activity (MVPA) and sedentary behaviour. METHODS One hundred thirty-three Hispanic adolescents aged 15-21 were randomized to a high or low social status position, facilitated through a rigged game of Monopoly™. SSS was assessed with MacArthur Scales. Post-manipulation 24-h MVPA and sedentary behaviour were assessed via accelerometry. Analyses were conducted with general linear regression models. RESULTS Experimentally manipulated social status did not significantly affect the total time spent in MVPA or sedentary behaviour; however, identifying as low SSS was significantly associated with less MVPA (p = 0.0060; 18.76 min less). CONCLUSIONS Tewnty-four-hour MVPA and sedentary behaviour are not affected by an acute experimental manipulation of social status. However, low SSS, independent of SES, was associated with clinically significant differences in MVPA. SSS may be a better predictor of MVPA than SES among Hispanic adolescents, potentially influencing obesity, and other health-related outcomes.
Collapse
Affiliation(s)
- Alexandra M. Lee
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Tianyao Huo
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Darci Miller
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Matthew J. Gurka
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Lindsay A. Thompson
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
- Department of Pediatrics, UF Health
| | - François P. Modave
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Young-Rock Hong
- Dept. of Health Services Research, Management, and Policy, University of Florida
| | - Gregory Pavela
- Dept. of Health Behavior, University of Alabama at Birmingham
| | - Michelle I. Cardel
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
- WW International, Inc
| |
Collapse
|
30
|
Wen X, Mi B, Wang Y, Taveras EM, Bartashevskyy M. Potentially modifiable mediators for socioeconomic disparities in childhood obesity in the United States. Obesity (Silver Spring) 2022; 30:718-732. [PMID: 35195362 PMCID: PMC8934591 DOI: 10.1002/oby.23379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States. METHODS This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics. RESULTS The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities. CONCLUSIONS Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States.
Collapse
Affiliation(s)
- Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Youfa Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Elsie M Taveras
- Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts, USA
| | - Maksym Bartashevskyy
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| |
Collapse
|
31
|
Hudomiet P, Hurd MD, Rohwedder S. Trends in Health in Midlife and Late Life. JOURNAL OF HUMAN CAPITAL 2022; 16:133-156. [PMID: 35419119 PMCID: PMC9004779 DOI: 10.1086/717542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gains in life expectancy have recently slowed and mortality inequalities have increased. This paper examines whether trends in health observed at ages 55 to 89 mirror those trends in mortality, which may serve as an early indicator for the future evolution of mortality. We found that many health outcomes have worsened from 1992 to 2016, especially at ages below 70, and that differentials in health between low and high education groups have increased among the more recent cohorts. Overall the findings cast a pessimistic light on the future evolution of mortality rates and mortality inequalities.
Collapse
Affiliation(s)
- Péter Hudomiet
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, U.S.A
| | - Michael D. Hurd
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, U.S.A
- NBER, 1050 Massachusetts Avenue, Cambridge, MA 02138-5398, U.S.A
- NETSPAR, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Susann Rohwedder
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, U.S.A
- NETSPAR, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| |
Collapse
|
32
|
Glei DA, Stokes AC, Weinstein M. Widening Socioeconomic Disparities in Pain and Physical Function Among Americans Are Linked with Growing Obesity. J Aging Health 2022; 34:78-87. [PMID: 34459255 PMCID: PMC8751296 DOI: 10.1177/08982643211028121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: We investigate whether obesity accounts for widening socioeconomic disparities in pain. Methods: Based on nationally representative samples of Americans aged 25-74 in 1995-1996 and 2011-2014, we use logistic regression to model period change in headaches, backaches, and joint aches as well as physical limitations and to determine whether those changes vary by a multidimensional measure of socioeconomic status. Results: Prevalence of backaches, joint aches, physical limitations, and obesity increased between the mid-1990s and the early 2010s, particularly among more disadvantaged Americans. Socioeconomic disparities in frequent backaches, frequent joint pain, and physical limitations more than doubled over this period. We estimate that obesity and health conditions may account for nearly a quarter of the widening disparity in frequent backaches and about half of the widening disparity in frequent joint pain and physical limitations. Discussion: Widening disparities in backaches, joint pain, and physical limitations have coincided with growing obesity.
Collapse
Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, Washington, DC
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, Washington, DC
| |
Collapse
|
33
|
Stratakis N, Garcia E, Chandran A, Hsu T, Alshawabkeh A, Aris IM, Aschner JL, Breton C, Burbank A, Camargo CA, Carroll KN, Chen Z, Claud EC, Dabelea D, Dunlop AL, Elliott AJ, Ferrara A, Ganiban JM, Gern JE, Gold DR, Gower WA, Hertz-Picciotto I, Karagas MR, Karr CJ, Lester B, Leve LD, Litonjua AA, Ludena Y, McEvoy CT, Miller RL, Mueller NT, O’Connor TG, Oken E, O’Shea TM, Perera F, Stanford JB, Rivera-Spoljaric K, Rundle A, Trasande L, Wright RJ, Zhang Y, Zhu Y, Berhane K, Gilliland F, Chatzi L. The Role of Childhood Asthma in Obesity Development: A Nationwide US Multicohort Study. Epidemiology 2022; 33:131-140. [PMID: 34561347 PMCID: PMC8633057 DOI: 10.1097/ede.0000000000001421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
Collapse
Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tingju Hsu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
| | - Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley NJ and the Albert Einstein College of Medicine, Bronx, NY
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Allison Burbank
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kecia N. Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika C. Claud
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, IL
| | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing and Department of Family & Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Jody M. Ganiban
- Department of Psychology The George Washington University, Washington, DC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Diane R Gold
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William A. Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Catherine J. Karr
- Department of Pediatrics & Environmental and Occupational Health Sciences, University of Washington, WA
| | - Barry Lester
- Department of Psychiatry and Human Behavior and Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Leslie D. Leve
- Department of Education, University of Oregon, Eugene, OR
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Yunin Ludena
- University of California, Davis, School of Medicine, CA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience and Obstetrics and Gynecology, University of Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of PediatricsSt. Louis Children’s Hospital, Washington University School of Medicine St. Louis, MO
| | - Andrew Rundle
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population Health, New York University School of Medicine, NY
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
34
|
Woo Baidal JA, Nichols K, Charles N, Chernick L, Duong N, Finkel MA, Falbe J, Valeri L. Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial. Nutrients 2021; 13:nu13124367. [PMID: 34959919 PMCID: PMC8703966 DOI: 10.3390/nu13124367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.
Collapse
Affiliation(s)
- Jennifer A. Woo Baidal
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
- Correspondence: ; Tel.: +1-(212)-305-5903
| | - Kelsey Nichols
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
| | - Nalini Charles
- New York Presbyterian Hospital Special Supplemental Nutrition Program for Women, Infants and Children, 622 W. 168th Street, New York, NY 10032, USA;
| | - Lauren Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA;
| | - Ngoc Duong
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Morgan A. Finkel
- Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA; (K.N.); (N.D.); (M.A.F.)
| | - Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA 95616, USA;
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| |
Collapse
|
35
|
Bernstein R, Sanchez N, Clark ELM, Conte I, Gulley LD, Legget KT, Cornier MA, Melby C, Johnson SA, Lucas-Thompson R, Shomaker LB. Mindfulness-based intervention in adolescents at risk for excess weight gain: 1.5-year follow-up of pilot randomized controlled trial. Eat Behav 2021; 43:101580. [PMID: 34775283 PMCID: PMC8691759 DOI: 10.1016/j.eatbeh.2021.101580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mindfulness-based intervention (MBI) may offer a novel means of preventing excess weight gain in adolescents, theoretically by decreasing stress-eating through altering executive functioning (EF) and food-reward sensitivity. METHODS N = 54 12-17y girls and boys at-risk for excess weight gain (i.e., BMI ≥70th percentile or two biological parents with reported obesity [BMI ≥30 kg/m2]) participated in a 1.5-year follow-up of a pilot randomized controlled trial comparing 6-week/6-session MBI (n = 29) and a health education (HE) control (n = 25). Laboratory stress-eating, food-reward sensitivity, EF, perceived stress, and BMI/adiposity were re-assessed at 1.5-years with validated measures. Changes from baseline to 1.5-year follow-up were explored with ANCOVA, accounting for the respective baseline outcome, age, and sex. RESULTS Compared to MBI (M = -21, SE = 59), HE had greater increases in stress-eating from baseline to 1.5-years (M = 194, SE = 63, Cohen's d = 0.59, p = .01). There were no other between-condition differences. DISCUSSION MBI may prevent worsening stress-eating for adolescents at-risk for excess weight gain. The potential for MBI as an intervention for stress-eating and ultimately, weight stabilization warrants testing in an adequately-powered trial.
Collapse
Affiliation(s)
- Ruth Bernstein
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Natalia Sanchez
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Emma L M Clark
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Isabella Conte
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Lauren D Gulley
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States
| | - Kristina T Legget
- Department of Psychiatry, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17(th) Pl, Aurora, CO 80045, United States; Research Service, Rocky Mountain Regional VA Medical Center, 1700 N. Wheeling St., Aurora, CO 80045, United States
| | - Marc-Andre Cornier
- Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, School of Medicine, Anschutz Medical Campus, University of Colorado, 13001 E. 17(th) Pl, 80045 Aurora, CO, United States
| | - Christopher Melby
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO 80523, United States
| | - Sarah A Johnson
- Food Science & Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO 80523, United States
| | - Rachel Lucas-Thompson
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States; Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17(th) Pl, Aurora, CO 80045, United States
| | - Lauren B Shomaker
- Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523, United States; Community & Behavioral Health, Colorado School of Public Health, 13001 E. 17(th) Pl, Aurora, CO 80045, United States.
| |
Collapse
|
36
|
Hudomiet P, Hurd MD, Rohwedder S. Forecasting mortality inequalities in the U.S. based on trends in midlife health. JOURNAL OF HEALTH ECONOMICS 2021; 80:102540. [PMID: 34634694 PMCID: PMC8643338 DOI: 10.1016/j.jhealeco.2021.102540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
Recent literature has documented a widening gap in mortality between older individuals of high versus low socioeconomic status (SES) in the U.S. This paper investigates whether this trend will continue. We analyze the health status of successive cohorts of 54-60-year-old U.S. individuals born between 1934 and 1959 and use a rich set of health indicators to forecast life expectancies. The detailed health measures come from the longitudinal Health and Retirement Study. We find that many health indicators have worsened recently. For example, rates of obesity, diabetes, and self-reported levels of pain sharply increased between 1992 and 2016. Directly relevant for mortality, recent cohorts report lower subjective survival probabilities. Using Social Security wealth as an SES indicator, we find strong evidence for increasing health inequalities. We predict overall life expectancy to increase further; but the increase will be concentrated among higher SES individuals and mortality inequality will continue to increase.
Collapse
|
37
|
Majumdar I, Espino B, Harmon CM. Pediatric multidisciplinary weight management-how can we improve further? Endocrine 2021; 74:723-726. [PMID: 34599694 DOI: 10.1007/s12020-021-02885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Indrajit Majumdar
- Division of Pediatric Endocrinology, Department of Pediatrics, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA.
| | - Brittany Espino
- Division of Pediatric Endocrinology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carroll M Harmon
- Department of Surgery, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA
| |
Collapse
|
38
|
Scott N, Silver EJ, Dodson NA, Coupey SM. Does Obesity Influence Body Mass Index Changes in Nulliparous Adolescent Users of Long-Acting Reversible Contraceptives? J Pediatr Adolesc Gynecol 2021; 34:815-820. [PMID: 34389461 DOI: 10.1016/j.jpag.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), specifically, the etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD), and copper IUD (Cu-IUD), by initial BMI category from the time of LARC insertion to within 6-18 months after insertion. DESIGN This was a single-center retrospective cohort study. SETTING AND PARTICIPANTS We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. MAIN OUTCOME MEASURE BMI change from LARC insertion to first BMI documented after 6-18 months RESULTS: Mean age was 17.2 ± 0.2 years; 59% of the cohort was Hispanic and 29% Black. Mean BMI was 26.4 ± 7.1 kg/m2. Of the total cohort of adolescents, 51% were underweight/normal, 24% overweight, and 25% obese. Mean time to first BMI documented after LARC insertion was 10.1 ± 3.2 months. Mean BMI change for the total cohort was +0.73 ± 1.8 kg/m2, indicating weight gain. Mean BMI change for the ENG-implant + LNG-IUD users (n = 127) was larger than for Cu-IUD users (n = 69) (+0.92 ± 1.9 kg/m2 vs +0.37 ± 1.6 kg/m2, respectively, P < .05). Two-way analysis of variance showed that both initial BMI category (P = .001) and type of LARC (P = .011) had an independent significant main effect on BMI change. A significant interaction effect (P = .017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC, either ENG-implant or LNG-IUD, as compared to a Cu-IUD (P < .05). CONCLUSION Adolescents using progestin-releasing LARCs had a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs was primarily contributed by obese users.
Collapse
Affiliation(s)
- Nadia Scott
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Ellen J Silver
- Division of Academic General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Nancy A Dodson
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Susan M Coupey
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.
| |
Collapse
|
39
|
Tripicchio GL, Jones GJ, Hart CN, Hyun M, DeSabato E, Giddings A, Ehrhardt A, Rosenberg E. A digitally enhanced home-based physical activity intervention for high-risk middle school youth during COVID-19. Transl Behav Med 2021; 13:17-24. [PMID: 34850218 PMCID: PMC8690196 DOI: 10.1093/tbm/ibab151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
COVID-19 significantly impacted physical activity among high-risk youth. Camp from Home, a digitally enhanced home-based intervention, was developed to address physical activity disparities among middle school youth during COVID-19. Camp from Home enrolled 62 youth in 54 families from five schools in Philadelphia during the summer of 2020. The 6-week intervention comprised of (1) three home deliveries of "activity kits" including exercise equipment and activity booklets, (2) asynchronous sport and exercise videos posted to a private YouTube channel, and (3) supportive text-messages from health coaches. YouTube analytics and self-report surveys completed by parents and youth at baseline and at the end of programming were used to assess engagement, acceptability, and preliminary efficacy. Youth participants were 12.4 (1.2) years, 38.7% female and 90.3% Black/African American. At follow-up, 41 parents (75.9%) and 34 youth (54.8%) completed measures. Youth self-reported increases in self-efficacy (ΔM(sd) = 0.4(1.0), p = .03) and physical activity (ΔM(sd) = 4.2(7.9), p = .004), despite suboptimal engagement in digital program components. Overall, participants highly rated the program. Activity kits and text-messages from health coaches were rated as most helpful. Most parents (95.1%) and youth (83.8%) expressed interested in participating again in the future. A 6-week digitally enhanced, home-based physical activity intervention was acceptable and feasible among parents and youth during the summer of 2020, with youth reporting improvements in self-efficacy and physical activity. Summer programs are critical for reducing disparities in physical activity and hold potential for addressing key barriers for high-risk youth even outside the context of COVID-19.
Collapse
Affiliation(s)
- Gina L Tripicchio
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA,Correspondence to: GL Tripicchio,
| | - Gareth J Jones
- Department of Sport and Recreation Management, Temple University, Philadelphia, PA, USA
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
| | - Moonsup Hyun
- Department of Sport and Recreation Management, Temple University, Philadelphia, PA, USA
| | - Emily DeSabato
- Philadelphia Youth Sports Collaborative, Philadelphia, PA, USA
| | - Amy Giddings
- Department of Sport and Recreation Management, Temple University, Philadelphia, PA, USA
| | - Amanda Ehrhardt
- Department of Sport and Recreation Management, Temple University, Philadelphia, PA, USA
| | - Emily Rosenberg
- Philadelphia Youth Sports Collaborative, Philadelphia, PA, USA
| |
Collapse
|
40
|
Tripicchio GL, Kay M, Herring S, Cos T, Bresnahan C, Gartner D, Sosinsky LS, Bass SB. Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2-9 Years. Nutrients 2021; 13:nu13124240. [PMID: 34959792 PMCID: PMC8708273 DOI: 10.3390/nu13124240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/22/2023] Open
Abstract
This research describes the development and preliminary feasibility of iByte4Health, a mobile health (mHealth) obesity prevention intervention designed for parents with a low-income of children 2–9 years of age. Study 1 (n = 36) presents findings from formative work used to develop the program. Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program.
Collapse
Affiliation(s)
- Gina L. Tripicchio
- Center for Obesity Research and Education, Temple University, Philadelphia, 19140 PA, USA;
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, 19122 PA, USA;
- Correspondence: ; Tel.: +1-215-707-8642
| | - Melissa Kay
- Department of Psychology & Neuroscience, Duke University, Durham, 27708 NC, USA;
| | - Sharon Herring
- Center for Obesity Research and Education, Temple University, Philadelphia, 19140 PA, USA;
| | - Travis Cos
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, 19122 PA, USA;
| | - Carolyn Bresnahan
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, 21205 MD, USA;
| | - Danielle Gartner
- Health Science Center at Houston, University of Texas, Houston, 77030 TX, USA;
| | - Laura Stout Sosinsky
- Research and Evaluation Group, Public Health Management Corporation, Philadelphia, 19102 PA, USA;
| | - Sarah B. Bass
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, 19122 PA, USA;
| |
Collapse
|
41
|
Dolcini MM, Canchola JA, Catania JA, Song Mayeda MM, Dietz EL, Cotto-Negrón C, Narayanan V. National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey. J Med Internet Res 2021; 23:e27723. [PMID: 34636728 PMCID: PMC8548978 DOI: 10.2196/27723] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.
Collapse
Affiliation(s)
- M Margaret Dolcini
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | | | - Joseph A Catania
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Marissa M Song Mayeda
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Erin L Dietz
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Coral Cotto-Negrón
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | | |
Collapse
|
42
|
Peña CM, Payne A. Parental experiences of adopting healthy lifestyles for children with disabilities living with overweight and obesity. Disabil Health J 2021; 15:101215. [PMID: 34556445 DOI: 10.1016/j.dhjo.2021.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with disabilities present with high obesity rates. OBJECTIVE This study explored the parental experience of adopting healthy lifestyle choices, for children with disabilities, who received dietetic weight management advice. METHODS Semi-structured qualitative interviews were carried out with eight parents/carers in their own homes or healthcare setting in an inner London locality, or by telephone. Data was analyzed using an interpretative phenomenological analysis (IPA) approach. RESULTS Five superordinate themes emerged: 1. Strategies to promote healthy lifestyles: encouraging physical activity, limiting access to food and taking a gradual approach to making lifestyle changes. 2. Challenges to adopting healthy lifestyles: selective eating patterns, the high cost of healthy foods and parental/carer lack of time. 3. The role of healthcare professionals (HCPs): revealed that not all parents/carers received advice or support, prior to dietetic referral, when managing their child's weight. Feeling reassured by HCPs was valued. Parents/carers reported a positive experience of seeing the dietitian, as they appreciated receiving practical and individualized advice. 4. Support needs: family support and support from families with children with disabilities was explored. 5. Parent/carer wellbeing: such as stress was found to have a detrimental impact on parents making healthy lifestyle changes. CONCLUSIONS Adopting a healthy lifestyle involved a variety of strategies and challenges, some of which are specific to this population group and should be considered by HCPs, when having weight-related discussions and offering advice. Parental/carer support needs and wellbeing should also be taken into consideration when planning weight management services for this population group.
Collapse
Affiliation(s)
- Constanza M Peña
- Community Nutrition and Dietetics Department, Evelina London Community Children's Services, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Anne Payne
- Faculty of Health & Human Sciences, School of Health Professions, The University of Plymouth, Plymouth, UK
| |
Collapse
|
43
|
Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption. Public Health Nutr 2021; 25:437-449. [PMID: 34482851 PMCID: PMC8883782 DOI: 10.1017/s1368980021003797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants. DESIGN This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program. SETTING Seven weekly classes took place in community centres and extension offices in central Illinois. PARTICIPANTS 120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45). RESULTS Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children's participation in cooking. CONCLUSIONS PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants' cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking.
Collapse
|
44
|
Acosta ME, Matsuzaki M, Slater SJ, Sanchez-Vaznaugh EV. Physical activity strategies in low-resource elementary schools: Why and how are they prioritized? Prev Med Rep 2021; 23:101430. [PMID: 34178588 PMCID: PMC8209743 DOI: 10.1016/j.pmedr.2021.101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/19/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
Most US children do not achieve the recommended daily 60 minutes of moderate to vigorous physical activity (PA). Schools are ideal settings to promote PA given their reach to large child populations, including students with less resources and limited access to PA opportunities. Although limited in numbers, schools that offer enough PA strategies can provide insights to increase PA in these settings. However, few studies have examined why and how these schools successfully prioritize PA strategies, particularly schools serving socioeconomically disadvantaged student populations. This qualitative study of low-resource, PA-supportive schools was conducted during 2017-2018 to obtain in-depth information about why and how schools make decisions to prioritize and implement PA strategies. Forty-two study participants in 17 states plus Washington DC were recruited. Content analysis revealed the following themes: (1) Schools prioritize PA because it helps advance learning and health goals; (2) Policies and standards for PA/PE reinforce the importance of PA; (3) A culture of learning and health advances decisions to offer PA; (4) Advocates play a key role in generating support to integrate PA; (5) Stakeholder buy-in enables decisions to offer PA opportunities; (6) Collaboration focused on PA specifically can facilitate decisions to increase PA strategies; and (7) Funding and resources drive decisions to put PA strategies into practice. The study findings offer insights that may be useful in efforts to increase access to PA opportunities in low-resource elementary schools.
Collapse
Affiliation(s)
- Maria Elena Acosta
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, USA
| | - Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Division of Human Nutrition, 615 N Wolfe St, Baltimore, MD, USA
| | - Sandra J. Slater
- College of Pharmacy, Concordia University Wisconsin, 12800 N Lake Shore Drive, Mequon, WI, USA
| | - Emma V. Sanchez-Vaznaugh
- Department of Public Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, USA
| |
Collapse
|
45
|
Diet quality, excess body weight and cardiometabolic risk factors in adolescents living in São Paulo, Brazil and in the USA: differences and similarities. Public Health Nutr 2021; 24:4091-4101. [PMID: 32907665 PMCID: PMC8501489 DOI: 10.1017/s1368980020002736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA. DESIGN Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression. SETTING São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. PARTICIPANTS Adolescents (12-16 years) living in São Paulo (n 189) and USA (n 787). RESULTS ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99). CONCLUSIONS Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.
Collapse
|
46
|
Bates S, Anderson-Butcher D, Hoffman J, Rooney L, Ramsey C. Addressing infant mortality through positive youth development opportunities for adolescent girls. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1260-1274. [PMID: 32893446 DOI: 10.1111/hsc.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/19/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Adolescent girls experience risks prior to pregnancy and giving birth that influence their overall health, and development, as well as community rates of infant mortality. Supporting adolescent girls through positive youth development (PYD) opportunities offers a potential long-term strategy to preventing infant mortality and improving maternal health outcomes. The current study sought to assess state-wide needs, resources and opportunities related to PYD supports for adolescent girls, especially among those most at risk for early pregnancy. A strengths, weaknesses, opportunities and threats (SWOT) analysis guided nine community forums in counties with the highest rates of infant mortality in one large Midwestern state. In total, 368 stakeholders attended the forums and provided insights related to the context of PYD for adolescent girls. Researchers also conducted three focus group with 19 parents/guardians and three focus groups with 25 adolescent girls aged 11-14 to validate the findings from the SWOT analysis. Content analysis was utilised to synthesise the qualitative results. Strengths and opportunities related to PYD for adolescent girls included access to afterschool programming and access to health and mental health services. Weaknesses brought awareness to more systemic problems as all nine counties reported a lack of communication and coordination among youth programs and a need for greater collaboration among youth agencies. Threats included challenges associated with technology and social media, unsafe neighbourhood conditions, and issues of racism, sexism, poverty and discrimination. Findings support the need for a continued focus and priority on improving access, services and supports for adolescent girls to prevent infant mortality and improve their health and well-being. Local, state and national leaders can use the results of this study to promote additional strategies for addressing infant mortality through PYD for adolescent girls.
Collapse
Affiliation(s)
- Samantha Bates
- Department of Social Work, Texas Christian University, Fort Worth, TX, USA
| | | | - Jill Hoffman
- School of Social Work, Portland State University, Portland, OR, USA
| | | | - Catelen Ramsey
- College of Social Work, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
47
|
Jebeile H, Cardel MI, Kyle TK, Jastreboff AM. Addressing psychosocial health in the treatment and care of adolescents with obesity. Obesity (Silver Spring) 2021; 29:1413-1422. [PMID: 34431234 DOI: 10.1002/oby.23194] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023]
Abstract
Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self-directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self-esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer-term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.
Collapse
Affiliation(s)
- Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
| | | | - Ania M Jastreboff
- Department of Internal Medicine (Endocrinology & Metabolism), Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
48
|
Papadakis JL, Holmbeck GN. Sociodemographic factors and health-related, neuropsychological, and psychosocial functioning in youth with spina bifida. Rehabil Psychol 2021; 66:286-299. [PMID: 34043409 PMCID: PMC8855727 DOI: 10.1037/rep0000381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Past research suggests that certain sociodemographic factors may put youth with spina bifida (SB) at risk for poor outcomes. The aims of this study were to examine (a) associations between ten sociodemographic factors and health-related, neuropsychological, and psychosocial functioning among youth with SB,(b) cumulative sociodemographic risk as a predictor of youth outcomes as moderated by age, and (c) SB-related family stress as a mediator of longitudinal associations between cumulative sociodemographic risk and youth outcomes. Method: Participants were youth with SB (N = 140 at Time 1; Mage at Time 1 = 11.43, 53.6% female) recruited as part of a larger, longitudinal study. The study included questionnaire (parent-, teacher-, and youth-report), neuropsychological testing, and medical chart data across three time points, spaced 2 years apart. Results: A subset of the sociodemographic factors and their cumulative risk were associated with study outcomes. Specifically, youth characterized by sociodemographic risk had greater pain and lower academic achievement, but also fewer urinary tract infections and fewer attention and executive function problems. Age did not moderate the association between cumulative risk and outcomes. Cumulative risk predicted lower SB-related family stress, which, in turn, predicted several outcomes. Conclusions: Examining a range of sociodemographic factors is warranted. Sociodemographic risk is linked to poorer outcomes for some risk indicators but similar or better outcomes for others. Results have implications for delivering evidence-based, diversity-sensitive clinical care to youth with SB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | |
Collapse
|
49
|
Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018. Nutrients 2021; 13:nu13082530. [PMID: 34444690 PMCID: PMC8399168 DOI: 10.3390/nu13082530] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.
Collapse
|
50
|
Johnson AE, Zhu J, Garrard W, Thoma FW, Mulukutla S, Kershaw KN, Magnani JW. Area Deprivation Index and Cardiac Readmissions: Evaluating Risk-Prediction in an Electronic Health Record. J Am Heart Assoc 2021; 10:e020466. [PMID: 34212757 PMCID: PMC8403312 DOI: 10.1161/jaha.120.020466] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Assessment of the social determinants of post-hospital cardiac care is needed. We examined the association and predictive ability of neighborhood-level determinants (area deprivation index, ADI), readmission risk, and mortality for heart failure, myocardial ischemia, and atrial fibrillation. Methods and Results Using a retrospective (January 1, 2011-December 31, 2018) analysis of a large healthcare system, we assess the predictive ability of ADI on 30-day and 1-year readmission and mortality following hospitalization. Cox proportional hazards models analyzed time-to-event. Log rank analyses determined survival. C-statistic and net reclassification index determined the model's discriminative power. Covariates included age, sex, race, comorbidity, number of medications, length of stay, and insurance. The cohort (n=27 694) had a median follow-up of 46.5 months. There were 14 469 (52.2%) men and 25 219 White (91.1%) patients. Patients in the highest ADI quintile (versus lowest) were more likely to be admitted within 1 year of index heart failure admission (hazard ratio [HR], 1.25; 95% CI, 1.03‒1.51). Patients with myocardial ischemia in the highest ADI quintile were twice as likely to be readmitted at 1 year (HR, 2.04; 95% CI, 1.44‒2.91]). Patients with atrial fibrillation living in areas with highest ADI were less likely to be admitted within 1 year (HR, 0.79; 95% CI, 0.65‒0.95). As ADI increased, risk of readmission increased, and risk reclassification was improved with ADI in the models. Patients in the highest ADI quintile were 25% more likely to die within a year (HR, 1.25 1.08‒1.44). Conclusions Residence in socioeconomically disadvantaged communities predicts rehospitalization and mortality. Measuring neighborhood deprivation can identify individuals at risk following cardiac hospitalization.
Collapse
Affiliation(s)
- Amber E Johnson
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Jianhui Zhu
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | | | - Floyd W Thoma
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Suresh Mulukutla
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| | - Kiarri N Kershaw
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Jared W Magnani
- Division of Cardiology Department of Medicine UPMC Heart and Vascular Institute University of Pittsburgh PA
| |
Collapse
|