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Boone-Heinonen J, Lyon-Scott K, Springer R, Schmidt T, Vesco KK, Booman A, Dinh D, Fortmann SP, Foster BA, Hauschildt J, Liu S, O'Malley J, Palma A, Snowden JM, Stratton K, Tran S. Pregnancy health in a multi-state U.S. population of systemically underserved patients and their children: PROMISE cohort design and baseline characteristics. BMC Public Health 2024; 24:886. [PMID: 38519895 PMCID: PMC10960496 DOI: 10.1186/s12889-024-18257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 03/02/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a routinely monitored aspect of pregnancy health, yet critical gaps remain about optimal GWG in pregnant people from socially marginalized groups, or with pre-pregnancy body mass index (BMI) in the lower or upper extremes. The PROMISE study aims to determine overall and trimester-specific GWG associated with the lowest risk of adverse birth outcomes and detrimental infant and child growth in these underrepresented subgroups. This paper presents methods used to construct the PROMISE cohort using electronic health record data from a network of community-based healthcare organizations and characterize the cohort with respect to baseline characteristics, longitudinal data availability, and GWG. METHODS We developed an algorithm to identify and date pregnancies based on outpatient clinical data for patients 15 years or older. The cohort included pregnancies delivered in 2005-2020 with gestational age between 20 weeks, 0 days and 42 weeks, 6 days; and with known height and adequate weight measures needed to examine GWG patterns. We linked offspring data from birth records and clinical records. We defined study variables with attention to timing relative to pregnancy and clinical data collection processes. Descriptive analyses characterize the sociodemographic, baseline, and longitudinal data characteristics of the cohort, overall and within BMI categories. RESULTS The cohort includes 77,599 pregnancies: 53% had incomes below the federal poverty level, 82% had public insurance, and the largest race and ethnicity groups were Hispanic (56%), non-Hispanic White (23%) and non-Hispanic Black (12%). Pre-pregnancy BMI groups included 2% underweight, 34% normal weight, 31% overweight, and 19%, 8%, and 5% Class I, II, and III obesity. Longitudinal data enable the calculation of trimester-specific GWG; e.g., a median of 2, 4, and 6 valid weight measures were available in the first, second, and third trimesters, respectively. Weekly rate of GWG was 0.00, 0.46, and 0.51 kg per week in the first, second, and third trimesters; differences in GWG between BMI groups were greatest in the second trimester. CONCLUSIONS The PROMISE cohort enables characterization of GWG patterns and estimation of effects on child growth in underrepresented subgroups, ultimately improving the representativeness of GWG evidence and corresponding guidelines.
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Affiliation(s)
- Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA.
| | | | - Rachel Springer
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | | | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, USA
| | - Anna Booman
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Dang Dinh
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, USA
| | - Byron A Foster
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | | | - Shuling Liu
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Jean O'Malley
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
- OCHIN, Inc., Portland, OR, 1881 SW Naito Pkwy, USA
| | - Amy Palma
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Jonathan M Snowden
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Kalera Stratton
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Sarah Tran
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
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Foster BA, Seeley K, Davis M, Boone-Heinonen J. Positive deviance in health and medical research on individual level outcomes - a review of methodology. Ann Epidemiol 2022; 69:48-56. [PMID: 34915122 PMCID: PMC9081135 DOI: 10.1016/j.annepidem.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research. METHODS We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement. RESULTS Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely. CONCLUSIONS Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.
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Affiliation(s)
- Byron A Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, OR; School of Public Health, Portland State University and Oregon Health & Science University.
| | - Kylie Seeley
- Department of Pediatrics, Stanford University, Stanford School of Medicine, Palo Alto, CA
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Janne Boone-Heinonen
- School of Public Health, Portland State University and Oregon Health & Science University
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Aris IM, Lin PID, Rifas-Shiman SL, Bailey LC, Boone-Heinonen J, Eneli IU, Solomonides AE, Janicke DM, Toh S, Forrest CB, Block JP. Association of Early Antibiotic Exposure With Childhood Body Mass Index Trajectory Milestones. JAMA Netw Open 2021; 4:e2116581. [PMID: 34251440 PMCID: PMC8276083 DOI: 10.1001/jamanetworkopen.2021.16581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Past studies have showed associations between antibiotic exposure and child weight outcomes. Few, however, have documented alterations to body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) trajectory milestone patterns during childhood after early-life antibiotic exposure. OBJECTIVE To examine the association of antibiotic use during the first 48 months of life with BMI trajectory milestones during childhood in a large cohort of children. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used electronic health record data from 26 institutions participating in the National Patient-Centered Clinical Research Network from January 1, 2009, to December 31, 2016. Participant inclusion required at least 1 valid set of same-day height and weight measurements at each of the following age periods: 0 to 5, 6 to 11, 12 to 23, 24 to 59, and 60 to 131 months (183 444 children). Data were analyzed from June 1, 2019, to June 30, 2020. EXPOSURES Antibiotic use at 0 to 5, 6 to 11, 12 to 23, 24 to 35, and 36 to 47 months of age. MAIN OUTCOMES AND MEASURES Age and magnitude of BMI peak and BMI rebound. RESULTS Of 183 444 children in the study (mean age, 3.3 years [range, 0-10.9 years]; 95 228 [51.9%] were boys; 80 043 [43.6%] were White individuals), 78.1% received any antibiotic, 51.0% had at least 1 episode of broad-spectrum antibiotic exposure, and 65.0% had at least 1 episode of narrow-spectrum antibiotic exposure at any time before 48 months of age. Exposure to any antibiotics at 0 to 5 months of age (vs no exposure) was associated with later age (β coefficient, 0.05 months [95% CI, 0.02-0.08 months]) and higher BMI (β coefficient, 0.09 [95% CI, 0.07-0.11]) at peak. Exposure to any antibiotics at 0 to 47 months of age (vs no exposure) was associated with an earlier age (-0.60 months [95% CI, -0.81 to -0.39 months]) and higher BMI at rebound (β coefficient, 0.02 [95% CI, 0.01-0.03]). These associations were strongest for children with at least 4 episodes of antibiotic exposure. Effect estimates for associations with age at BMI rebound were larger for those exposed to antibiotics at 24 to 35 months of age (β coefficient, -0.63 [95% CI, -0.83 to -0.43] months) or 36 to 47 (β coefficient, -0.52 [95% CI, -0.72 to -0.31] months) than for those exposed at 0 to 5 months of age (β coefficient, 0.26 [95% CI, 0.01-0.51] months) or 6 to 11 (β coefficient, 0.00 [95% CI, -0.20 to 0.20] months). CONCLUSIONS AND RELEVANCE In this cohort study, antibiotic exposure was associated with statistically significant, but small, differences in BMI trajectory milestones in infancy and early childhood. The small risk of an altered BMI trajectory milestone pattern associated with early-life antibiotic exposure is unlikely to be a key factor during prescription decisions for children.
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Affiliation(s)
- Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Pi-I D. Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - L. Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Ihuoma U. Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio
| | - Anthony E. Solomonides
- Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois
| | - David M. Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Sengwee Toh
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher B. Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jason P. Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Potis K, Youngers EH, Tandy TK, Takemoto E, Boone-Heinonen J. The Association Between Birth Weight and Fat, Sugar, and Vegetable Consumption in a National Sample of U.S. Preschool Age Children. Matern Child Health J 2021; 25:1050-1056. [PMID: 33929650 DOI: 10.1007/s10995-021-03126-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adverse prenatal development is a contributor to obesity susceptibility in children. Dietary behavior is one mechanism through which adverse prenatal development may promote obesity, but evidence for the role of prenatal overnutrition in dietary intake in young children is scant. METHODS We used data from the National Health and Nutrition Examination Survey 2009-2014. Our study sample included 1782 U.S. children 2-5 years old with available birth weight and two 24-h dietary recalls. We used linear and Poisson regression to examine the association of birth weight (LBW < 2500 g, HBW > 4100 g) and 2-day average intake of dietary variables. We tested interactions between birthweight and breastfeeding (breastfed > 5 months vs. not breastfed or breastfed 0-5 months), and report breastfeeding-specific results. RESULTS In multivariable regression analysis, in boys, LBW was associated with 2.4 (95% CI - 4.3, - 0.5) lower percent of kcal from solid fat; lower sugar intake, marginally lower saturated and total fat intake, and 0.6 cup (95% CI 0.1, 1.0) greater vegetable consumption; HBW was marginally associated with lower fat. Birth weight was unrelated to diet in girls. Breastfeeding modified associations between birth weight and dietary intake, but the direction of modification was mixed. DISCUSSION Our findings do not support the hypothesis that LBW or HBW are associated with adverse diet consumption in preschool age U.S. children. Improved understanding of the role of early life development of dietary behavior requires further research on the development of appetitive traits and the role of the family and preschool food environments.
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Affiliation(s)
- Kacey Potis
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code VPT, Portland, OR, 97239-3098, USA
| | - Emily H Youngers
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code VPT, Portland, OR, 97239-3098, USA
| | - Thomas K Tandy
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code VPT, Portland, OR, 97239-3098, USA
| | - Erin Takemoto
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code VPT, Portland, OR, 97239-3098, USA
| | - Janne Boone-Heinonen
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code VPT, Portland, OR, 97239-3098, USA.
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Harrod CS, Elman MR, Vesco KK, Wolfe BM, Mitchell JE, Pories WJ, Pomp A, Boone-Heinonen J, Purnell JQ. Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study. Obesity (Silver Spring) 2020; 28:2209-2215. [PMID: 32918404 PMCID: PMC7650043 DOI: 10.1002/oby.22944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. RESULTS Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). CONCLUSIONS Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.
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Affiliation(s)
| | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Alfons Pomp
- Weill Cornell University Medical Center, New York, New York, USA
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Boone-Heinonen J, Biel FM, Marshall NE, Snowden JM. Maternal prepregnancy BMI and size at birth: race/ethnicity-stratified, within-family associations in over 500,000 siblings. Ann Epidemiol 2020; 46:49-56.e5. [DOI: 10.1016/j.annepidem.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
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Andrea SB, Messer LC, Marino M, Goodman JM, Boone-Heinonen J. The tipping point: could increasing the subminimum wage reduce poverty-related antenatal stressors in U.S. women? Ann Epidemiol 2020; 45:47-53.e6. [PMID: 32336654 DOI: 10.1016/j.annepidem.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage, contributing to economic hardship. Poverty-related antenatal stress has deleterious health effects for women and their children. The purpose of this study was to investigate the effects of increasing the state-level subminimum wage (currently $2.13 per hour) on poverty-related antenatal stress for women in the United States. METHODS Utilizing a difference-in-differences approach comparing state wage policies over time, we estimated the impact of increases in the subminimum wage on poverty-related antenatal stress using data from 35 states participating in the Pregnancy Risk Assessment Monitoring System between 2004 and 2014, linked to state-level wage laws, census, and antipoverty policy data. RESULTS The effect of increasing the subminimum wage on poverty-related stress differed by year and sociodemographics. Wage increases in 2014 were associated with the largest decreases in stress for unmarried women of color with less than a college degree, a population that we estimated would have experienced a 19.7% reduction in stress from 2004 to 2014 if subminimum wage was equivalent to the federal minimum wage. CONCLUSIONS Increasing the subminimum wage can reduce poverty-related stress and may be a potential intervention for reducing poor health outcomes.
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Affiliation(s)
- Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.
| | | | - Miguel Marino
- OHSU-PSU School of Public Health, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR
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Takemoto E, Wolfe BM, Nagel CL, Boone-Heinonen J. Physical and Mental Health-Related Quality of Life Changes Among Insurer Subgroups Following Bariatric Surgery. Obesity (Silver Spring) 2020; 28:669-675. [PMID: 31984660 PMCID: PMC7042072 DOI: 10.1002/oby.22718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/21/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study sought to determine improvements in mental and physical health-related quality of life (HRQOL) following bariatric surgery in Medicaid and commercially insured patients. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery (2006-2009), changes in Short Form 36 mental component summary (MCS) and physical component summary (PCS) scores were examined in 1,529 patients who underwent Roux-en-Y gastric bypass, laparoscopic adjustable band, or sleeve gastrectomy and were followed for 5 years. Piecewise linear mixed-effects models estimated MCS and PCS scores as a function of insurance group (Medicaid, N = 177; commercial, N = 1,352) from 0 to 1 year and from 1 to 5 years after surgery, with interactions between insurance group and surgery type. RESULTS Patients with Medicaid had lower PCS and MCS scores at baseline. At 1 year after surgery, patients with Medicaid and commercial insurance experienced similar improvement in PCS scores (commercial-Medicaid difference in PCS change [95% CI]: Roux-en-Y gastric bypass, 1.5 [-0.2, 3.3]; laparoscopic adjustable band, 1.9 [-2.2, 6.0]; sleeve gastrectomy, 6.4 [0.0, 12.8]). One-year MCS score improvement was minimal and similar between insurance groups. In years 1 to 5, PCS and MCS scores were stable in all groups. CONCLUSIONS Both insurance groups experienced improvements in physical HRQOL and minimal changes in mental HRQOL.
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Affiliation(s)
- Erin Takemoto
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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9
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Andrea SB, Messer LC, Marino M, Goodman JM, Boone-Heinonen J. A nationwide investigation of the impact of the tipped worker subminimum wage on infant size for gestational age. Prev Med 2020; 133:106016. [PMID: 32045614 DOI: 10.1016/j.ypmed.2020.106016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Tipped workers, primarily women of reproductive-age, can be paid a "subminimum wage" 71% lower than the federal minimum wage. We estimated the effects of increasing the state-level tipped worker subminimum wage (federally, $2.13 per hour) on infant size for gestational age in the US as infants born small or large are at risk for poor health across the lifecourse. Utilizing unconditional quantile regression and difference-in-differences analysis of data from 2004 to 2016 Vital Statistics Natality Files (N = 41,219,953 mother-infant dyads), linked to state-level wage laws, census, and antipoverty policy data, we estimated the effect of increasing the subminimum wage on birthweight standardized for gestational age (BWz). Smallest and largest infants are defined as those in the 5th and 95th BWz percentiles, respectively. Increases in the subminimum wage affected the BWz distribution. When compared to a static wage of $2.13 for the duration of the study period, wage set to 100% of the federal minimum ($5.15-$7.25) was associated with an increase in BWz of 0.024 (95% CI: 0.004, 0.045) for the smallest infants and a decrease by 0.041 (95% CI: -0.054, -0.029) for the largest infants. Increasing the subminimum wage may be one strategy to promote healthier birthweight in infants.
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Affiliation(s)
- Sarah B Andrea
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Miguel Marino
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Julia M Goodman
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
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10
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Boone-Heinonen J, Weeks HM, Sturza J, Miller AL, Lumeng JC, Bauer KW. Prenatal predictors of objectively measured appetite regulation in low-income toddlers and preschool-age children. Pediatr Obes 2019; 14:e12554. [PMID: 31215152 PMCID: PMC6812586 DOI: 10.1111/ijpo.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/14/2019] [Accepted: 05/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal nutrition impacts offspring appetite regulation in animal models. However, evidence from humans is scarce. OBJECTIVE To determine associations between indicators of prenatal nutrition and appetite regulation among young children. METHODS Participants included 454 low-income mother/child dyads (mean child age = 45.2 months [SD = 9.7]). Children's appetite regulation was ascertained with the maternal-reported Child Eating Behavior Questionnaire and objectively assessed using the Eating in the Absence of Hunger protocol. Using hierarchical linear regression, we modelled child appetite regulation measures as a function of prenatal nutrition indicators (child birthweight z scores [BWz, BWz2 ]; maternal pre-pregnancy body mass index [BMI], gestational weight gain [GWG]), adjusted for sociodemographic characteristics. RESULTS Among girls, higher and lower birthweight were associated with greater energy consumed in the absence of hunger, primarily sweet foods, coeff (95% CI): BWz 0.17 (0.05, 0.28), BWz2 0.15 (0.04, 0.26), but not food responsiveness or food enjoyment. Higher birthweight was also associated with greater satiety responsiveness among girls. Among boys, birthweight was unrelated to measures of appetite regulation. Associations between maternal BMI and GWG and child appetite regulation were inconsistent. CONCLUSIONS Among low-income girls, but not boys, indicators of adverse prenatal conditions were associated with poor objectively measured appetite regulation during early childhood.
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Affiliation(s)
- Janne Boone-Heinonen
- School of Public Health, Oregon Health & Science
University, Portland, OR, USA,Corresponding author: 3181 SW Sam Jackson Park Rd,
CB669, Portland, OR 97239,
| | - Heidi M. Weeks
- Department of Nutritional Sciences, University of Michigan
School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical
School, Ann Arbor, MI
| | - Alison L. Miller
- Center for Human Growth and Development, University of
Michigan, Ann Arbor, MI, USA,Department of Health Behavior and Health Education,
University of Michigan School of Public Health, University of Michigan, Ann Arbor,
MI, USA
| | - Julie C. Lumeng
- Department of Nutritional Sciences, University of Michigan
School of Public Health, University of Michigan, Ann Arbor, MI, USA,Department of Pediatrics, University of Michigan Medical
School, Ann Arbor, MI,Center for Human Growth and Development, University of
Michigan, Ann Arbor, MI, USA
| | - Katherine W. Bauer
- Department of Nutritional Sciences, University of Michigan
School of Public Health, University of Michigan, Ann Arbor, MI, USA,Center for Human Growth and Development, University of
Michigan, Ann Arbor, MI, USA
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11
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Marshall NE, Biel FM, Boone-Heinonen J, Dukhovny D, Caughey AB, Snowden JM. The Association between Maternal Height, Body Mass Index, and Perinatal Outcomes. Am J Perinatol 2019; 36:632-640. [PMID: 30292175 PMCID: PMC6453733 DOI: 10.1055/s-0038-1673395] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To test the hypothesis that maternal height is associated with adverse perinatal outcomes, controlling for and stratified by maternal body mass index (BMI). STUDY DESIGN This was a retrospective cohort study of all births in California between 2007 and 2010 (n = 1,775,984). Maternal height was categorized into quintiles, with lowest quintile (≤20%) representing shorter stature and the uppermost quintile (≥80%) representing taller stature. Outcomes included gestational diabetes mellitus (GDM), preeclampsia, cesarean, preterm birth (PTB), macrosomia, and low birth weight (LBW). We calculated height/outcome associations among BMI categories, and BMI/outcome associations among height categories, using various multivariable logistic regression models. RESULTS Taller women were less likely to have GDM, nulliparous cesarean, PTB, and LBW; these associations were similar across maternal BMI categories and persisted after multivariable adjustment. In contrast, when stratified by maternal height, the associations between maternal BMI and birth outcomes varied by specific outcomes, for example, the association between morbid obesity (compared with normal or overweight) and the risk of GDM was weaker among shorter women (adjusted odds ratio [aOR], 95% confidence interval [CI]: 3.48, 3.28-3.69) than taller women (aOR, 95% CI: 4.42, 4.19-4.66). CONCLUSION Maternal height is strongly associated with altered perinatal risk even after accounting for variations in complications by BMI.
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Affiliation(s)
- Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Frances M Biel
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | | | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Jonathan M Snowden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.,School of Public Health, Oregon Health and Science University, Portland, Oregon
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Frank LD, Kuntz JL, Chapman JE, Fox EH, Dickerson JF, Meenan RT, Saelens BE, Young DR, Boone-Heinonen J, Fortmann SP. The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment. BMC Public Health 2019; 19:200. [PMID: 30770737 PMCID: PMC6377787 DOI: 10.1186/s12889-019-6518-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions. METHODS The Rails & Health study is a natural experiment evaluating changes in clinical measures, health care utilization and health care costs among Kaiser Permanente Northwest (KPNW) members following the opening of a new light rail transit (LRT) line in Portland, Oregon. The study is prospectively following 3036 adults exposed to the new LRT line and a similar cohort of 4386 adults who do not live close to the new line. Individual-level outcomes and covariates are extracted from the electronic medical record at KPNW, including member demographics and comorbidities, blood pressure, body mass index, lipids, glycosylated hemoglobin, and health care utilization and costs. In addition, participants are surveyed about additional demographics, travel patterns, physical activity (PA), and perceived neighborhood walkability. In a subsample of the study population, we are collecting direct measures of travel-related behavior-physical activity (accelerometry), global positioning system (GPS) tracking, and travel diaries-to document mechanisms responsible for observed changes in health outcomes and cost. Comprehensive measures of the built environment at baseline and after rail construction are also collected. Statistical analyses will (1) examine the effects of opening a new LRT line on chronic disease indicators, health care utilization, and health care costs and (2) evaluate the degree to which observed effects of the LRT line on health measures and costs are mediated by changes in total and transportation-associated PA. DISCUSSION The results of the Rails & Health study will provide urban planners, transportation engineers, health practitioners, developers, and decision makers with critical information needed to document how transit investments impact population health and related costs.
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Affiliation(s)
- Lawrence D. Frank
- Urban Design 4 Health, Inc., Rochester, NY USA
- Health & Community Design Lab, Schools of Population and Public Health and Community and Regional Planning, University of British Columbia, Vancouver, BC Canada
| | - Jennifer L. Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland USA
| | | | - Eric H. Fox
- Urban Design 4 Health, Inc., Rochester, NY USA
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland USA
| | - Richard T. Meenan
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute and the University of Washington, Seattle, WA USA
| | - Deborah R. Young
- Center for Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Janne Boone-Heinonen
- Oregon Health & Science University, School of Public Health, Oregon, Portland USA
| | - Stephen P. Fortmann
- Center for Health Research, Kaiser Permanente Northwest, Oregon, Portland USA
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13
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Goodman JM, Boone-Heinonen J, Richardson DM, Andrea SB, Messer LC. Analyzing Policies Through a DOHaD Lens: What Can We Learn? Int J Environ Res Public Health 2018; 15:E2906. [PMID: 30572594 PMCID: PMC6313805 DOI: 10.3390/ijerph15122906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022]
Abstract
Social, health, and environmental policies are critical tools for providing the conditions needed for healthy populations. However, current policy analyses fall short of capturing their full potential impacts across the life course and from generation to generation. We argue that the field of Developmental Origins of Health and Disease (DOHaD), a conceptual and research framework positing that early life experiences significantly affect health trajectories across the lifespan and into future generations, provides an important lens through which to analyze social policies. To illustrate this point, we synthesized evidence related to policies from three domains-family leave, nutrition, and housing-to examine the health implications for multiple generations. We selected these policy domains because they represent increasing distance from a reproductive health focus, each with a growing evidence base to support a potential impact on pregnant women and their offspring. Each of these examples represents an opportunity to extend our understanding of policy impact using a DOHaD lens, taking into account the potential life course and intergenerational effects that have previously been overlooked.
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Affiliation(s)
- Julia M Goodman
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR 97201, USA.
| | - Janne Boone-Heinonen
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR 97201, USA.
| | - Dawn M Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR 97201, USA.
| | - Sarah B Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR 97201, USA.
| | - Lynne C Messer
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR 97201, USA.
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Takemoto E, Wolfe BM, Nagel CL, Boone-Heinonen J. Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients. Obesity (Silver Spring) 2018; 26:1807-1814. [PMID: 30358155 PMCID: PMC6817972 DOI: 10.1002/oby.22312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study sought to determine changes in the prevalence of comorbid disease following bariatric surgery in Medicaid patients compared with commercially insured patients. METHODS Data were obtained from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery at one of six geographically diverse centers in the United States. A total of 1,201 patients who underwent Roux-en-Y gastric bypass with 5 years of follow-up were identified. Poisson mixed models were used to estimate relative risks (RRs) and compare changes in common comorbidities between insurance groups within 0-1 and 1-5 years post surgery. Propensity scores were used to achieve balance in the baseline comorbidity burden between Medicaid and commercial patients. RESULTS In the first year, risk of all six comorbidities decreased substantially over time in both groups, ranging from a 32% to a 69% decrease from baseline. After 1 year post surgery, the risk of disease was stable in both groups (RRs ranged from 1.0 to 1.1). After propensity score weighting, the RRs in the first year were more similar in magnitude, while the RRs in the 1- to 5-year period were unchanged. CONCLUSIONS These results suggest that Medicaid patients experience a medium-term reduction in comorbid disease after bariatric surgery.
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Affiliation(s)
- Erin Takemoto
- Oregon Health & Science University—Portland State University School of Public Health 3181 SW Sam Jackson Park Rd., Mail Code CB669 Portland, OR 97239-3098
| | - Bruce M. Wolfe
- Oregon Health & Science University School of Medicine Department of Surgery, Portland, OR
| | - Corey L. Nagel
- University of Arkansas for Medical Sciences School of Nursing Little Rock, AR
| | - Janne Boone-Heinonen
- Oregon Health & Science University—Portland State University School of Public Health 3181 SW Sam Jackson Park Rd., Mail Code CB669 Portland, OR 97239-3098
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Andrea SB, Messer LC, Marino M, Boone-Heinonen J. Associations of Tipped and Untipped Service Work With Poor Mental Health in a Nationally Representative Cohort of Adolescents Followed Into Adulthood. Am J Epidemiol 2018; 187:2177-2185. [PMID: 29893781 DOI: 10.1093/aje/kwy123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/05/2018] [Indexed: 12/11/2022] Open
Abstract
Precarious work is concentrated in the service industry in the United States and is a risk factor for poor mental health. Service occupations in which workers receive tips are potentially more precarious due to unstable schedule and income, and lack of benefits. We tested hypotheses that individuals working in tipped service occupations have greater odds of experiencing poor mental health (as indicated by self-reported depression, sleep problems, and/or greater perceived stress) relative to individuals in untipped service and nonservice occupations, using cross-sectional data from wave IV of the National Longitudinal Study of Adolescent to Adult Health data set (2007-2008; age range, 24-33 years). To improve comparability of occupation types, propensity scores were computed as a function of childhood factors, then used to construct a sample of 2,815 women and 2,586 men. In gender-stratified multivariable regression, women in tipped service had greater odds of reporting a depression diagnosis or symptoms relative to women in nonservice work (odds ratio = 1.61; 95% confidence interval: 1.11, 2.34). Associations of similar magnitude for sleep problems and perceived stress were observed among women but were not statistically significant; all associations were close to the null among men. Additional research is necessary to understand the factors that underlie differences in poor mental health in tipped and untipped service versus nonservice workers.
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Affiliation(s)
- Sarah B Andrea
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Miguel Marino
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
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16
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Takemoto E, Wolfe BM, Nagel CL, Pories W, Flum DR, Pomp A, Mitchell J, Boone-Heinonen J. Insurance status differences in weight loss and regain over 5 years following bariatric surgery. Int J Obes (Lond) 2018; 42:1211-1220. [PMID: 29892045 DOI: 10.1038/s41366-018-0131-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/14/2018] [Accepted: 05/09/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effectiveness of bariatric surgery among Medicaid beneficiaries, a population with a disproportionately high burden of obesity, remains unclear. We sought to determine if weight loss and regain following bariatric surgery differed in Medicaid patients compared to commercial insurance. SUBJECTS/METHODS Data from the Longitudinal Assessment of Bariatric Surgery, a ten-site observational cohort of adults undergoing bariatric surgery (2006-2009) were examined for patients who underwent Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Band (LAGB), or Sleeve Gastrectomy (SG). Using piecewise spline linear mixed-effect models, weight change over 5 years was modeled as a function of insurance type (Medicaid, N = 190; commercially insured, N = 1448), time, procedure type, and sociodemographic characteristics; additionally, interactions between all time, insurance, and procedure type indicators allowed time- and procedure-specific associations with insurance type. For each time-spline, mean (kg) difference in weight change in commercially insured versus Medicaid patients was calculated. RESULTS Medicaid patients had higher mean weight at baseline (138.3 kg vs. 131.2 kg). From 0 to 1 year post-operatively, Medicaid patients lost similar amounts of weight to commercial patients following all procedure types (mean weight Δ difference [95% CI]: RYGB: -0.9 [-3.2, 1.4]; LAGB: -1.5 [-6.7, 3.8]; SG: 5.1 [-4.0, 14.2]). From 1 to 3 years post-operatively Medicaid and commercial patients continued to experience minimal weight loss or began to slowly regain weight (mean weight Δ difference [95% CI]: RYGB: 0.9 [0.0, 2.0]; LAGB: -2.1 [-4.2, 0.1]; SG: 0.7 [-3.0, 4.3]). From 3 to 5 years post-operatively, the rate of regain tended to be faster among commercial patients compared to Medicaid patients (mean weight Δ difference [95% CI]: RYGB: 1.1 [0.1, 2.0]; LAGB: 1.5 [-0.5, 3.5]; SG: 1.0 [-2.5, 4.5]). CONCLUSIONS Although Medicaid patients had a higher baseline weight, they achieved similar amounts of weight loss and tended to regain weight at a slower rate than commercial patients.
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Affiliation(s)
- Erin Takemoto
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.
| | - Bruce M Wolfe
- Oregon Health & Science University School of Medicine Department of Surgery, Portland, OR, USA
| | - Corey L Nagel
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA
| | - Walter Pories
- East Carolina University School of Medicine Department of Surgery, Greenville, NC, USA
| | - David R Flum
- University of Washington Department of Surgery, Seattle, WA, USA
| | - Alfons Pomp
- Weill Cornell Medical College Department of Surgery, New York, NY, USA
| | | | - Janne Boone-Heinonen
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA
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17
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Grandy M, Snowden JM, Boone-Heinonen J, Purnell JQ, Thornburg KL, Marshall NE. Poorer maternal diet quality and increased birth weight . J Matern Fetal Neonatal Med 2018; 31:1613-1619. [PMID: 28514885 PMCID: PMC5694379 DOI: 10.1080/14767058.2017.1322949] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/14/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Maternal diet and gestational weight gain (GWG) influence birth weight and infant adiposity, which are important predictors of lifetime health. To better understand these relationships, we studied associations between maternal diet and GWG, adiposity, and birth weight in a well characterized cohort of pregnant women. STUDY DESIGN Data were obtained from 41 term (>37 weeks), uncomplicated, singleton pregnancies according to pre-pregnancy BMI categories of normal (n = 11), overweight (n = 15), or obese (n = 15). Daily consumption of protein, fat, and carbohydrates and a Healthy Eating Index (HEI-2010) score were determined from 24 h food recall collections. Associations were modeled using multinomial logistic and linear regression. RESULTS Neither the third trimester maternal diet quality nor the macronutrient consumption was associated with GWG after adjusting for pre-pregnancy BMI, maternal age, and parity. A ten-point lower HEI-2010 score was associated with 200 g higher infant birth weight and a 1.0 cm longer length. However, maternal HEI-2010 and macronutrient composition were unrelated to infant percent body fat, ponderal index, or abdominal circumference. CONCLUSIONS Poorer third trimester maternal diet quality was associated with higher birth weight and longer length, but was unrelated to markers of infant adiposity. GWG was independent of third trimester maternal diet composition and quality.
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Affiliation(s)
- Madeline Grandy
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jonathan M. Snowden
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Janne Boone-Heinonen
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, OR
| | - Jonathan Q. Purnell
- Department of Medicine, Oregon Health & Science University, Portland, OR
- Knight Cardiovascular Institute, Center for Developmental Health, Oregon Health & Science University, Portland, OR
| | - Kent L. Thornburg
- Knight Cardiovascular Institute, Center for Developmental Health, Oregon Health & Science University, Portland, OR
| | - Nicole E. Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Boone-Heinonen J, Tillotson CJ, O'Malley JP, Cottrell EK, Gaudino JA, Amofah A, Rivo ML, Brickman A, Mayer K, McBurnie MA, Gold R, DeVoe JE. Characterizing a "Big Data" Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort. Matern Child Health J 2018; 21:421-431. [PMID: 28093689 DOI: 10.1007/s10995-016-2232-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Low-income populations have elevated exposure to early life risk factors for obesity, but are understudied in longitudinal research. Our objective was to assess the utility of a cohort derived from electronic health record data from safety net clinics for investigation of obesity emerging in early life. Methods We examined data from the PCORNet ADVANCE Clinical Data Research Network, a national network of Federally-Qualified Health Centers serving >1.7 million safety net patients across the US. This cohort includes patients who, in 2012-2014, had ≥1 valid body mass index measure when they were 0-5 years of age. We characterized the cohort with respect to factors required for early life obesity research in vulnerable subgroups: sociodemographic diversity, weight status based on World Health Organization (<2 years) or Centers for Disease Control (≥2 years) growth curves, and data longitudinality. Results The cohort includes 216,473 children and is racially/ethnically diverse (e.g., 17.9% Black, 45.4% Hispanic). A majority (56.9%) had family incomes below the Federal Poverty Level (FPL); 32% were <50% of FPL. Among children <2 years, 7.6 and 5.3% had high and low weight-for-length, respectively. Among children 2-5 years, 15.0, 12.7 and 2.4% were overweight, obese, and severely obese, respectively; 5.3% were underweight. In the study period, 79.2% of children had ≥2 BMI measures. Among 4-5 year olds, 21.9% had >1 BMI measure when they were <2 years. Discussion The ADVANCE Early Life cohort offers unique opportunities to investigate early life determinants of obesity in the understudied population of low income and minority children.
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Affiliation(s)
- J Boone-Heinonen
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.
| | - C J Tillotson
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - J P O'Malley
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - E K Cottrell
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Rd., Mail Code FM, Portland, OR, 97239-3098, USA
| | - J A Gaudino
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - A Amofah
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - M L Rivo
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - A Brickman
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - K Mayer
- The Fenway Institute, 1340 Boylston St., Boston, MA, 02215, USA
| | - M A McBurnie
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - R Gold
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - J E DeVoe
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Rd., Mail Code FM, Portland, OR, 97239-3098, USA
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Boone-Heinonen J, Sacks RM, Takemoto EE, Hooker ER, Dieckmann NF, Harrod CS, Thornburg KL. Prenatal Development and Adolescent Obesity: Two Distinct Pathways to Diabetes in Adulthood. Child Obes 2018; 14:173-181. [PMID: 29624412 PMCID: PMC5910034 DOI: 10.1089/chi.2017.0290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Higher body-mass index (BMI) and lower birth weight (BW) are associated with elevated risk of diabetes in adulthood, but the extent to which they compose two distinct pathways is unclear. METHODS We used data from the National Longitudinal Study of Adolescent to Adult Health, a cohort of adolescents (1994-1995) followed for 14 years over four waves into adulthood (n = 13,413). Sex-stratified path analysis was used to examine pathways from BW [kg; linear (BW) and quadratic (BW2)] to latent trajectories in BMI from adolescence to adulthood to prevalent diabetes or prediabetes (pre/diabetes) in adulthood, adjusting for sociodemographic characteristics. RESULTS Two pathways from BW to pre/diabetes were characterized: one from higher BW to elevated BMI and pre/diabetes and a second from lower BW, independent of BMI. In the BMI-independent pathway, greater BW was associated with marginally lower odds of pre/diabetes in women, but not men. Girls born at lower and higher BW exhibited elevated BMI in adolescence [coeff (95% CI): BW: -2.1 (-4.1, -0.05); BW2: 0.43 (0.09, 0.76)]; higher BW predicted marginally faster BMI gain and higher adolescent BMI and faster BMI gain were associated with pre/diabetes [coeff (95% CI): BMI intercept: 0.09 (0.06, 0.11); BMI slope: 0.11 (0.07, 0.15)]. In boys, BW was weakly associated with BMI intercept and slope; BMI slope, but not BMI intercept, was positively associated with pre/diabetes [coeff (95% CI): 0.29 (0.19, 0.39)]. CONCLUSIONS Findings suggest that in girls, slowing BMI gain is critical for diabetes prevention, yet it may not address distinct pathology stemming from early life.
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Affiliation(s)
- Janne Boone-Heinonen
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, OR
| | - Rebecca M. Sacks
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, OR
| | - Erin E. Takemoto
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, OR
| | - Elizabeth R. Hooker
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, OR
| | - Nathan F. Dieckmann
- Oregon Health & Science University, School of Nursing and School of Medicine, Portland, OR
| | - Curtis S. Harrod
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, OR
- Center for Evidence-Based Policy, Oregon Health & Science University, Portland, OR
| | - Kent L. Thornburg
- Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR
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Takemoto E, Andrea SB, Wolfe BM, Nagel CL, Boone-Heinonen J. Weighing in on Bariatric Surgery: Effectiveness Among Medicaid Beneficiaries-Limited Evidence and Future Research Needs. Obesity (Silver Spring) 2018; 26:463-473. [PMID: 29464910 DOI: 10.1002/oby.22059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/09/2017] [Accepted: 09/12/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In the general population, bariatric surgery is well documented as the most effective obesity treatment for sustained weight loss and remission of comorbidities. Characterization of the patient populations most likely to benefit from surgical intervention is needed, but the heterogeneity of treatment effects across payer groups has not been reviewed. METHODS A systematic review of published studies focusing on bariatric surgery outcomes among Medicaid beneficiaries was conducted. By using PubMed and Scopus, this study searched for studies that quantitatively compared clinical or social bariatric surgery outcomes for United States adult Medicaid recipients and commercially insured patients. RESULTS Of the 568 titles reviewed, 21 met inclusion criteria. Weight loss and the remission of comorbidities at 1 or 2 years postoperatively were similar between groups despite differences in baseline health status. Short-term health care utilization and mortality outcomes were worse in Medicaid recipients; for instance, Medicaid patients had an average length of stay that was 2 days longer and experienced three more deaths in the first postoperative year. CONCLUSIONS The critical research gaps in the evidence base needed to improve treatment guidelines for Medicaid patients undergoing bariatric surgery include an understanding of the causes of the baseline health differences and how these differences contribute to postoperative outcomes.
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Affiliation(s)
- Erin Takemoto
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Bruce M Wolfe
- Department of Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Corey L Nagel
- OHSU-PSU School of Public Health, Portland, Oregon, USA
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Jeanne TL, Hooker ER, Nguyen T, Messer LC, Sacks RM, Andrea SB, Boone-Heinonen J. High birth weight modifies association between adolescent physical activity and cardiometabolic health in women and not men. Prev Med 2018; 108:29-35. [PMID: 29277411 PMCID: PMC5828988 DOI: 10.1016/j.ypmed.2017.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 01/08/2023]
Abstract
Recent evidence suggests that adverse prenatal development alters physiological response to physical activity, but longitudinal epidemiologic evidence is scant. This study tested the hypothesis that lower physical activity during adolescence and young adulthood is more strongly associated with later cardiovascular disease (CVD) risk and diabetes or prediabetes (DM/PDM) in women and men who were born with high or low birth weight (HBW, LBW), compared to normal birth weight (NBW). We analyzed data from the National Longitudinal Study of Adolescent to Adult Health, a cohort study of US adolescents followed into adulthood (1994-2009). Using sex-stratified multivariable regression, 30-year CVD risk score (calculated using objective measures; n=12,775) and prevalent DM/PDM (n=15,138) at 24-32years of age were each modeled as a function of birth weight category, self-reported moderate-to-vigorous physical activity frequency in adolescence (MVPA1) and young adulthood (MVPA3), and MVPA-birth weight interactions. Greater MVPA1 was associated with lower 30-year CVD risk score and DM/PDM risk in HBW women but not NBW or LBW women. Associations between MVPA1 and 30-year CVD risk or DM/PDM were not modified by HBW in men; or by LBW in women or men. Additionally, birth weight did not modify estimated effects of MVPA3. Findings suggest that frequent MVPA in adolescence may be a particularly important cardiometabolic risk reduction strategy in girls born HBW; however, we found no evidence that birth weight and MVPA interact in cardiometabolic disease risk in men, for MVPA in adulthood, or for LBW.
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Affiliation(s)
- Thomas L Jeanne
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Elizabeth R Hooker
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Thuan Nguyen
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Lynne C Messer
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Rebecca M Sacks
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Sarah B Andrea
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA
| | - Janne Boone-Heinonen
- Oregon Health & Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR 97239-3098, USA.
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Sacks RM, Takemoto E, Andrea S, Dieckmann NF, Bauer KW, Boone-Heinonen J. Childhood Maltreatment and BMI Trajectory: The Mediating Role of Depression. Am J Prev Med 2017; 53:625-633. [PMID: 28928037 PMCID: PMC5679065 DOI: 10.1016/j.amepre.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 06/09/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Childhood maltreatment is associated with later obesity, but the underlying mechanisms are unknown. The objective of this study was to estimate the extent to which depression mediates the associations between childhood maltreatment and BMI in adolescence through adulthood. METHODS Data on a cohort of 13,362 adolescents in the National Longitudinal Study of Adolescent to Adult Health (Wave I [1994-1995] to Wave IV [2008-2009]) were analyzed in 2015-2016. Classes of maltreatment experienced prior to age 12 years were statistically identified using latent class analysis. Gender-stratified latent growth curve analysis was used to estimate total effects of maltreatment classes on latent BMI trajectory (aged 13-31 years) and indirect effects of maltreatment classes that occurred through latent depression trajectory (aged 12-31 years). RESULTS Four latent maltreatment classes were identified: high abuse and neglect; physical abuse dominant; supervisory neglect dominant; and no/low maltreatment. In girls, compared with no/low maltreatment, supervisory neglect dominant (coefficient=0.3, 95% CI=0.0, 0.7) and physical abuse dominant (coefficient=0.6, 95% CI=0.1, 1.2) maltreatment were associated with faster gain in BMI. Change in depression over time fully mediated the association of BMI slope with physical abuse dominant maltreatment, but not with supervisory neglect dominant maltreatment. In boys, high abuse and neglect maltreatment was associated with marginally greater BMI at baseline (coefficient=0.7, 95% CI= -0.1, 1.5); this association was not mediated by depression. CONCLUSIONS Although maltreatment was associated with depression and BMI trajectories from adolescence to adulthood, depression only mediated associations with physical abuse dominant maltreatment in girls.
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Affiliation(s)
- Rebecca M Sacks
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Erin Takemoto
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Sarah Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Nathan F Dieckmann
- Oregon Health & Science University School of Nursing, Portland, Oregon; Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Janne Boone-Heinonen
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon.
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Andrea SB, Hooker ER, Messer LC, Tandy T, Boone-Heinonen J. Does the association between early life growth and later obesity differ by race/ethnicity or socioeconomic status? A systematic review. Ann Epidemiol 2017; 27:583-592.e5. [PMID: 28911983 DOI: 10.1016/j.annepidem.2017.08.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/16/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Rapid growth during infancy predicts higher risk of obesity later in childhood. The association between patterns of early life growth and later obesity may differ by race/ethnicity or socioeconomic status (SES), but prior evidence syntheses do not consider vulnerable subpopulations. METHODS We systemically reviewed published studies that explored patterns of early life growth (0-24 months of age) as predictors of later obesity (>24 months) that were either conducted in racial/ethnic minority or low-SES study populations or assessed effect modification of this association by race/ethnicity or SES. Literature searches were conducted in PubMed and SocINDEX. RESULTS Ten studies met the inclusion criteria. Faster growth during the first 2 years of life was consistently associated with later obesity irrespective of definition and timing of exposure and outcome measures. Associations were strongest in populations composed of greater proportions of racial/ethnic minority and/or low-SES children. For example, ORs ranged from 1.17 (95% CI: 1.11, 1.24) in a heterogeneous population to 9.24 (95% CI: 3.73, 22.9) in an entirely low-SES nonwhite population. CONCLUSIONS The impact of rapid growth in infancy on later obesity may differ by social stratification factors such as race/ethnicity and family income. More robust and inclusive studies examining these associations are needed.
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Affiliation(s)
- Sarah B Andrea
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Elizabeth R Hooker
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Lynne C Messer
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Thomas Tandy
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
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24
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Snowden JM, Robinson WR, Marshall NE, Boone-Heinonen J. Race, obesity, and birth outcomes: Unraveling a complex association to improve maternal-child health. Obesity (Silver Spring) 2016; 24:2447. [PMID: 27891831 PMCID: PMC5557633 DOI: 10.1002/oby.21642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nicole E Marshall
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Janne Boone-Heinonen
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon, USA
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Winett L, Wallack L, Richardson D, Boone-Heinonen J, Messer L. A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease. Curr Environ Health Rep 2016; 3:169-77. [PMID: 27449924 PMCID: PMC5560864 DOI: 10.1007/s40572-016-0102-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation.
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Affiliation(s)
- Liana Winett
- School of Community Health and OHSU/PSU School of Public Health, Portland State University, PO Box 751, Portland, OR, 97201, USA.
| | - Lawrence Wallack
- School of Community Health and OHSU/PSU School of Public Health, Portland State University, PO Box 751, Portland, OR, 97201, USA
| | - Dawn Richardson
- School of Community Health and OHSU/PSU School of Public Health, Portland State University, PO Box 751, Portland, OR, 97201, USA
| | - Janne Boone-Heinonen
- Public Health and Preventive Medicine and OHSU/PSU School of Public Health, Oregon Health and Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Lynne Messer
- School of Community Health and OHSU/PSU School of Public Health, Portland State University, PO Box 751, Portland, OR, 97201, USA
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Boone-Heinonen J, Markwardt S, Fortmann SP, Thornburg KL. Overcoming birth weight: can physical activity mitigate birth weight-related differences in adiposity? Pediatr Obes 2016; 11:166-73. [PMID: 25988588 PMCID: PMC4653090 DOI: 10.1111/ijpo.12040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals born at low or high birth weight (BW) have elevated adiposity. The extent to which physical activity can mitigate this risk is unknown. OBJECTIVES The aim of this study was to determine if associations between BW and adiposity vary by self-reported moderate-to-vigorous physical activity (MVPA) among adolescents. METHODS We used data on adolescents in the National Health and Nutrition Examination Survey (1999-2006; 12-15 years; n = 4064). Using gender-stratified linear regression, we modelled body mass index (BMI) and waist circumference (WC) z-scores as a function of low, normal and high BW, MVPA (weekly Metabolic Equivalent of Task hours) and MVPA*BW cross-product terms, adjusting for sociodemographics, diet and, in WC models, BMI. RESULTS Among girls with low MVPA, those born with high BW had greater BMI than normal BW; this difference diminished with greater MVPA (coefficient [95% confidence interval]: low MVPA: 0.72 [0.29, 1.14]; high MVPA: -0.04 [-0.48, 0.39]; P for interaction = 0.05). Among boys, MVPA did not modify the associations between BW and BMI. WC was unrelated to BW, regardless of MVPA. CONCLUSIONS Findings suggest that effects of high BW in total adiposity can be more easily modified with MVPA in adolescent girls than in boys.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University; Portland, OR, USA
| | - Sheila Markwardt
- Department of Public Health and Preventive Medicine, Oregon Health & Science University; Portland, OR, USA
| | | | - Kent L. Thornburg
- Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health & Science University; Portland, OR, USA
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27
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Boone-Heinonen J, Messer L, Andrade K, Takemoto E. Connecting the Dots in Childhood Obesity Disparities: A Review of Growth Patterns from Birth to Pre-Adolescence. CURR EPIDEMIOL REP 2016; 3:113-124. [PMID: 27172171 DOI: 10.1007/s40471-016-0065-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this review, we considered how disparities in obesity emerge between birth, when socially disadvantaged infants tend to be small, and later in childhood, when socially disadvantaged groups have high risk of obesity. We reviewed epidemiologic evidence of socioeconomic and racial/ethnic differences in growth from infancy to pre-adolescence. Minority race/ethnicity and lower socioeconomic status was associated with rapid weight gain in infancy but not in older age groups, and social differences in linear growth and relative weight were unclear. Infant feeding practices was the most consistent mediator of social disparities in growth, but mediation analysis was uncommon and other factors have only begun to be explored. Complex life course processes challenge the field of social epidemiology to develop innovative study designs and analytic techniques with which to pose and test challenging yet impactful research questions about how obesity disparities evolve throughout childhood.
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Affiliation(s)
- Janne Boone-Heinonen
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098
| | - Lynne Messer
- Portland State University; OHSU-PSU School of Public Health 470H Urban Center; 506 SW Mill St. Portland, OR 37201 (P) 503.725.5182 (F) 503.725.5100
| | - Kate Andrade
- University of Minnesota, Division of Epidemiology & Community Health 1300 S 2 St, Ste 300 Minneapolis, MN 55454
| | - Erin Takemoto
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098 (P) 503-418-9810
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28
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Boone-Heinonen J, Messer LC, Fortmann SP, Wallack L, Thornburg KL. From fatalism to mitigation: A conceptual framework for mitigating fetal programming of chronic disease by maternal obesity. Prev Med 2015; 81:451-9. [PMID: 26522092 PMCID: PMC4679670 DOI: 10.1016/j.ypmed.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
Prenatal development is recognized as a critical period in the etiology of obesity and cardiometabolic disease. Potential strategies to reduce maternal obesity-induced risk later in life have been largely overlooked. In this paper, we first propose a conceptual framework for the role of public health and preventive medicine in mitigating the effects of fetal programming. Second, we review a small but growing body of research (through August 2015) that examines interactive effects of maternal obesity and two public health foci - diet and physical activity - in the offspring. Results of the review support the hypothesis that diet and physical activity after early life can attenuate disease susceptibility induced by maternal obesity, but human evidence is scant. Based on the review, we identify major gaps relevant for prevention research, such as characterizing the type and dose response of dietary and physical activity exposures that modify the adverse effects of maternal obesity in the offspring. Third, we discuss potential implications of interactions between maternal obesity and postnatal dietary and physical activity exposures for interventions to mitigate maternal obesity-induced risk among children. Our conceptual framework, evidence review, and future research directions offer a platform to develop, test, and implement fetal programming mitigation strategies for the current and future generations of children.
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Affiliation(s)
| | - Lynne C Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | | | - Lawrence Wallack
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - Kent L Thornburg
- Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR, USA
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29
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Richardson AS, Meyer KA, Howard AG, Boone-Heinonen J, Popkin BM, Evenson KR, Shikany JM, Lewis CE, Gordon-Larsen P. Multiple pathways from the neighborhood food environment to increased body mass index through dietary behaviors: A structural equation-based analysis in the CARDIA study. Health Place 2015; 36:74-87. [PMID: 26454248 PMCID: PMC4791952 DOI: 10.1016/j.healthplace.2015.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine longitudinal pathways from multiple types of neighborhood restaurants and food stores to BMI, through dietary behaviors. METHODS We used data from participants (n=5114) in the United States-based Coronary Artery Risk Development in Young Adults study and a structural equation model to estimate longitudinal (1985-86 to 2005-06) pathways simultaneously from neighborhood fast food restaurants, sit-down restaurants, supermarkets, and convenience stores to BMI through dietary behaviors, controlling for socioeconomic status (SES) and physical activity. RESULTS Higher numbers of neighborhood fast food restaurants and lower numbers of sit-down restaurants were associated with higher consumption of an obesogenic fast food-type diet. The pathways from food stores to BMI through diet were inconsistent in magnitude and statistical significance. CONCLUSIONS Efforts to decrease the numbers of neighborhood fast food restaurants and to increase the numbers of sit-down restaurant options could influence diet behaviors. Availability of neighborhood fast food and sit-down restaurants may play comparatively stronger roles than food stores in shaping dietary behaviors and BMI.
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Affiliation(s)
| | - Katie A Meyer
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; Carolina Population Center, 137 East Franklin Street, Campus Box 8120, Chapel Hill, NC 27516, USA
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; Carolina Population Center, 137 East Franklin Street, Campus Box 8120, Chapel Hill, NC 27516, USA
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30
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Boone-Heinonen J, Howard AG, Meyer K, Lewis CE, Kiefe CI, Laroche HH, Gunderson EP, Gordon-Larsen P. Marriage and parenthood in relation to obesogenic neighborhood trajectories: The CARDIA study. Health Place 2015; 34:229-40. [PMID: 26093081 PMCID: PMC4496281 DOI: 10.1016/j.healthplace.2015.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
Abstract
Marriage and parenthood are associated with weight gain and residential mobility. Little is known about how obesity-relevant environmental contexts differ according to family structure. We estimated trajectories of neighborhood poverty, population density, and density of fast food restaurants, supermarkets, and commercial and public physical activity facilities for adults from a biracial cohort (CARDIA, n=4,174, aged 25-50) over 13 years (1992-93 through 2005-06) using latent growth curve analysis. We estimated associations of marriage, parenthood, and race with the observed neighborhood trajectories. Married participants tended to live in neighborhoods with lower poverty, population density, and availability of all types of food and physical activity amenities. Parenthood was similarly but less consistently related to neighborhood characteristics. Marriage and parenthood were more strongly related to neighborhood trajectories in whites (versus blacks), who, in prior studies, exhibit weaker associations between neighborhood characteristics and health. Greater understanding of how interactive family and neighborhood environments contribute to healthy living is needed.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie Meyer
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, MS, USA
| | - Helena H Laroche
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Meyer KA, Boone-Heinonen J, Duffey KJ, Rodriguez DA, Kiefe CI, Lewis CE, Gordon-Larsen P. Combined measure of neighborhood food and physical activity environments and weight-related outcomes: The CARDIA study. Health Place 2015; 33:9-18. [PMID: 25723792 PMCID: PMC4409510 DOI: 10.1016/j.healthplace.2015.01.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Abstract
Engagement in healthy lifestyle behaviors likely reflects access to a diverse and synergistic set of food and physical activity resources, yet most research examines discrete characteristics. We characterized neighborhoods with respect to their composition of features, and quantified associations with diet, physical activity (PA), body mass index (BMI), and insulin resistance (IR) in a longitudinal biracial cohort (n=4143; aged 25-37; 1992-2006). We used latent class analysis to derive population-density-specific (
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Affiliation(s)
- Katie A Meyer
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Janne Boone-Heinonen
- Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Kiyah J Duffey
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute, Blacksburg, VA, United States
| | - Daniel A Rodriguez
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Catarina I Kiefe
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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32
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Rummo PE, Meyer KA, Boone-Heinonen J, Jacobs DR, Kiefe CI, Lewis CE, Steffen LM, Gordon-Larsen P. Neighborhood availability of convenience stores and diet quality: findings from 20 years of follow-up in the coronary artery risk development in young adults study. Am J Public Health 2015; 105:e65-73. [PMID: 25790410 PMCID: PMC4386512 DOI: 10.2105/ajph.2014.302435] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between neighborhood convenience stores and diet outcomes for 20 years of the Coronary Artery Risk Development in Young Adults study. METHODS We used dietary data from the Coronary Artery Risk Development in Young Adults study years 1985-1986, 1992-1993, and 2005-2006 (n = 3299; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically and temporally matched neighborhood-level food resource and US Census data. We used random effects repeated measures regression to estimate associations between availability of neighborhood convenience stores with diet outcomes and whether these associations differed by individual-level income. RESULTS In multivariable-adjusted analyses, greater availability of neighborhood convenience stores was associated with lower diet quality (mean score = 66.3; SD = 13.0) for participants with lower individual-level income (b = -2.40; 95% CI = -3.30, -1.51); associations at higher individual-level income were weaker. We observed similar associations with whole grain consumption across time but no statistically significant associations with consumption of sugar-sweetened beverages, artificially sweetened beverages, snacks, processed meats, fruits, or vegetables. CONCLUSIONS The presence of neighborhood convenience stores may be associated with lower quality diets. Low-income individuals may be most sensitive to convenience store availability.
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Affiliation(s)
- Pasquale E Rummo
- Pasquale E. Rummo, Katie A. Meyer, and Penny Gordon-Larsen are with the Department of Nutrition, University of North Carolina, Chapel Hill. Janne Boone-Heinonen is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. David R. Jacobs Jr and Lyn M. Steffen are with the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis. Catarina I. Kiefe is with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston. Cora E. Lewis is with the Division of Preventive Medicine, University of Alabama, Birmingham
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Messer LC, Boone-Heinonen J, Mponwane L, Wallack L, Thornburg KL. Developmental Programming: Priming Disease Susceptibility for Subsequent Generations. CURR EPIDEMIOL REP 2015; 2:37-51. [PMID: 26366336 PMCID: PMC4563822 DOI: 10.1007/s40471-014-0033-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Racial and/or ethnic minorities carry the highest burden of many adverse health outcomes intergenerationally We propose a paradigm in which developmental programming exacerbates the effects of racial patterning of adverse environmental conditions, thereby contributing to health disparity persistence. Evidence that developmental programming induces a heightened response to adverse exposures ("second hits") encountered later in life is considered. We evaluated the evidence for the second hit phenomenon reported in animal and human studies from three domains (air, stress, nutrition). Original research including a gestational exposure and a childhood or adulthood second hit exposure was reviewed. Evidence from animal studies suggest that prenatal exposure to air pollutants is associated with an exaggerated reaction to postnatal air pollution exposure, which results in worse health outcomes. It also indicates offspring exposed to prenatal maternal stress produce an exaggerated response to subsequent stressors, including anxiety and hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. Similarly, prenatal and postnatal Western-style diets induce synergistic effects on weight gain, metabolic dysfunction, and atherosclerotic risk. Cross-domain second hits (e.g., gestational air pollution followed by childhood stressor) were also considered. Suboptimal gestational environments induce exaggerated offspring responses to subsequent environmental and social exposures. These developmental programming effects may result in enhanced sensitivity of ongoing, racially patterned, adverse exposures in race/ethnic minorities, thereby exacerbating health disparities from one generation to the next. Empirical assessment of the hypothesized role of priming processes in the propagation of health disparities is needed. Future social epidemiology research must explicitly consider synergistic relationships among social environmental conditions to which gestating females are exposed and offspring exposures when assessing causes for persistent health disparities.
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Affiliation(s)
- L. C. Messer
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - J. Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L. Mponwane
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - L. Wallack
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA
| | - K. L. Thornburg
- Moore Institute, Oregon Health & Science University, Portland, OR, USA
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Richardson AS, Meyer KA, Howard AG, Boone-Heinonen J, Popkin BM, Evenson KR, Kiefe CI, Lewis CE, Gordon-Larsen P. Neighborhood socioeconomic status and food environment: a 20-year longitudinal latent class analysis among CARDIA participants. Health Place 2014; 30:145-53. [PMID: 25280107 PMCID: PMC4252601 DOI: 10.1016/j.healthplace.2014.08.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 11/25/2022]
Abstract
Cross-sectional studies suggest that neighborhood socioeconomic (SES) disadvantage is associated with obesogenic food environments. Yet, it is unknown how exposure to neighborhood SES patterning through adulthood corresponds to food environments that also change over time. We used latent class analysis (LCA) to classify participants in the U.S.-based Coronary Artery Risk Development in Young Adults study [n=5,114 at baseline 1985-1986 to 2005-2006] according to their longitudinal neighborhood SES residency patterns (upward, downward, stable high and stable low). For most classes of residents, the availability of fast food and non-fast food restaurants and supermarkets and convenience stores increased (p<0.001). Yet, socioeconomically disadvantaged neighborhood residents had fewer fast food and non-fast food restaurants, more convenience stores, and the same number of supermarkets in their neighborhoods than the advantaged residents. In addition to targeting the pervasive fast food restaurant and convenient store retail growth, improving neighborhood restaurant options for disadvantaged residents may reduce food environment disparities.
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Affiliation(s)
- Andrea S Richardson
- Department of Nutrition, University of North Carolina at Chapel Hill, NC 27516, USA; Carolina Population Center, 137 East Franklin St. Campus Box 8120, Chapel Hill, NC 27516, USA
| | - Katie A Meyer
- Department of Nutrition, University of North Carolina at Chapel Hill, NC 27516, USA
| | - Annie Green Howard
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC 27516, USA
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, NC 27516, USA; Carolina Population Center, 137 East Franklin St. Campus Box 8120, Chapel Hill, NC 27516, USA
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC 27516, USA; UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, NC 27516, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Cora E Lewis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina at Chapel Hill, NC 27516, USA; Carolina Population Center, 137 East Franklin St. Campus Box 8120, Chapel Hill, NC 27516, USA
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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Boone-Heinonen J, Diez-Roux AV, Goff DC, Loria CM, Kiefe CI, Popkin BM, Gordon-Larsen P. The neighborhood energy balance equation: does neighborhood food retail environment + physical activity environment = obesity? The CARDIA study. PLoS One 2013; 8:e85141. [PMID: 24386458 PMCID: PMC3874030 DOI: 10.1371/journal.pone.0085141] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent obesity prevention initiatives focus on healthy neighborhood design, but most research examines neighborhood food retail and physical activity (PA) environments in isolation. We estimated joint, interactive, and cumulative impacts of neighborhood food retail and PA environment characteristics on body mass index (BMI) throughout early adulthood. METHODS AND FINDINGS We used cohort data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study [n=4,092; Year 7 (24-42 years, 1992-1993) followed over 5 exams through Year 25 (2010-2011); 12,921 person-exam observations], with linked time-varying geographic information system-derived neighborhood environment measures. Using regression with fixed effects for individuals, we modeled time-lagged BMI as a function of food and PA resource density (counts per population) and neighborhood development intensity (a composite density score). We controlled for neighborhood poverty, individual-level sociodemographics, and BMI in the prior exam; and included significant interactions between neighborhood measures and by sex. Using model coefficients, we simulated BMI reductions in response to single and combined neighborhood improvements. Simulated increase in supermarket density (from 25(th) to 75(th) percentile) predicted inter-exam reduction in BMI of 0.09 kg/m(2) [estimate (95% CI): -0.09 (-0.16, -0.02)]. Increasing commercial PA facility density predicted BMI reductions up to 0.22 kg/m(2) in men, with variation across other neighborhood features [estimate (95% CI) range: -0.14 (-0.29, 0.01) to -0.22 (-0.37, -0.08)]. Simultaneous increases in supermarket and commercial PA facility density predicted inter-exam BMI reductions up to 0.31 kg/m(2) in men [estimate (95% CI) range: -0.23 (-0.39, -0.06) to -0.31 (-0.47, -0.15)] but not women. Reduced fast food restaurant and convenience store density and increased public PA facility density and neighborhood development intensity did not predict reductions in BMI. CONCLUSIONS Findings suggest that improvements in neighborhood food retail or PA environments may accumulate to reduce BMI, but some neighborhood changes may be less beneficial to women.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Ana V. Diez-Roux
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David C. Goff
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Catherine M. Loria
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland, United States of America
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, Massachusetts, United States of America
| | - Barry M. Popkin
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Penny Gordon-Larsen
- Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Boone-Heinonen J, Gordon-Larsen P. Obesogenic environments in youth: concepts and methods from a longitudinal national sample. Am J Prev Med 2012; 42:e37-46. [PMID: 22516502 PMCID: PMC3382037 DOI: 10.1016/j.amepre.2012.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/02/2012] [Accepted: 02/15/2012] [Indexed: 11/26/2022]
Abstract
To effectively prevent and reduce childhood obesity through healthy community design, it is essential to understand which neighborhood environment features influence weight gain in various age groups. However, most neighborhood environment research is cross-sectional, focuses on adults, and is often carried out in small, nongeneralizable geographic areas. Thus, there is a great need for longitudinal neighborhood environment research in diverse populations across the life cycle. This paper describes (1) insights and challenges of longitudinal neighborhood environment research and (2) advancements and remaining gaps in measurement and study design that examine individuals and neighborhoods within the context of the broader community. Literature-based research and findings from the Obesity and Neighborhood Environment Database (ONEdata), a unique longitudinal GIS that is spatially and temporally linked to data in the National Longitudinal Study of Adolescent Health (N=20,745), provide examples of current limitations in this area of research. Findings suggest a need for longitudinal methodologic advancements to better control for dynamic sources of bias, investigate and capture appropriate temporal frameworks, and address complex residential location processes within families. Development of improved neighborhood environment measures that capture relevant geographic areas within complex communities and investigation of differences across urbanicity and sociodemographic composition are needed. Further longitudinal research is needed to identify, refine, and evaluate national and local policies to most effectively reduce childhood obesity.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, USA
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Richardson AS, Boone-Heinonen J, Popkin BM, Gordon-Larsen P. Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum. BMJ Open 2012; 2:e000698. [PMID: 22505308 PMCID: PMC3329604 DOI: 10.1136/bmjopen-2011-000698] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Many recent policies focus on socioeconomic inequities in availability of healthy food stores and restaurants. Yet understanding of how socioeconomic inequities vary across neighbourhood racial composition and across the range from rural to urban settings is limited, largely due to lack of large, geographically and socio-demographically diverse study populations. Using a national sample, the authors examined differences in neighbourhood food resource availability according to neighbourhood-level poverty and racial/ethnic population in non-urban, low-density urban and high-density urban areas. DESIGN Cross-sectional data from an observational cohort study representative of the US middle and high school-aged population in 1994 followed into young adulthood. PARTICIPANTS Using neighbourhood characteristics of participants in the National Longitudinal Study of Adolescent Health (Wave III, 2001-2002; n=13 995 young adults aged 18-28 years representing 7588 US block groups), the authors examined associations between neighbourhood poverty and race/ethnicity with neighbourhood food resource availability in urbanicity-stratified multivariable linear regression. PRIMARY AND SECONDARY OUTCOME MEASURES Neighbourhood availability of grocery/supermarkets, convenience stores and fast-food restaurants (measured as number of outlets per 100 km roadway). RESULTS Neighbourhood race and income disparities were most pronounced in low-density urban areas, where high-poverty/high-minority areas had lower availability of grocery/supermarkets (β coefficient (β)=-1.91, 95% CI -2.73 to -1.09) and convenience stores (β=-2.38, 95% CI -3.62 to -1.14) and greater availability of fast-food restaurants (β=4.87, 95% CI 2.26 to 7.48) than low-poverty/low-minority areas. However, in high-density urban areas, high-poverty/low-minority neighbourhoods had comparatively greater availability of grocery/supermarkets (β=8.05, 95% CI 2.52 to 13.57), convenience stores (β=2.89, 95% CI 0.64 to 5.14) and fast-food restaurants (β=4.03, 95% CI 1.97 to 6.09), relative to low-poverty/low-minority areas. CONCLUSIONS In addition to targeting disproportionate fast-food availability in disadvantaged dense urban areas, our findings suggest that policies should also target disparities in grocery/supermarket and fast-food restaurant availability in low-density areas.
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Affiliation(s)
- Andrea S Richardson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, Shikany JM, Lewis CE, Popkin BM. Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study. ACTA ACUST UNITED AC 2011; 171:1162-70. [PMID: 21747011 DOI: 10.1001/archinternmed.2011.283] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND A growing body of cross-sectional, small-sample research has led to policy strategies to reduce food deserts--neighborhoods with little or no access to healthy foods--by limiting fast food restaurants and small food stores and increasing access to supermarkets in low-income neighborhoods. METHODS We used 15 years of longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of US young adults (aged 18-30 years at baseline) (n = 5115), with linked time-varying geographic information system-derived food resource measures. Using repeated measures from 4 examination periods (n = 15,854 person-examination observations) and conditional regression (conditioned on the individual), we modeled fast food consumption, diet quality, and adherence to fruit and vegetable recommendations as a function of fast food chain, supermarket, or grocery store availability (counts per population) within less than 1.00 km, 1.00 to 2.99 km, 3.00 to 4.99 km, and 5.00 to 8.05 km of respondents' homes. Models were sex stratified, controlled for individual sociodemographic characteristics and neighborhood poverty, and tested for interaction by individual-level income. RESULTS Fast food consumption was related to fast food availability among low-income respondents, particularly within 1.00 to 2.99 km of home among men (coefficient, 0.34; 95% confidence interval, 0.16-0.51). Greater supermarket availability was generally unrelated to diet quality and fruit and vegetable intake, and relationships between grocery store availability and diet outcomes were mixed. CONCLUSION Our findings provide some evidence for zoning restrictions on fast food restaurants within 3 km of low-income residents but suggest that increased access to food stores may require complementary or alternative strategies to promote dietary behavior change.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA
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Richardson AS, Boone-Heinonen J, Popkin BM, Gordon-Larsen P. Neighborhood fast food restaurants and fast food consumption: a national study. BMC Public Health 2011; 11:543. [PMID: 21740571 PMCID: PMC3160374 DOI: 10.1186/1471-2458-11-543] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022] Open
Abstract
Background Recent studies suggest that neighborhood fast food restaurant availability is related to greater obesity, yet few studies have investigated whether neighborhood fast food restaurant availability promotes fast food consumption. Our aim was to estimate the effect of neighborhood fast food availability on frequency of fast food consumption in a national sample of young adults, a population at high risk for obesity. Methods We used national data from U.S. young adults enrolled in wave III (2001-02; ages 18-28) of the National Longitudinal Study of Adolescent Health (n = 13,150). Urbanicity-stratified multivariate negative binomial regression models were used to examine cross-sectional associations between neighborhood fast food availability and individual-level self-reported fast food consumption frequency, controlling for individual and neighborhood characteristics. Results In adjusted analysis, fast food availability was not associated with weekly frequency of fast food consumption in non-urban or low- or high-density urban areas. Conclusions Policies aiming to reduce neighborhood availability as a means to reduce fast food consumption among young adults may be unsuccessful. Consideration of fast food outlets near school or workplace locations, factors specific to more or less urban settings, and the role of individual lifestyle attitudes and preferences are needed in future research.
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Boone-Heinonen J, Diez Roux AV, Kiefe CI, Lewis CE, Guilkey DK, Gordon-Larsen P. Neighborhood socioeconomic status predictors of physical activity through young to middle adulthood: the CARDIA study. Soc Sci Med 2011; 72:641-9. [PMID: 21316829 DOI: 10.1016/j.socscimed.2010.12.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 11/23/2010] [Accepted: 12/14/2010] [Indexed: 11/29/2022]
Abstract
Neighborhood socioeconomic status (SES) is related to a wide range of health outcomes, but existing research is dominated by cross-sectional study designs, which are particularly vulnerable to bias by unmeasured characteristics related to both residential location decisions and health-related outcomes. Further, little is known about the mechanisms by which neighborhood SES might influence health. Therefore, we estimated longitudinal relationships between neighborhood SES and physical activity (PA), a theorized mediator of the neighborhood SES-health association. We used data from four years of the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 5115, 18-30 years at baseline, 1985-1986), a cohort of U.S. young adults followed over 15 years, and a time-varying geographic information system. Using two longitudinal modeling strategies, this is the first study to explicitly examine how the estimated association between neighborhood SES (deprivation) and PA is biased by (a) measured characteristics theorized to influence residential decisions (e.g., controlling for individual SES, marriage, and children in random effects models), and (b) time-invariant, unmeasured characteristics (e.g., controlling for unmeasured motivation to exercise that is constant over time using repeated measures regression modeling, conditioned on the individual). After controlling for sociodemographics (age, sex, race) and individual SES, associations between higher neighborhood deprivation and lower PA were strong and incremental in blacks, but less consistent in whites. Furthermore, adjustment for measured characteristics beyond sociodemographics and individual SES had little influence on the estimated associations; adjustment for unmeasured characteristics attenuated negative associations more strongly in whites than in blacks.
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Boone-Heinonen J, Gordon-Larsen P, Guilkey DK, Jacobs DR, Popkin BM. Environment and Physical Activity Dynamics: The Role of Residential Self-selection. Psychol Sport Exerc 2011; 12:54-60. [PMID: 21516236 PMCID: PMC3079234 DOI: 10.1016/j.psychsport.2009.09.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES: Within the socio-ecologic framework, diet and physical activity are influenced by individual, interpersonal, organizational, community, and public policy factors. A basic principle underlying this framework is that environments can influence an individual's behavior. However, in the vast majority of cross-sectional and even the few longitudinal studies of this relationship, the question of whether individuals select their area of residence based on physical activity-related amenities is ignored. In this paper, we address a critical methodological issue: self-selection of residential location, which is generally not accounted for, and can significantly compromise research on the relationship between environmental factors and physical activity behaviors. METHOD: We define and discuss the problem of residential self-selection in the study of neighborhood influences on health and health behavior, review methods used to control for residential self-selection in the literature, and present our strategy for addressing this potentially important source of bias. CONCLUSION: Existing research has built our understanding of residential self-selection bias, but important gaps remain. Our strategy uses data from a longitudinal cohort study linked to contemporaneous environmental measures to create a multi-equation model system to simultaneously estimate residential choice, environmental influences on physical activity, and downstream health outcomes such as obesity and clinical cardiovascular disease risk factor measures.
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Affiliation(s)
- Janne Boone-Heinonen
- University of North Carolina at Chapel Hill, 123 West Franklin St. CB#8120; Chapel Hill, NC 27516-3997
| | - Penny Gordon-Larsen
- Please Address Correspondence & Reprint Requests To: Penny Gordon-Larsen, Ph.D., , Fax: 919-966-9159
| | - David K Guilkey
- University of North Carolina at Chapel Hill, 123 West Franklin St. CB#8120; Chapel Hill, NC 27516-3997
| | - David R Jacobs
- University of Minnesota, Division of Epidemiology and Community Health, 1300 South Second Street, Suite 300; Minneapolis, MN 55454
| | - Barry M Popkin
- University of North Carolina at Chapel Hill, 123 West Franklin St. CB#8120; Chapel Hill, NC 27516-3997
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Boone-Heinonen J, Gordon-Larsen P. Life stage and sex specificity in relationships between the built and socioeconomic environments and physical activity. J Epidemiol Community Health 2010; 65:847-52. [PMID: 20930092 DOI: 10.1136/jech.2009.105064] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the largely cross-sectional literature, built environment characteristics such as walkability and recreation centres are variably related to physical activity. Subgroup-specific effects could help explain inconsistent findings, yet few studies have compared built environment associations by key characteristics such as sex or life stage. METHODS Using data from the National Longitudinal Study of Adolescent Health (wave I 1994-5, wave III 2001-2; n=12 701) and a linked geographic information system, cross-sectional relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures were estimated. Negative binomial generalised estimating equation regression modelled MVPA as a function of log-transformed environment measures, controlling for individual sociodemographics and testing for interactions with sex and life stage (waves I and III, when respondents were adolescents and young adults, respectively). RESULTS Higher landscape diversity (coefficient 0.040; 95% CI 0.019 to 0.062) and lower crime (coefficient -0.047; 95% CI -0.071 to -0.022) were related to greater weekly MVPA regardless of sex or life stage. Higher street connectivity was marginally related to lower MVPA (coefficient -0.176; 95% CI -0.357 to 0.005) in females but not males. Pay facilities and public facilities per 10 000 population and median household income were unrelated to MVPA. CONCLUSIONS Similar relationships between higher MVPA and higher landscape diversity and lower crime rate across sex and life stage suggest that application of these environment features may benefit broad populations. Sex-specific associations for street connectivity may partly account for the variation in findings across studies and have implications for targeting physical activity promotion strategies.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Boone-Heinonen J, Guilkey DK, Evenson KR, Gordon-Larsen P. Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood. Int J Behav Nutr Phys Act 2010; 7:70. [PMID: 20920341 PMCID: PMC2959083 DOI: 10.1186/1479-5868-7-70] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/04/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Built environment research is dominated by cross-sectional designs, which are particularly vulnerable to residential self-selection bias resulting from health-related attitudes, neighborhood preferences, or other unmeasured characteristics related to both neighborhood choice and health-related outcomes. METHODS We used cohort data from the National Longitudinal Study of Adolescent Health (United States; Wave I, 1994-95; Wave III, 2001-02; n = 12,701) and a time-varying geographic information system. Longitudinal relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures (landcover diversity, pay and public physical activity facilities per 10,000 population, street connectivity, median household income, and crime rate) from adolescence to young adulthood were estimated using random effects models (biased by unmeasured confounders) and fixed effects models (within-person estimator, which adjusts for unmeasured confounders that are stable over time). RESULTS Random effects models yielded null associations except for negative crime-MVPA associations [coefficient (95% CI): -0.056 (-0.083, -0.029) in males, -0.061 (-0.090, -0.033) in females]. After controlling for measured and time invariant unmeasured characteristics using within-person estimators, MVPA was higher with greater physical activity pay facilities in males [coefficient (95% CI): 0.024 (0.006, 0.042)], and lower with higher crime rates in males [coefficient (95% CI): -0.107 (-0.140, -0.075)] and females [coefficient (95% CI): -0.046 (-0.083, -0.009)]. Other associations were null or in the counter-intuitive direction. CONCLUSIONS Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self-selection can bias associations toward the null, as opposed to its typical characterization as a positive confounder. Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias. The authors discuss complexities of adjusting for residential self-selection and residential relocation, particularly during the adolescent to young adult transition.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, University of North Carolina at Chapel Hill, Carolina Population Center, 123 West Franklin St,, Campus Box 8120, Chapel Hill, 27516-3997, USA.
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Boone-Heinonen J, Casanova K, Richardson AS, Gordon-Larsen P. Where can they play? Outdoor spaces and physical activity among adolescents in U.S. urbanized areas. Prev Med 2010; 51:295-8. [PMID: 20655948 PMCID: PMC2962438 DOI: 10.1016/j.ypmed.2010.07.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 07/14/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To estimate behavior-specific effects of several objectively measured outdoor spaces on different types of moderate to vigorous physical activity (MVPA) in a large, diverse sample of U.S. adolescents. METHODS Using data from Wave I (1994-1995) of the National Longitudinal Study of Adolescent Health (U.S., n=10,359) and a linked geographic information system, we calculated percent greenspace coverage and distance to the nearest neighborhood and major parks. Using sex-stratified multivariable logistic regression, we modeled reported participation in wheel-based activities, active sports, exercise, and ≥ 5 MVPA bouts/week as a function of each outdoor space variable, controlling for individual- and neighborhood-level sociodemographics. RESULTS Availability of major or neighborhood parks was associated with higher participation in active sports and, in females, wheel-based activity and reporting ≥ 5 MVPA bouts/week [OR (95% CI): up to 1.71 (1.29, 2.27)]. Greater greenspace coverage was associated with reporting ≥ 5 MVPA bouts/week in males and females [OR (95% CI): up to 1.62 (1.10, 2.39) for 10.1 to 20% versus ≤ 10% greenspace] and exercise participation in females [OR (95% CI): up to 1.73 (1.21, 2.49)]. CONCLUSIONS Provision of outdoor spaces may promote different types of physical activities, with potentially greater benefits in female adolescents, who have particularly low physical activity levels.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA.
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Boone-Heinonen J, Popkin BM, Song Y, Gordon-Larsen P. What neighborhood area captures built environment features related to adolescent physical activity? Health Place 2010; 16:1280-6. [PMID: 20650673 DOI: 10.1016/j.healthplace.2010.06.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 06/11/2010] [Accepted: 06/24/2010] [Indexed: 11/19/2022]
Abstract
In research investigating built environment (BE) influences on physical activity (PA), inconsistent neighborhood definitions may contribute to inconsistent findings. Using data from the National Longitudinal Study of Adolescent Health (Wave I; 1994-95), we compared associations between moderate-vigorous PA (MVPA) and PA facility counts and street connectivity measures (intersection density and link:node ratio) within 1, 3, 5, and 8.05 km of each respondent's residence (Euclidean neighborhood buffers). BE-MVPA associations varied by BE characteristic, urbanicity, and sex. PA facilities within 3 km buffers and intersection density within 1 km buffers exhibited the most consistent associations with MVPA. Policy recommendations and corresponding research should address potential differences in relevant neighborhood areas across environment feature and population subgroup.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA
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Abstract
OBJECTIVE To examine sex- and race/ethnicity-specific relationships between adolescents' self-esteem and weight perception. METHOD Descriptive analysis and logistic regression of Wave II of the National Longitudinal Study of Adolescent Health (N = 6,427 males, 6,574 females; ages 11-21) examined associations between low self-esteem and perceived overweight within body mass index (BMI) percentile categories, controlling for sociodemographics and stratified by sex and race/ethnicity. RESULTS 25.1% and 8% of normal weight females and males, respectively, perceived themselves as overweight, with variation by race/ethnicity. Low self-esteem was most strongly associated with misperceived overweight in moderate BMI percentile categories (males: OR = 2.34; 95% CI: 1.60-3.41; females: OR = 2.39; 95% CI: 1.82, 3.16). Odds of correctly perceived overweight were higher for low (versus high) self-esteem in white and black females but not males of any race/ethnicity. DISCUSSION Understanding subgroup differences by race/ethnicity in perceived overweight-self-esteem relationships may inform eating disorders' prevention strategies.
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Affiliation(s)
- Eliana M. Perrin
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina,Correspondence to: Eliana M. Perrin, MD, MPH, Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, 231 MacNider Building, CB 7225, 333 South Columbia St., Chapel Hill, North Carolina 27599-7225. E-mail:
| | - Janne Boone-Heinonen
- Department of Nutrition, University of North Carolina at Chapel Hill Schools of Public Health and Medicine, Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | - Alison E. Field
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tamera Coyne-Beasley
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina at Chapel Hill Schools of Public Health and Medicine, Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
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Boone-Heinonen J, Evenson KR, Song Y, Gordon-Larsen P. Built and socioeconomic environments: patterning and associations with physical activity in U.S. adolescents. Int J Behav Nutr Phys Act 2010; 7:45. [PMID: 20487564 PMCID: PMC3152773 DOI: 10.1186/1479-5868-7-45] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 05/20/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-relationships among built and socioeconomic environmental characteristics may result in confounding of associations between environment exposure measures and health behaviors or outcomes, but traditional multivariate adjustment can be inappropriate due to collinearity. METHODS We used principal factor analysis to describe inter-relationships between a large set of Geographic Information System-derived built and socioeconomic environment measures for adolescents in the National Longitudinal Study of Adolescent Health (Wave I, 1995-96, n = 17,294). Using resulting factors in sex-stratified multivariate negative binomial regression models, we tested for confounding of associations between built and socioeconomic environment characteristics and moderate to vigorous physical activity (MVPA). Finally, we used knowledge gained from factor analysis to construct replicable environmental measures that account for inter-relationships and avoid collinearity. RESULTS Using factor analysis, we identified three built environment constructs [(1) homogenous landscape; 2) development intensity with high pay facility count; 3) development intensity with high public facility count] and two socioeconomic environment constructs [1) advantageous economic environment, 2) disadvantageous social environment]. In regression analysis, confounding of built environment-MVPA associations by socioeconomic environment factors was stronger than among built environment factors. In fully adjusted models, MVPA was negatively associated with the highest (versus lowest) quartile of homogenous land cover in males [exp(coeff) (95% CI): 0.91 (0.86, 0.96)] and intensity (pay facilities) [exp(coeff) (95% CI): 0.92 (0.85, 0.99)] in females. Single proxy measures (Simpson's diversity index, count of pay facilities, count of public facilities, median household income, and crime rate) representing each environmental construct replicated associations with MVPA. CONCLUSIONS Environmental characteristics are inter-related. Both built and SES environments should be incorporated into analysis in order to minimize confounding. Single environmental measures may be useful proxies for environmental constructs in longitudinal analysis and replication in external populations, but more research is needed to better understand mechanisms of action, and ultimately identify policy-relevant environmental determinants of physical activity.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA.
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Boone-Heinonen J, Jacobs DR, Sidney S, Sternfeld B, Lewis CE, Gordon-Larsen P. A walk (or cycle) to the park: active transit to neighborhood amenities, the CARDIA study. Am J Prev Med 2009; 37:285-92. [PMID: 19765499 PMCID: PMC2881319 DOI: 10.1016/j.amepre.2009.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/14/2009] [Accepted: 06/01/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Building on known associations between active commuting and reduced cardiovascular disease (CVD) risk, this study examines active transit to neighborhood amenities and differences between walking and cycling for transportation. METHODS Year-20 data from the Coronary Artery Risk Development in Young Adults study (3549 black and white adults aged 38-50 years in 2005-2006) were analyzed in 2008-2009. Sociodemographic correlates of transportation mode (car-only, walk-only, any cycling, other) to neighborhood amenities were examined in multivariable multinomial logistic models. Gender-stratified multivariable linear or multinomial regression models compared CVD risk factors across transit modes. RESULTS Active transit was most common to parks and public transit stops; walking was more common than cycling. Among those who used each amenity, active transit (walk-only and any cycling versus car-only transit) was more common in men and those with no live-in partner and less than full-time employment (significant ORs [95% CI] ranging from 1.56 [1.08, 2.27] to 4.54 [1.70, 12.14]), and less common in those with children. Active transit to any neighborhood amenity was associated with more favorable BMI, waist circumference, and fitness (largest coefficient [95% CI] -1.68 [-2.81, -0.55] for BMI, -3.41 [-5.71, -1.11] for waist circumference [cm], and 36.65 [17.99, 55.31] for treadmill test duration [seconds]). Only cycling was associated with lower lifetime CVD risk classification. CONCLUSIONS Active transit to neighborhood amenities was related to sociodemographics and CVD risk factors. Variation in health-related benefits by active transit mode, if validated in prospective studies, may have implications for transportation planning and research.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Gordon-Larsen P, Boone-Heinonen J, Sidney S, Sternfeld B, Jacobs DR, Lewis CE. Active commuting and cardiovascular disease risk: the CARDIA study. Arch Intern Med 2009; 169:1216-23. [PMID: 19597071 PMCID: PMC2736383 DOI: 10.1001/archinternmed.2009.163] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is little research on the association of lifestyle exercise, such as active commuting (walking or biking to work), with obesity, fitness, and cardiovascular disease (CVD) risk factors. METHODS This cross-sectional study included 2364 participants enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study who worked outside the home during year 20 of the study (2005-2006). Associations between walking or biking to work (self-reported time, distance, and mode of commuting) with body weight (measured height and weight); obesity (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, >or= 30); fitness (symptom-limited exercise stress testing); objective moderate-vigorous physical activity (accelerometry); CVD risk factors (blood pressure [oscillometric systolic and diastolic]); and serum measures (fasting measures of lipid, glucose, and insulin levels) were separately assessed by sex-stratified multivariable linear (or logistic) regression modeling. RESULTS A total of 16.7% of participants used any means of active commuting to work. Controlling for age, race, income, education, smoking, examination center, and physical activity index excluding walking, men with any active commuting (vs none) had reduced likelihood of obesity (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.33-0.76), reduced CVD risk: ratio of geometric mean triglyceride levels (trig(active))/(trig(nonactive)) = 0.88 (95% CI, 0.80 to 0.98); ratio of geometric mean fasting insulin (FI(active))/(FI(nonactive)) = 0.86 (95% CI, 0.78 to 0.93); difference in mean diastolic blood pressure (millimeters of mercury) (DBP(active)) - (DBP(nonactive)) = -1.67 (95% CI, -3.20 to -0.15); and higher fitness: mean difference in treadmill test duration (in seconds) in men (TT(active)) - (TT(nonactive)) = 50.0 (95% CI, 31.45 to 68.59) and women (TT(active)) - (TT(nonactive)) = 28.77 (95% CI, 11.61 to 45.92). CONCLUSIONS Active commuting was positively associated with fitness in men and women and inversely associated with BMI, obesity, triglyceride levels, blood pressure, and insulin level in men. Active commuting should be investigated as a modality for maintaining or improving health.
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Affiliation(s)
- Penny Gordon-Larsen
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC 27516-3997, USA.
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