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Kliethermes SA, Asif IM, Blauwet C, Christensen L, Coleman N, Lavallee ME, Moeller JL, Phillips SF, Rao A, Rizzone KH, Sund S, Tanji JL, Tuakli-Wosornu YA, Stafford CD. Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review. Br J Sports Med 2024; 58:164-171. [PMID: 38216322 PMCID: PMC10961938 DOI: 10.1136/bjsports-2023-107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN Scoping review. DATA SOURCES Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Irfan M Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Leslie Christensen
- Department of Library Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nailah Coleman
- Pediatric Primary Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Mark E Lavallee
- Department of Orthopedics, UPMC, Harrisburg, Pennsylvania, USA
| | - James L Moeller
- Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shawn F Phillips
- Department of Family and Community Medicine, Penn State Health, Mount Joy, Pennsylvania, USA
| | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine H Rizzone
- Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Sund
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitations Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2023; 19:341-352. [PMID: 36170116 PMCID: PMC10316527 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
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Affiliation(s)
| | - Margaret M. Reid
- Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Jenny J. Chang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y. Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M. Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R. Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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3
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Mei K, Huang H, Xia F, Hong A, Chen X, Zhang C, Qiu G, Chen G, Wang Z, Wang C, Yang B, Xiao Q, Jia P. State-of-the-art of measures of the obesogenic environment for children. Obes Rev 2021; 22 Suppl 1:e13093. [PMID: 32725754 PMCID: PMC7988549 DOI: 10.1111/obr.13093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
Abstract
Various measures of the obesogenic environment have been proposed and used in childhood obesity research. The variety of measures poses methodological challenges to designing new research because methodological characteristics integral to developing the measures vary across studies. A systematic review has been conducted to examine the associations between different levels of obesogenic environmental measures (objective or perceived) and childhood obesity. The review includes all articles published in the Cochrane Library, PubMed, Web of Science and Scopus by 31 December 2018. A total of 339 associations in 101 studies have been identified from 18 countries, of which 78 are cross-sectional. Overall, null associations are predominant. Among studies with non-null associations, negative relationships between healthy food outlets in residential neighbourhoods and childhood obesity is found in seven studies; positive associations between unhealthy food outlets and childhood obesity are found in eight studies, whereas negative associations are found in three studies. Measures of recreational or physical activity facilities around the participants' home are also negatively correlated to childhood obesity in nine out of 15 studies. Results differ by the types of measurement, environmental indicators and geographic units used to characterize obesogenic environments in residential and school neighbourhoods. To improve the study quality and compare reported findings, a reporting standard for spatial epidemiological research should be adopted.
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Affiliation(s)
- Kun Mei
- Health Assessment Center, Wenzhou Medical University, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Watershed Science and Health, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Hong Huang
- Health Assessment Center, Wenzhou Medical University, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Watershed Science and Health, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Fang Xia
- School of Life Science, Shaoxing University, Shaoxing, China
| | - Andy Hong
- The George Institute for Global Health, University of Oxford, Oxford, UK.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xiang Chen
- Department of Geography, University of Connecticut, Storrs, Connecticut, USA
| | - Chi Zhang
- Zhejiang Provincial Key Laboratory of Watershed Science and Health, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Ge Qiu
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Gang Chen
- Zhejiang Provincial Key Laboratory of Watershed Science and Health, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Zhenfeng Wang
- Health Assessment Center, Wenzhou Medical University, Wenzhou, China.,Zhejiang Provincial Key Laboratory of Watershed Science and Health, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bo Yang
- Institute of Lipids Medicine, Wenzhou Medical University, Wenzhou, China.,School of Public Health, Wenzhou Medical University, Wenzhou, China
| | - Qian Xiao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Peng Jia
- Health Assessment Center, Wenzhou Medical University, Wenzhou, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.,Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, The Netherlands
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4
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do Amaral e Melo GR, Silva PO, Nakabayashi J, Bandeira MV, Toral N, Monteiro R. Family meal frequency and its association with food consumption and nutritional status in adolescents: A systematic review. PLoS One 2020; 15:e0239274. [PMID: 32946506 PMCID: PMC7500660 DOI: 10.1371/journal.pone.0239274] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 09/03/2020] [Indexed: 01/01/2023] Open
Abstract
This systematic review evaluated the association between frequency of family meals (FFM) and nutritional status (NS) and/or food consumption (FC) in adolescents. The protocol was registered with PROSPERO (CRD42017062180) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No publication date, language, or meal type restrictions were imposed. Only full-text original articles were included; qualitative studies were excluded. Studies were identified by searching 5 electronic databases (PubMed, Web of Science, Scopus, BVS Brazil, and Adolec) and gray literature (Google Scholar) and by scanning reference lists of included articles. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and cross-sectional studies. Initial search yielded 2001 results and 47 articles were included. An updated literature search added 3 articles. Of the 50 studies included, 25 studied the association between FFM and NS, 32 investigated the association between FFM and FC, being that seven studies analyzed both outcomes. Thirty-four were cross-sectional studies, 12 were longitudinal studies, and 4 studies analyzed both cross-sectional and longitudinal data. Thirty-five studies were rated as having good quality, whereas 19 were of fair quality. Sample size ranged from 140 to 102 072 participants. Most investigations evaluated the frequency of breakfast, lunch, and/or dinner/supper/evening meals over a 1-week period. Seventeen studies identified a positive relationship between high FFM and better NS, and 26 found a positive association between high FFM and better FC. In conclusion, this review showed an association between FFM and healthy dietary patterns, such as increased consumption of fruits and vegetables. Further research is needed to understand the association between FFM and NS, since some studies showed a protective role of family meals against obesity in this age group, whereas other studies identified no significant association between these variables.
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Affiliation(s)
| | - Priscila Olin Silva
- Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil
| | - Jennifer Nakabayashi
- Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil
| | | | - Natacha Toral
- Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil
| | - Renata Monteiro
- Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil
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5
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Elm JHL, Walls ML, Aronson BD. Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2020; 26:33-62. [PMID: 30690701 DOI: 10.5820/aian.2601.2019.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.
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Dai H, Ramirez G, Zheng S. Dietary Minerals Measurement in Normal Versus Obese Native American Adolescents. J Racial Ethn Health Disparities 2020; 7:769-775. [PMID: 32020546 DOI: 10.1007/s40615-020-00713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
Obesity remains one of the five leading global risks for mortality in both developed and developing countries. Changes in dietary approaches have recently emerged as an approach to combat and prevent the high prevalence of obesity, specifically for minority groups having higher obesity rates. However, little research has been conducted on specific obesity rates in the Native American adolescent population and its' correlation to micronutrient intake. Our study chose a specific minority population of adolescents in order to contribute more academic research on obesity rates and micronutrient intake on Native American adolescents. Data was compiled using the Harvard School of Public Health Youth/Adolescent Questionnaire, which allowed significant results to be found among normal weight, overweight, and obese, male and female adolescents. This study used anthropometric measurements and dietary assessments to obtain baseline measurements and further determine the cause of the prevalence of obesity within Native American adolescent population. The majority of minerals featured significant results among various populations, more specifically among normal weight and obese males. Our finding indicates a relationship between a higher mineral intake and lower body weight in the male adolescent population. The data revealed an innovative correlation between micronutrient intake and obesity prevalence in Native American adolescents, which may provide a potential intervention to further prevent or combat obesity rates.
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Affiliation(s)
- Hanchu Dai
- College of Health Science, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - Gwendolyn Ramirez
- College of Health Science, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - Shasha Zheng
- College of Health Science, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA.
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7
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Understanding Correlates of Physical Activity in American Indian Families: The Healthy Children Strong Families-2 Study. J Phys Act Health 2018; 15:866-873. [PMID: 30336717 DOI: 10.1123/jpah.2017-0584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about factors contributing to physical activity (PA) in American Indian (AI) populations. Addressing this gap is paramount as sedentary activity and obesity continue to increase in this population. The purpose of this study was to determine factors associated with PA among AI families with young children. METHODS Height and weight of both adult (n = 423) and child (n = 390) were measured, and surveys assessed demographics, PA, stress (adult only), sleep, and screen time. Separate multivariate logistic regression models were constructed for adults and children (reported as adjusted odds ratios, aORs). RESULTS For adults, age (aOR = 0.952; P ≤ .001), television viewing (aOR = 0.997; P = .01), and computer use (aOR = 0.996; P = .003) decreased the odds of being active. For children, high adult activity (aOR = 1.795; P ≤ .01), longer weekday sleep (aOR = 1.004; P = .01), and family income >$35,000 (aOR = 2.772; P = .01) increased the odds of being active. We found no association between adult PA with stress or adult sleep or between child PA with body mass index and screen time. CONCLUSIONS Given the complexity of the factors contributing to obesity among AI families, multigenerational interventions focused on healthy lifestyle change such as decreasing adult screen time and increasing child sleep time may be needed to increase PA within AI families.
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8
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Dallacker M, Hertwig R, Mata J. The frequency of family meals and nutritional health in children: a meta-analysis. Obes Rev 2018; 19:638-653. [PMID: 29334693 DOI: 10.1111/obr.12659] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
Findings on the relationship between family meal frequency and children's nutritional health are inconsistent. The reasons for these mixed results have to date remained largely unexplored. This systematic review and meta-analysis of 57 studies (203,706 participants) examines (i) the relationship between family meal frequency and various nutritional health outcomes and (ii) two potential explanations for the inconsistent findings: sociodemographic characteristics and mealtime characteristics. Separate meta-analyses revealed significant associations between higher family meal frequency and better overall diet quality (r = 0.13), more healthy diet (r = 0.10), less unhealthy diet (r = -0.04) and lower body mass index, BMI (r = -0.05). Child's age, country, number of family members present at meals and meal type (i.e. breakfast, lunch or dinner) did not moderate the relationship of meal frequency with healthy diet, unhealthy diet or BMI. Socioeconomic status only moderated the relationship with BMI. The findings show a significant relationship between frequent family meals and better nutritional health - in younger and older children, across countries and socioeconomic groups, and for meals taken with the whole family vs. one parent. Building on these findings, research can now target the causal direction of the relationship between family meal frequency and nutritional health.
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Affiliation(s)
- M Dallacker
- Max Planck Institute for Human Development, Berlin, Germany
| | - R Hertwig
- Max Planck Institute for Human Development, Berlin, Germany
| | - J Mata
- Max Planck Institute for Human Development, Berlin, Germany.,University of Mannheim, Mannheim, Germany
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9
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Deen JF, Adams AK, Fretts A, Jolly S, Navas-Acien A, Devereux RB, Buchwald D, Howard BV. Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need. J Am Heart Assoc 2017; 6:e007576. [PMID: 29066451 PMCID: PMC5721901 DOI: 10.1161/jaha.117.007576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jason F Deen
- Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Alexandra K Adams
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT
| | - Amanda Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Stacey Jolly
- Department of General Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Dedra Buchwald
- College of Medicine, Washington State University, Spokane, WA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
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Zamora-Kapoor A, Omidpanah A, Nelson LA, Kuo AA, Harris R, Buchwald DS. Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites. J Acad Nutr Diet 2017; 117:1049-1056. [PMID: 28082060 PMCID: PMC5586593 DOI: 10.1016/j.jand.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/17/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/m2) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included American Indians and Alaska Natives. OBJECTIVE This study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults. DESIGN Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008). PARTICIPANTS Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents. STATISTICAL ANALYSES PERFORMED Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables. RESULTS The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI -3.46 to -1.92; P<0.01) and 1.54 (95% CI -2.75 to -0.33; P<0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI -0.93 to -0.50; P<0.01), 0.68 (95% CI -0.87 to -0.50; P<0.01), and 0.85 (95% CI -1.09 to -0.62; P<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P<0.01). CONCLUSIONS Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.
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Affiliation(s)
- Anna Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Adam Omidpanah
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
| | - Lonnie A. Nelson
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
| | - Alice A. Kuo
- Department of Pediatrics, University of California-Los Angeles, Los Angeles, CA
| | - Raymond Harris
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
| | - Dedra S. Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
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11
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Zhang T, Cai L, Ma L, Jing J, Chen Y, Ma J. The prevalence of obesity and influence of early life and behavioral factors on obesity in Chinese children in Guangzhou. BMC Public Health 2016; 16:954. [PMID: 27613102 PMCID: PMC5016860 DOI: 10.1186/s12889-016-3599-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/25/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Childhood obesity has become a public health concern in many countries. In Southern China, the prevalence of childhood obesity increased from 6.2 to 7.5 % between 2007 and 2011. This study aimed to report the current prevalence of overweight and obesity, analyzed the early life and behavioral determinants of obesity, and investigated the weight-loss practices among Chinese children in Guangzhou. METHODS Three thousand seven hundred sixty-six primary school students aged 7-12 years were recruited in Guangzhou, China in 2013. Questionnaires were used to assess (1) early life factors: birth weight, delivery mode, gestational age and feeding patterns; (2) behavioral factors: dietary intake, eating speed, sedentary time, physical activities and sleep duration; and (3) weight-loss practices: improving diet, increasing exercise, taking weight-loss drugs and undergoing a diet. The criteria of Working Group of Obesity in China were applied to classify overweight and obesity based on measured weight and height. Multivariable logistic regression analyses were performed to examine the determinants of overweight/obesity and adoption of weight-loss practices. RESULTS The prevalence of childhood overweight and obesity were 11.2 and 10.0 %, respectively. High birth weight (≥4.0 kg versus 2.5 ~ 4.0 kg, odd ratio [OR]: 2.34; 95 % confidence interval [CI]: 1.53-3.58), sugar-sweetened beverages (SSBs) intake (OR: 1.39; 95 % CI: 1.05-1.85), vegetable intake (OR: 1.12; 95 % CI: 1.01-1.24), and doing homework (OR: 1.24; 95 % CI: 1.08-1.43) were positively associated with obesity. Eating speed faster than peers was positively associated with obesity and yielded the highest OR (versus "as fast as peers", OR: 3.18; 95 % CI: 2.28-4.44). Approximately 57, 81 and 87 % of normal-weight, overweight and obese children, respectively, reported weight-loss practices. Self-perception of weight status presented as the strongest determinant for weight-loss practices. CONCLUSIONS The prevalence of overweight and obesity were high in Chinese children in Guangzhou, and both were higher than previous level in 2011. Further research should address the unhealthy dietary (e.g. SSBs intake, fast eating speed) and sedentary behaviors (e.g. doing homework) of these children. Moreover, an accurate perception of body weight can help promote the adoption of weight-loss practices in overweight and obese children.
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Affiliation(s)
- Ting Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Lu Ma
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, 100191, China
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Nelson LA, Zamora-Kapoor A. Challenges in conducting mHealth research with underserved populations: Lessons learned. J Telemed Telecare 2016; 22:436-40. [DOI: 10.1177/1357633x15609853] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/12/2015] [Indexed: 11/17/2022]
Abstract
Previous studies have recognized the potential of mobile technology to improve health outcomes among underserved populations, but the challenges in conducting research into the use of mobile technology to improve health (mHealth) are not well understood. This manuscript identifies some of the most important challenges in conducting mHealth research with a sample of urban American Indian and Alaska Native mothers. We examined these challenges through an existing partnership with a community health agency. We conducted community consultations and a process monitoring phase for a pilot trial aimed at measuring the effect of a brief counselling session on participants’ adherence to use of a mobile app. We identify generalizable challenges in administrative, technological, and logistical domains that will be useful foreknowledge to other investigators planning to conduct mHealth research with underserved populations.
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Affiliation(s)
- Lonnie A Nelson
- Initiative for Research and Education to Advance Community Health (I-REACH), Washington State University, Seattle, WA
| | - Anna Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health (I-REACH), Washington State University, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Fuentes MM, Jimenezb N, Apkona SD, Rivarab FP. Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury. J Pediatr Rehabil Med 2016; 9:133-41. [PMID: 27285806 PMCID: PMC5099074 DOI: 10.3233/prm-160376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) people have the highest traumatic brain injury (TBI)-related mortality in the United States, but little is known about AI/AN children who survive traumatic brain injury (TBI). This study compares function and factors associated with discharge function between AI/AN and White children with TBI during inpatient rehabilitation. METHODS Retrospective national cohort study of 114 AI/AN and 7,267 White children aged 6 months-18 years who received inpatient TBI rehabilitation between 2002-2012 at facilities utilizing the Uniform Data System for Medical Rehabilitation\scriptsize®. The outcome measure was developmental functional quotients (DFQ is the FIM\scriptsize® or WeeFIM\scriptsize® score divided by age norms x 100) at discharge. RESULTS AI/AN race was not associated with motor (regression coefficient (β) 0.18, 95% confidence interval (CI) -2.39, 2.76) or cognitive (β -1.54, 95% CI -3.75, 0.67) function. Among a subgroup with loss of consciousness > 24 hours (AI/AN n= 13, White n= 643), AI/AN race was associated with lower motor DFQ (β -12.83, 95% CI -25.39, -0.34). CONCLUSIONS Overall, AI/AN race was not associated with inpatient rehabilitation function for children with TBI, but providers should not assume AI/ANs with more severe injuries have equitable outcomes.
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Affiliation(s)
- Molly M. Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Nathalia Jimenezb
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Susan D. Apkona
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Frederick P. Rivarab
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Assessment of Body Mass Index, Sugar Sweetened Beverage Intake and Time Spent in Physical Activity of American Indian Children in Oklahoma. J Community Health 2016; 40:808-14. [PMID: 25750107 DOI: 10.1007/s10900-015-0004-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
American Indian (AI) children have a combined overweight and obesity prevalence of 53%. Behaviors that contribute to obesity, such as sugar sweetened beverage (SSB) intake and time spent in physical activity (PA), have been poorly explored in this population. The purpose of this study is to report body mass index (BMI), SSB intake, and time spent in PA of 7-to-13-year-old AI children who reside in rural and urban areas in Oklahoma. Cross-sectional survey study. Self-reported SSB intake in the last month, and time spent in PA were collected via questionnaires. Height and weight were professionally measured. The sample included 124 7-to-13-year-old AI children who attended a diabetes prevention summer camp in 2013. BMI percentile, overweight and obesity prevalence, SSB intake, time spent in PA, and number of participants meeting the Physical Activity Guidelines for Americans. Descriptive characteristics for BMI percentile, overweight and obesity, SSB intake, time spent in PA, and meeting PA recommendations were calculated using means, standard deviations, and frequencies. Independent t test and Chi square analyses were used to test for gender differences. Participants were 10.2 ± 1.5 years old and 57% female. Sixty-three percent were overweight or obese. Children consumed 309 ± 309 kcal/day of SSB and spent 4.4 ± 3.8 h per week in moderate-to-vigorous PA. Approximately 32% met the 2008 Physical Activity Guidelines for Americans. No gender differences were observed. The prevalence of overweight and obesity was higher than previously reported in a similar population, and higher than that of US children in the general population. SSB intake and physical activity levels were also found to be higher in this group than in the general population.
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Zamora-Kapoor A, Nelson L, Buchwald D. Maternal correlates of body mass index in American Indian/Alaska Native and White adolescents: Differences between mother/son and mother/daughter pairs. Eat Behav 2016; 20:43-7. [PMID: 26643590 PMCID: PMC4691400 DOI: 10.1016/j.eatbeh.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/03/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Obesity rates for American Indian and Alaska Native (AI/AN) adolescents are among the highest in the US. However, little is known about the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race. METHODS We conducted a cross-sectional analysis with a sample of 531 AI/AN and 8896 White mother/adolescent pairs from Wave 1 of the National Longitudinal Study of Adolescent to Adult Health. We used generalized estimating equations to measure the association of maternal educational attainment, marital status, employment status, obesity status, and adolescent BMI of AI/AN and White adolescents, while controlling for adolescents' demographic and behavioral covariates. We sought to determine whether the size and statistical significance of maternal correlates differed by race, and between mother/son and mother/daughter pairs. RESULTS The strength and statistical significance of maternal correlates varied between mother/son and mother/daughter pairs in both races. However, we did not find effect modification by race. Maternal obesity showed the strongest effect on adolescent BMI in all mother/adolescent pairs. CONCLUSION Our findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites. We encourage future work aimed at preventing adolescent obesity to investigate causal pathways between maternal correlates and adolescent BMI.
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Affiliation(s)
- Anna Zamora-Kapoor
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States; Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, United States.
| | - Lonnie Nelson
- Initiative for Research and Education to Advance Community Health (IREACH) Washington State University
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH) Washington State University
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Sabin JA, Moore K, Noonan C, Lallemand O, Buchwald D. Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children. Child Obes 2015; 11:456-65. [PMID: 26186413 PMCID: PMC4692112 DOI: 10.1089/chi.2014.0125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children. METHODS We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches. RESULTS Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30-60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60-100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management. CONCLUSIONS Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.
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Affiliation(s)
- Janice A. Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado, Aurora, CO
| | - Carolyn Noonan
- Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA
| | - Odile Lallemand
- Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA
| | - Dedra Buchwald
- Department of Epidemiology and Medicine, University of Washington, Seattle, WA
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Eisenberg ME, Larson NI, Berge JM, Thul C, Neumark-Sztainer D. The home physical activity environment and adolescent BMI, physical activity and TV viewing: Disparities across a diverse sample. J Racial Ethn Health Disparities 2014; 1:326-336. [PMID: 25396114 DOI: 10.1007/s40615-014-0040-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Characteristics of the home and family have been associated with adolescents' BMI and physical and sedentary activity, but few studies have examined how these characteristics vary across ethnic/racial groups. This study explores whether recommendations for activity promotion are equally relevant to different adolescent populations. DESIGN Participants included 2,374 adolescents and their parent(s), recruited through 20 public schools in Minneapolis/St. Paul, MN in 2009-2010. Ethnic/racial groups included African American, Asian (primarily Hmong), East African, Hispanic, Native American, White, and mixed/other race. Linear regression analysis modeled adolescents' BMI z-scores and physical and sedentary activity based on six measures of the family/home activity environment, adjusted for covariates. Interactions of ethnicity/race and family/home environment were tested. RESULTS All six family/home environment measures varied significantly across ethnicity/race. Family/home variables were significantly associated with adolescent physical activity and TV viewing in the expected directions, and these relationships were consistent across ethnic/racial groups in two-thirds of the models. However, in one-third of the cases, these associations were modified by ethnicity/race. For example, home access to a greater number of media devices was significantly associated with more TV viewing (β=.40, p=.015) only among White youth. CONCLUSION Health promotion recommendations for adolescent physical activity are largely relevant across ethnic/racial groups. However, given differences found in the family/home environments of adolescents, cultural sensitivity is recommended in discussing these issues, and tailored recommendations may be appropriate for select groups or behaviors. Further mixed methods research is warranted to help identify key messages for specific groups.
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Affiliation(s)
- Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN 55414. 612-624-9462
| | - Nicole I Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. 1300 South 2 St., Minneapolis, MN 55454. 612-625-5881
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota. 717 Delaware St. SE Room 424, Minneapolis, MN 55112
| | - Chelsey Thul
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN 55414
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454
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Wahi G, Anand SS. Race/Ethnicity, Obesity, and Related Cardio-Metabolic Risk Factors: A Life-Course Perspective. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:326-335. [PMID: 24672590 PMCID: PMC3962848 DOI: 10.1007/s12170-013-0329-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The adoption of health behaviors characterized by minimal energy expenditure and overconsumption of energy has led to cardiometabolic risk factors in pregnancy, childhood, and youth, all of which increase the prevalence of cardiovascular disease in adulthood. The propensity to develop abdominal obesity and cardiometabolic risk factors appears to disproportionally affect non-white ethnic groups. While the majority of observational research has been conducted in populations of European origin, studies in non-white ethnic groups across the life-course are underway and there is evidence that unique ethnic-specific differences exist. This review will focus on the life-course determinants of obesity and its related cardio-metabolic risk factors among diverse ethnic groups including people of Afro-Caribbean origin, South Asian, East Asian, and indigenous ancestry.
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Affiliation(s)
- Gita Wahi
- />Department of Pediatrics, McMaster University, Hamilton, ON Canada
- />Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
| | - Sonia S. Anand
- />Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, MDCL 3204, Hamilton, ON L8S4K1 Canada
- />Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada
- />Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
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Kroelinger CD, Barfield WD, Callaghan WM. Expanding and enhancing federal, state, tribal, and academic partnerships to advance the field of maternal and child health. Matern Child Health J 2012. [PMID: 23196411 DOI: 10.1007/s10995-012-1193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Charlan D Kroelinger
- Division of Reproduction Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA.
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