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Hirsch JA, Michael YL, Moore KA, Melly S, Hughes TM, Hayden K, Luchsinger JA, Jimenez MP, James P, Besser LM, Sánchez B, Diez Roux AV. Longitudinal neighbourhood determinants with cognitive health and dementia disparities: protocol of the Multi-Ethnic Study of Atherosclerosis Neighborhoods and Aging prospective cohort study. BMJ Open 2022; 12:e066971. [PMID: 36368762 PMCID: PMC9660618 DOI: 10.1136/bmjopen-2022-066971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The burden of Alzheimer's disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of-and disparities in-cognitive decline and dementia. METHODS AND ANALYSES We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing. ETHICS AND DISSEMINATION This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.
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Affiliation(s)
- Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Steven Melly
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, Carolina, USA
| | - Kathleen Hayden
- Department of Social Sciences and Health Policy, Bowman Gray Center for Medical Education, Winston-Salem, Carolina, USA
| | - Jose A Luchsinger
- Department of Medicine, Columbia University, New York, New York, USA
| | - Marcia P Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Peter James
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Lilah M Besser
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brisa Sánchez
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
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Babashahi M, Omidvar N, Joulaei H, Zargaraan A, Veisi E, Kelishadi R. Food Products with the Child-Targeted Packaging in Food Stores around Primary Schools in Tehran, Iran. JOURNAL OF PREVENTION (2022) 2022; 43:513-527. [PMID: 35476310 DOI: 10.1007/s10935-022-00679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The local retail food environment around schools can have an important role in encouraging children to low-quality food choices; and may act as a potential risk factor in their diet. Thus, evaluating the food environment is essential for adopting policies and programs that support healthy nutrition in children. This study aimed to investigate the frequency and nutritional characteristics of packaged processed/ultra-processed food and beverage products with child-oriented marketing attributes in food stores around primary schools in Tehran, Iran. This cross-sectional study was conducted on 239 food stores located within a 500-meter buffer around 64 primary schools in Tehran province. The presence of marketing strategies directed at children and nutrition information from traffic light labels of packaged foods available in these stores were extracted. Data were analyzed overall and separately for the subset of foods placed on front shelves at the entrance of stores. Among 445 discrete food products marketed to children via their packaging, 198 (44.49%) were placed on shelves in front of the stores entrance. Potato chips and bulky cereals group had the highest energy density (507.15 ± 44.05 Kcal/100gr). Due to the color code of traffic light labels, 100% of fruit juices had high levels of sugar. Of potato chips and bulky cereals, 89.38% were assigned a red color traffic light for total fat levels. Moreover, 62.50% of processed fruit and vegetables contained high levels of salt. The level of trans-fatty acids were not high in any of the food products. The high amount of sugar, salt, and fat in a remarkable proportion of food products marketed to children can be considered a risk factor for children's health. Initiation and implementation of appropriate policies to control the food environment around schools in Iran is recommended.
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Affiliation(s)
- Mina Babashahi
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azizollaah Zargaraan
- Department of Food and Nutrition Policy and Planning Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Veisi
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Garg PK, Platt JM, Hirsch JA, Hurvitz P, Rundle A, Biggs ML, Psaty BM, Moore K, Lovasi GS. Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study. Health Place 2021; 70:102596. [PMID: 34091144 DOI: 10.1016/j.healthplace.2021.102596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87-0.99) and 12% (95% CI = 0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Jonathan M Platt
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Philip Hurvitz
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA; Urban Form Lab, Department of Urban Design and Planning, University of Washington, Seattle, WA, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Lou Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA
| | - Kari Moore
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gina S Lovasi
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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da Costa Peres CM, Gardone DS, Costa BVDL, Duarte CK, Pessoa MC, Mendes LL. Retail food environment around schools and overweight: a systematic review. Nutr Rev 2021; 78:841-856. [PMID: 31968100 DOI: 10.1093/nutrit/nuz110] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students. OBJECTIVE To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents. DATA SOURCES Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019. DATA EXTRACTION Two independent reviewers extracted relevant data. DATA ANALYSIS Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates. CONCLUSION Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors.
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Affiliation(s)
- Carla Marien da Costa Peres
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danielle Soares Gardone
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Vieira de Lima Costa
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Loures Mendes
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Xin J, Zhao L, Wu T, Zhang L, Li Y, Xue H, Xiao Q, Wang R, Xu P, Visscher T, Ma X, Jia P. Association between access to convenience stores and childhood obesity: A systematic review. Obes Rev 2021; 22 Suppl 1:e12908. [PMID: 31274248 PMCID: PMC7988541 DOI: 10.1111/obr.12908] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 02/05/2023]
Abstract
Childhood obesity increases the risk of adulthood obesity and is associated with other adverse health outcomes later in life. It may be influenced by environmental characteristics of neighborhoods where children live, particularly dietary supply-related environmental factors. This study aimed to systematically review the evidence on the association between access to convenience stores and childhood obesity. We searched and filtered relevant literature in PubMed, Embase, Web of Science, and Cochrane Library published before 1 January 2019. Data on the basic characteristics of studies, measures of access to convenience stores, and associations of convenience stores with weight-related behaviors and outcomes were extracted from 41 included studies. In general, the density of and proximity to convenience stores in children's residential and school neighborhoods were positively associated with unhealthy eating behaviors. However, their associations with children's weight status varied significantly by regions. The association between convenience store access and children's weight status was found to be negative in Canada, rather mixed in the United States and the United Kingdom, and not significant in East Asia. We suggest future research to clearly define the convenience store, better measure the access to convenience store, and also measure children's journey and food purchasing and consumption behaviors, to explain pathways from convenience store access to childhood obesity for designing effective interventions and policies.
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Affiliation(s)
- Junguo Xin
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,School of Public Health, Chengdu Medical College, Chengdu, China.,International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands
| | - Li Zhao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands.,Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Tong Wu
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands.,Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Longhao Zhang
- Office of "Double First Class" Construction, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, 10029.,Center for Health Innovation, The New York Academy of Medicine, New York, New York, 10029
| | - Hong Xue
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands.,Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, 23298
| | - Qian Xiao
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands.,Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, 52242.,Department of Epidemiology, University of Iowa, Iowa City, Iowa, 52242
| | - Ruiou Wang
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peiyao Xu
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tommy Visscher
- Research Center for Healthy Cities, Windesheim University of Applied Sciences, Zwolle, the Netherlands.,European Association for the Study of Obesity, Patient Council and Prevention and Public Health Taskforce, Founding Chair New Investigators United, London, UK.,JOGG (Youth at a Healthy Weight), Chair Scientific Advisory Board, The Hague, the Netherlands
| | - Xiao Ma
- Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Enschede, the Netherlands.,Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, the Netherlands
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Warren JL, Luben TJ, Chang HH. A spatially varying distributed lag model with application to an air pollution and term low birth weight study. J R Stat Soc Ser C Appl Stat 2020; 69:681-696. [PMID: 32595237 DOI: 10.1111/rssc.12407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Distributed lag models have been used to identify critical pregnancy periods of exposure (i.e. critical exposure windows) to air pollution in studies of pregnancy outcomes. However, much of the previous work in this area has ignored the possibility of spatial variability in the lagged health effect parameters that may result from exposure characteristics and/or residual confounding. We develop a spatially varying Gaussian process model for critical windows called 'SpGPCW' and use it to investigate geographic variability in the association between term low birth weight and average weekly concentrations of ozone and PM2:5 during pregnancy by using birth records from North Carolina. SpGPCW is designed to accommodate areal level spatial correlation between lagged health effect parameters and temporal smoothness in risk estimation across pregnancy. Through simulation and a real data application, we show that the consequences of ignoring spatial variability in the lagged health effect parameters include less reliable inference for the parameters and diminished ability to identify true critical window sets, and we investigate the use of existing Bayesian model comparison techniques as tools for determining the presence of spatial variability. We find that exposure to PM2:5 is associated with elevated term low birth weight risk in selected weeks and counties and that ignoring spatial variability results in null associations during these periods. An R package (SpGPCW) has been developed to implement the new method.
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Affiliation(s)
| | - Thomas J Luben
- US Environmental Protection Agency, Research Triangle Park, USA
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Demirhan H. dLagM: An R package for distributed lag models and ARDL bounds testing. PLoS One 2020; 15:e0228812. [PMID: 32084162 PMCID: PMC7034805 DOI: 10.1371/journal.pone.0228812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
In this article, we introduce the R package dLagM for the implementation of distributed lag models and autoregressive distributed lag (ARDL) bounds testing to explore the short and long-run relationships between dependent and independent time series. Distributed lag models constitute a large class of time series regression models including the ARDL models used for cointegration analysis. The dLagM package provides a user-friendly and flexible environment for the implementation of the finite linear, polynomial, Koyck, and ARDL models and ARDL bounds cointegration test. Particularly, in this article, a new search algorithm to specify the orders of ARDL bounds testing is proposed and implemented by the dLagM package. Main features and input/output structures of the dLagM package and use of the proposed algorithm are illustrated over the datasets included in the package. Features of dLagM package are benchmarked with some mainstream software used to implement distributed lag models and ARDLs.
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Affiliation(s)
- Haydar Demirhan
- Mathematical Sciences Discipline, School of Science, RMIT University, Melbourne, Victoria, Australia
- * E-mail:
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Socioeconomic Inequalities in the Retail Food Environment around Schools in a Southern European Context. Nutrients 2019; 11:nu11071511. [PMID: 31277242 PMCID: PMC6683257 DOI: 10.3390/nu11071511] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Across Europe, excess body weight rates are particularly high among children and adolescents living in Southern European contexts. In Spain, current food policies appeal to voluntary self-regulation of the food industry and parents’ responsibility. However, there is no research (within Spain) assessing the food environment surrounding schools. We examined the association between neighborhood-level socioeconomic status (NSES) and the spatial access to an unhealthy food environment around schools using both counts and distance measures, across the city of Madrid. We conducted a cross-sectional study citywide (n = 2443 census tracts). In 2017, we identified all schools (n = 1321) and all food retailers offering unhealthy food and beverages surrounding them (n = 6530) using publicly available data. We examined both the counts of retailers (within 400 m) and the distance (in meters) from the schools to the closest retailer. We used multilevel regressions to model the association of neighborhood-level socioeconomic status (NSES) with both measures, adjusting both models for population density. Almost all schools (95%) were surrounded by unhealthy retailers within 400 m (median = 17 retailers; interquartile range = 8–34). After adjusting for population density, NSES remained inversely associated with unhealthy food availability. Schools located in low-NSES areas (two lowest quintiles) showed, on average, 29% (IRR (Incidence Rate Ratio) = 1.29; 95% CI (Confidence Interval) = 1.12, 1.50) and 62% (IRR = 1.62; 95% CI = 1.35, 1.95) more counts of unhealthy retailers compared with schools in middle-NSES areas (ref.). Schools in high-NSES areas were farther from unhealthy food sources than those schools located in middle-NSES areas (β = 0.35; 95% CI = 0.14, 0.47). Regulating the school food environment (within and beyond school boundaries) may be a promising direction to prevent and reduce childhood obesity.
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Horton MK, Hsu L, Claus Henn B, Margolis A, Austin C, Svensson K, Schnaas L, Gennings C, Hu H, Wright R, Rojo MMT, Arora M. Dentine biomarkers of prenatal and early childhood exposure to manganese, zinc and lead and childhood behavior. ENVIRONMENT INTERNATIONAL 2018; 121:148-158. [PMID: 30205321 PMCID: PMC6373872 DOI: 10.1016/j.envint.2018.08.045] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Metal exposure alters neurodevelopmental outcomes; little is known about critical windows of susceptibility when exposure exerts the strongest effect. OBJECTIVE To examine associations between dentine biomarkers of manganese (Mn), zinc (Zn) and lead (Pb) and later childhood behaviors. METHODS Subjects enrolled in a longitudinal birth cohort study in Mexico City provided naturally shed deciduous teeth. We estimated weekly prenatal and postnatal dentine Mn, Zn and Pb concentrations in teeth using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) and measured behavior at ages 8-11 years of age using the Behavior Assessment System for Children, 2nd edition (BASC-2). We used distributed lag models and lagged weighted quantile sum regression to identify the role of individual and combined dentine biomarkers of Mn, Zn and Pb on behavioral outcomes controlling for maternal education and gestational age. RESULTS Among the 133 subjects included in this study, prenatal and early postnatal dentine Mn appeared protective against childhood behavioral problems, specifically hyperactivity and attention. Postnatal dentine Mn was associated with increased reporting of internalizing problems, specifically anxiety. At 6 months, a 1-unit increase (unit = 1 SD of log concentration) in Mn was associated with a 0.18-unit (unit = 1 SD of BASC-2 score) increase in internalizing symptoms score and a 0.25-unit increase in anxiety. Postnatal Pb was associated with increasing anxiety symptoms; at 12 months, a 1-unit increase in Pb was associated with a 0.4 unit increase in anxiety symptoms. When examined as a metal mixture, we observed two potential windows of susceptibility to increased anxiety symptoms: the first window (0-8 months) appeared driven by Mn, the second window (8-12 months) was driven by the metal mixture and dominated by Pb. A 1-unit increase in the mixture index was associated with a 0.7-unit increase in SD of anxiety symptoms. CONCLUSIONS Childhood behaviors may demonstrate postnatal windows of susceptibility to individual and mixed metal concentrations measured in deciduous teeth. Prenatal dentine Mn may be protective, while excessive early postnatal Mn may increase risk for adverse behaviors. In combination, higher concentrations of Mn, Zn and Pb may have an adverse impact on behavior.
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Affiliation(s)
- Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Leon Hsu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, United States of America
| | - Amy Margolis
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center, 1051 Riverside Drive New York, New York 10032, United States of America
| | - Christine Austin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Katherine Svensson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Lourdes Schnaas
- Division of Research in Community Interventions, Instituto Nacional de Perinatología, Montes Urales 800, Lomas Virreyes, Mexico City CP 11000, Mexico
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Howard Hu
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6(th) floor, Toronto M5T 3M7, Canada
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
| | - Martha María Téllez Rojo
- Center for Nutrition and Health Research, National Institute of Public Health (Mexico), Universidad 655, Cuernavaca 62100, Mexico.
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1057, New York, NY 10029, United States of America
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Placing Salt/Soy Sauce at Dining Tables and Out-Of-Home Behavior Are Related to Urinary Sodium Excretion in Japanese Secondary School Students. Nutrients 2017; 9:nu9121290. [PMID: 29182529 PMCID: PMC5748741 DOI: 10.3390/nu9121290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 12/24/2022] Open
Abstract
We investigated whether home environment, salt knowledge, and salt-use behavior were associated with urinary sodium (Na) excretion in Japanese secondary school students. Students (267; mean age, 14.2 years) from Suo-Oshima, Japan, collected three overnight urine samples and completed a salt environment/knowledge/behavior questionnaire. A subset of students (n = 66) collected, on non-consecutive days, two 24 h urine samples, and this subset was used to derive a formula for estimating 24 h Na excretion. Generalized linear models were used to examine the association between salt environment/knowledge/behavior and Na excretions. Students that had salt or soy sauce placed on the dining table during meals excreted more Na than those that did not (pfor trend < 0.05). A number of foods to which the students added seasonings were positively associated with Na excretion (pfor trend = 0.005). The students who frequently bought foods at convenience stores or visited restaurants excreted more Na in urine than those who seldom bought foods (pfor trend < 0.05). Knowledge about salt or discretionary seasoning use was not significantly associated with Na excretion. The associations found in this study indicate that home environment and salt-use behavior may be a target for a public health intervention to reduce salt intake of secondary school students.
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11
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Bello GA, Arora M, Austin C, Horton MK, Wright RO, Gennings C. Extending the Distributed Lag Model framework to handle chemical mixtures. ENVIRONMENTAL RESEARCH 2017; 156:253-264. [PMID: 28371754 PMCID: PMC5657400 DOI: 10.1016/j.envres.2017.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 05/18/2023]
Abstract
Distributed Lag Models (DLMs) are used in environmental health studies to analyze the time-delayed effect of an exposure on an outcome of interest. Given the increasing need for analytical tools for evaluation of the effects of exposure to multi-pollutant mixtures, this study attempts to extend the classical DLM framework to accommodate and evaluate multiple longitudinally observed exposures. We introduce 2 techniques for quantifying the time-varying mixture effect of multiple exposures on an outcome of interest. Lagged WQS, the first technique, is based on Weighted Quantile Sum (WQS) regression, a penalized regression method that estimates mixture effects using a weighted index. We also introduce Tree-based DLMs, a nonparametric alternative for assessment of lagged mixture effects. This technique is based on the Random Forest (RF) algorithm, a nonparametric, tree-based estimation technique that has shown excellent performance in a wide variety of domains. In a simulation study, we tested the feasibility of these techniques and evaluated their performance in comparison to standard methodology. Both methods exhibited relatively robust performance, accurately capturing pre-defined non-linear functional relationships in different simulation settings. Further, we applied these techniques to data on perinatal exposure to environmental metal toxicants, with the goal of evaluating the effects of exposure on neurodevelopment. Our methods identified critical neurodevelopmental windows showing significant sensitivity to metal mixtures.
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Affiliation(s)
- Ghalib A Bello
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA.
| | - Manish Arora
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA
| | - Christine Austin
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA
| | - Megan K Horton
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA
| | - Robert O Wright
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA
| | - Chris Gennings
- Deptartment of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 17E 102nd St, New York, NY 10029, USA
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12
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Baek J, Hirsch JA, Moore K, Tabb LP, Barrientos-Gutierrez T, Lisabeth LD, Diez-Roux AV, Sánchez BN. Statistical Methods to Study Variation in Associations Between Food Store Availability and Body Mass in the Multi-Ethnic Study of Atherosclerosis. Epidemiology 2017; 28:403-411. [PMID: 28145983 PMCID: PMC5378605 DOI: 10.1097/ede.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research linking characteristics of the neighborhood environment to health has relied on traditional regression methods where prespecified distances from participant's locations or areas are used to operationalize neighborhood-level measures. Because the relevant spatial scale of neighborhood environment measures may differ across places or individuals, using prespecified distances could result in biased association estimates or efficiency losses. We use novel hierarchical distributed lag models and data from the Multi-Ethnic Study of Atherosclerosis (MESA) to (1) examine whether and how the association between the availability of favorable food stores and body mass index (BMI) depends on continuous distance from participant locations (instead of traditional buffers), thus allowing us to indirectly infer the spatial scale at which this association operates; (2) examine if the spatial scale and magnitude of the association differs across six MESA sites, and (3) across individuals. As expected, we found that the association between higher availability of favorable food stores within closer distances from participant's residential location was stronger than at farther distances, and that the magnitude of the adjusted association declined quickly from zero to two miles. Furthermore, between-individual heterogeneity in the scale and magnitude of the association was present; the extent of this heterogeneity was different across the MESA sites. Individual heterogeneity was partially explained by sex. This study illustrated novel methods to examine how neighborhood environmental factors may be differentially associated with health at different scales, providing nuance to previous research that ignored the heterogeneity found across individuals and contexts.
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Affiliation(s)
- Jonggyu Baek
- University of Michigan, Ann Arbor, Michigan, USA
| | - Jana A. Hirsch
- University of North Carolina at Chapel Hill, North
Carolina, USA
| | - Kari Moore
- Drexel University, Philadelphia, Pennsylvania, USA
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13
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Missbach B, Pachschwöll C, Kuchling D, König J. School food environment: Quality and advertisement frequency of child-oriented packaged products within walking distance of public schools. Prev Med Rep 2017; 6:307-313. [PMID: 28435784 PMCID: PMC5393165 DOI: 10.1016/j.pmedr.2017.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/08/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022] Open
Abstract
Food marketing for children is a major concern for public health nutrition and many schools make efforts to increase healthy eating. Food environments surrounding schools in urban areas may undermine these efforts for healthy nutrition within school programs. Our study aim is to describe the nutrition environment within walking distance of schools in terms of food quality and food marketing and to explore the degree to which elements of the nutrition environment varies by proximity to schools. In a cross-sectional study, we analyzed the surrounding food environments of a convenience sample of 46 target schools within 950m walking distance in 7 different urban districts across Vienna, Austria. In total, we analyzed data from 67 fast food outlets and 54 supermarkets analyzing a total of 43.129 packaged snack food and beverage products, from which 85% were for adults and 15% of the products were child-oriented. Proximity to the schools did not affect the availability of child-oriented products and dedicated food advertisements for children. After applying nutrient profiling using the Nutrient Profiling Model (NPM) on child-oriented products, results showed that 15.8% of the packaged snack food were categorized as “healthy” foods and 84.2% as “less healthy”; for beverages 65.7% were categorized as “healthy” and 34.3% as “less healthy”. In conclusion, our results show that child-oriented snacks are not more frequently advertised around schools but substantially lack in nutritional quality with the potential to undermine efforts for promoting healthy eating practices within schools. Child-oriented food quality and advertisement were assessed within school walking distance. Food advertisement frequency was not influenced by proximity to schools. Quality of child-oriented products was categorized as less healthy in most food categories.
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Affiliation(s)
- Benjamin Missbach
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Caterina Pachschwöll
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Daniel Kuchling
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Jürgen König
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
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