1
|
Snelling A, Hawkins M, McClave R, Irvine Belson S. The Role of Teachers in Addressing Childhood Obesity: A School-Based Approach. Nutrients 2023; 15:3981. [PMID: 37764765 PMCID: PMC10535151 DOI: 10.3390/nu15183981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Childhood obesity is one of the most prevalent public health challenges in the United States, and although rates are declining overall, rates among children living in underserved neighborhoods are increasing. This five-year intervention project seeks to empower teachers (n = 92) to invest in their own health and then integrate nutrition concepts into core subjects' lessons in elementary schools. The professional development sessions reflect the concepts in the Whole Child, Whole School, Whole Community model. Results indicate that teachers who attended professional development sessions were more likely to implement nutrition lessons in the classroom (r = 0.54, p < 0.01), and students demonstrated a significant increase in nutrition knowledge (p < 0.001, df = 2, F = 9.66). Investing in school-based programs that ensure teacher well-being and professional development can yield positive benefits for both teachers and students.
Collapse
Affiliation(s)
- Anastasia Snelling
- Department of Health Studies, College of Arts & Sciences, American University, Washington, DC 20016, USA; (M.H.); (R.M.)
| | - Melissa Hawkins
- Department of Health Studies, College of Arts & Sciences, American University, Washington, DC 20016, USA; (M.H.); (R.M.)
| | - Robin McClave
- Department of Health Studies, College of Arts & Sciences, American University, Washington, DC 20016, USA; (M.H.); (R.M.)
| | | |
Collapse
|
2
|
An R, Ji M. Building Machine Learning Models to Correct Self-Reported Anthropometric Measures. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:671-674. [PMID: 37131277 DOI: 10.1097/phh.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Monitoring population obesity risk primarily depends on self-reported anthropometric data prone to recall error and bias. This study developed machine learning (ML) models to correct self-reported height and weight and estimate obesity prevalence in US adults. Individual-level data from 50 274 adults were retrieved from the National Health and Nutrition Examination Survey (NHANES) 1999-2020 waves. Large, statistically significant differences between self-reported and objectively measured anthropometric data were present. Using their self-reported counterparts, we applied 9 ML models to predict objectively measured height, weight, and body mass index. Model performances were assessed using root-mean-square error. Adopting the best performing models reduced the discrepancy between self-reported and objectively measured sample average height by 22.08%, weight by 2.02%, body mass index by 11.14%, and obesity prevalence by 99.52%. The difference between predicted (36.05%) and objectively measured obesity prevalence (36.03%) was statistically nonsignificant. The models may be used to reliably estimate obesity prevalence in US adults using data from population health surveys.
Collapse
Affiliation(s)
- Ruopeng An
- Brown School, Washington University in St Louis, St Louis, Missouri (Dr An) Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, Missouri (Dr Ji)
| | | |
Collapse
|
3
|
Mooney SJ, Song L, Drewnowski A, Buskiewicz J, Mooney SD, Saelens BE, Arterburn DE. From the clinic to the community: Can health system data accurately estimate population obesity prevalence? Obesity (Silver Spring) 2021; 29:1961-1968. [PMID: 34605194 PMCID: PMC8571026 DOI: 10.1002/oby.23273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Health system data were assessed for how well they can estimate obesity prevalence in census tracts. METHODS Clinical visit data were available from two large health systems (Kaiser Permanente Washington and University of Washington Medicine) in King County, Washington, as were census tract-level obesity prevalence estimates from the Behavioral Risk Factor Surveillance System (BRFSS). The health system data were geocoded to identify each patient's tract of residence, and the cross-sectional concordance between census tract-level obesity prevalence estimates computed from the two health systems in 2005 to 2006 and the concordance between University of Washington Medicine and BRFSS from 2012 to 2016 were assessed. RESULTS The spatial distribution of obesity was similar between the health systems (Spearman r = 0.63). The University of Washington Medicine estimates of rank order correlated well with BRFSS estimates (Spearman r = 0.85), though prevalence estimates from BRFSS were lower (mean obesity prevalence = 26% for University of Washington Medicine versus 20% for BRFSS, Wilcoxon rank sum test p < 0.001). Across all data sources, obesity was more prevalent in tracts with less educational attainment. CONCLUSIONS Health system clinical weight data can reliably replicate census tract-level spatial patterns in the ranking of obesity prevalence. Health system data may be an efficient resource for geographic obesity surveillance.
Collapse
Affiliation(s)
- Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Lin Song
- Seattle-King County Public Health, Seattle, Washington, USA
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington, USA
| | - James Buskiewicz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - David E Arterburn
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
| |
Collapse
|
4
|
Berrigan D, Arteaga SS, Colón-Ramos U, Rosas LG, Monge-Rojas R, O'Connor TM, Pérez-Escamilla R, Roberts EFS, Sanchez B, Téllez-Rojo MM, Vorkoper S. [Desafíos de medición para la investigación de la obesidad infantil en y entre América Latina y Estados Unidos]. Obes Rev 2021; 22 Suppl 5:e13353. [PMID: 34708534 DOI: 10.1111/obr.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
- David Berrigan
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - S Sonia Arteaga
- Environmental Influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington D.C., EE. UU
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Ministerio de Salud, Tres Ríos, Costa Rica
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, EE. UU
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU
| | | | - Brisa Sanchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Filadelfia, Pensilvania, EE. UU
| | - Martha Maria Téllez-Rojo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| | | |
Collapse
|
5
|
Berrigan D, Arteaga SS, Colón‐Ramos U, Rosas LG, Monge‐Rojas R, O'Connor TM, Pérez‐Escamilla R, Roberts EFS, Sanchez B, Téllez‐Rojo MM, Vorkoper S. Measurement challenges for childhood obesity research within and between Latin America and the United States. Obes Rev 2021; 22 Suppl 3:e13242. [PMID: 33942975 PMCID: PMC8365689 DOI: 10.1111/obr.13242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/27/2022]
Abstract
Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.
Collapse
Affiliation(s)
- David Berrigan
- National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - S. Sonia Arteaga
- Environmental Influences on Child Health Outcomes ProgramOffice of the Director, National Institutes of HealthBethesdaMarylandUSA
| | - Uriyoán Colón‐Ramos
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Lisa G. Rosas
- Department of Epidemiology and Population HealthStanford UniversityStanfordCaliforniaUSA
| | - Rafael Monge‐Rojas
- Nutrition and Health Unit, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA)Ministry of HealthTres RíosCosta Rica
| | - Teresia M. O'Connor
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTexasUSA
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | | | - Brisa Sanchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Susan Vorkoper
- Fogarty International CenterNational Institutes of HealthBethesdaMarylandUSA
| | | |
Collapse
|
6
|
Madsen KA, Thompson HR, Linchey J, Ritchie LD, Gupta S, Neumark-Sztainer D, Crawford PB, McCulloch CE, Ibarra-Castro A. Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:251-259. [PMID: 33196797 PMCID: PMC7670394 DOI: 10.1001/jamapediatrics.2020.4768] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Annually, US schools screen millions of students' body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms. OBJECTIVE To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020. INTERVENTIONS School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years. MAIN OUTCOMES AND MEASURES Changes in BMI z score and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up. RESULTS A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMI z score change (-0.003; 95% CI, -0.02 to 0.01 at 1 year and 0.01; 95% CI, -0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (-0.11; 95% CI, -0.18 to -0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (-0.06; 95% CI, -0.10 to -0.02). CONCLUSIONS AND RELEVANCE Body mass index reports alone do not improve children's weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02088086.
Collapse
Affiliation(s)
| | - Hannah R. Thompson
- Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley
| | - Jennifer Linchey
- Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland
| | - Shalika Gupta
- Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Patricia B. Crawford
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland
| | - Charles E. McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Ana Ibarra-Castro
- Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley
| |
Collapse
|
7
|
Hardy LL, Mihrshahi S. Elements of Effective Population Surveillance Systems for Monitoring Obesity in School Aged Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186812. [PMID: 32962004 PMCID: PMC7558984 DOI: 10.3390/ijerph17186812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
The continuing high prevalence of child overweight and obesity globally means that it remains the most common chronic health condition in children. Population-based child obesity surveillance systems are critical for monitoring trends in obesity and related behaviours, and determining the overall effect of child obesity prevention strategies. Effective surveillance systems may vary in methods, scope, purpose, objectives, and attributes, and our aim was to provide an overview of child obesity surveillance systems globally, and to highlight main components and other types of survey data that can enhance our understanding of child obesity. Measures of adiposity, including body mass index and waist circumference are essential, but effective surveillance must also include measures of weight-related behaviours, including diet, physical activity, sedentary time, and sleep. While objective measures are desirable, the variability in psychometrics and rapid evolution of wearable devices is potentially problematic for examining long-term trends over time and how behaviours may change. Questionnaires on self-reported behaviours are often used but also have limitations. Because the determinants of obesity are not only functioning at the individual level, some measures of the broader environmental and commercial determinants, including the built and food environments, are useful to guide upstream policy decisions.
Collapse
Affiliation(s)
- Louise L. Hardy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Correspondence: ; Tel.: +61-2-86271846
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2190, Australia;
| |
Collapse
|
8
|
PEREIRA LJ, HINNIG PDF, DI PIETRO PF, ASSIS MAAD, VIEIRA FGK. Trends in food consumption of schoolchildren from 2nd to 5th grade: a panel data analysis. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Objective To identify trends in food consumption among schoolchildren (2nd-5th grades) from public schools in the city of Florianópolis, Brazil, in a period of three years. Methods Three cross-sectional surveys were carried out in 2013 (n=1,942), 2014 (n=1,989) and 2015 (n=2,418). Dietary intake data were obtained using the Web-Based Food Intake and Physical Activity of Schoolchildren questionnaire. Food items were aggregated to eight food groups. Kruskal-Wallis heterogeneity and trend tests were used to analyze the differences and trends among the mean intake frequency of food groups. Results There were trends to decrease the mean intake frequency of sweets in the total sample (2013: 0.72±0.91; 2014: 0.68±0.87; 2015: 0.67±0.89, p=0.03) which was determined by children between 7-9 years old (2013: 0.69±0.88; 2014: 0.64±0.85; 2015: 0.62±0.87, p=0.02), and boys (2013: 0.75±0.90; 2014: 0.70±0.86; 2015: 0.68±0.88, p=0.03). Younger children also tended to increase the mean intake frequency of fruits and vegetables (2013: 1.03±1.35; 2014: 1.16±1.45; 2015: 1.17±1.41, p=0.03) and those aged ten-12 years decreased their intake of dairy products (2013: 1.32±1.25; 2014: 1.23±1.18; 2015: 1.20±1.20, p=0.05). Conclusion The results suggest positive trends for younger children, with an increased consumption of fruits and vegetables in both sexes and decreased consumption of sweets for boys. Older children reduced their consumption of dairy products over the three-year period of this study.
Collapse
|
9
|
Gibb S, Shackleton N, Audas R, Taylor B, Swinburn B, Zhu T, Taylor R, Derraik JG, Cutfield W, Milne B. Child obesity prevalence across communities in New Zealand: 2010–2016. Aust N Z J Public Health 2019; 43:176-181. [DOI: 10.1111/1753-6405.12881] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/01/2018] [Accepted: 01/01/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sheree Gibb
- Department of Public HealthUniversity of Otago Wellington New Zealand
- A Better Start National Science Challenge Dunedin New Zealand
| | - Nichola Shackleton
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rick Audas
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Barry Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of Women’s and Children’s HealthUniversity of Otago Dunedin New Zealand
| | - Boyd Swinburn
- Population Nutrition and Global HealthUniversity of Auckland New Zealand
| | - Tong Zhu
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| | - Rachael Taylor
- A Better Start National Science Challenge Dunedin New Zealand
- Department of MedicineUniversity of Otago Dunedin New Zealand
| | - José G.B. Derraik
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Wayne Cutfield
- A Better Start National Science Challenge Dunedin New Zealand
- Liggins InstituteUniversity of Auckland New Zealand
| | - Barry Milne
- A Better Start National Science Challenge Dunedin New Zealand
- Centre of Methods and Policy Application in the Social Sciences (COMPASS)University of Auckland New Zealand
| |
Collapse
|
10
|
Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. ENVIRONMENTAL RESEARCH 2018; 166:100-107. [PMID: 29883903 DOI: 10.1016/j.envres.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To conduct a state-wide examination of public schools and the school neighborhood as potential targets for environmental public health tracking to address childhood obesity. METHODS We examined the relationship of social and physical environmental attributes of the school environment (within school and neighborhood) and childhood obesity in California with machine learning (Random Forest) and multilevel methods. We used data compiled from the California Department of Education, the U.S. Geological Survey, ESRI's Business Analyst, the U.S. Census, and other public sources for ecologic level variables for various years and assessed their relative importance to obesity as determined from the statewide Physical Fitness Test 2003 through 2007 for grades 5, 7, and 9 (n = 5,265,265). RESULTS In addition to individual-level race and gender, the following within and school neighborhood variables ranked as the most important model contributors based on the Random Forest analysis and were included in multilevel regressions clustered on the county. Violent crime, English learners, socioeconomic disadvantage, fewer physical education (PE) and fully credentialed teachers, and diversity index were positively associated with obesity while academic performance index, PE participation, mean educational attainment and per capita income were negatively associated with obesity. The most highly ranked built or physical environment variables were distance to the nearest highway and greenness, which were 10th and 11th most important, respectively. CONCLUSIONS Many states in the U.S. do not have school-based surveillance programs that collect body mass index data. System-level determinants of obesity can be important for tracking and intervention. The results of these analyses suggest that the school social environment factors may be especially important. Disadvantaged and low academic performing schools have a higher risk for obesity. Supporting such schools in a targeted way may be an efficient way to intervene and could impact both health and academic outcomes. Some of the more important variables, such as having credentialed teachers and participating in PE, are modifiable risk factors.
Collapse
Affiliation(s)
- Alberto M Ortega Hinojosa
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; IMPAQ International, LLC, Oakland, CA 94612, United States
| | - Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - John Balmes
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States
| | - Michael Jerrett
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
| |
Collapse
|