1
|
Bailin SS, Koethe JR. Weight Gain and Antiretroviral Therapy. Infect Dis Clin North Am 2024; 38:499-515. [PMID: 38871568 PMCID: PMC11305935 DOI: 10.1016/j.idc.2024.04.005] [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] [Indexed: 06/15/2024]
Abstract
Antiretroviral therapy (ART) agents as a determinant of body weight in ART-naïve and ART-experienced persons with human immunodeficiency virus (HIV) (PWH) has become a major focus area in research and clinical settings. Recent studies demonstrating weight-suppressing properties of efavirenz and tenofovir disoproxil fumarate led to re-evaluation of weight gain studies, and a reassessment of whether other agents are weight promoting versus weight neutral. In this review, the authors synthesize recent literature on factors related to obesity, clinical measurements of adiposity, weight gain in ART-naïve and ART-experienced PWH, metabolic consequences of ART and weight gain, and the clinical management of weight gain in PWH.
Collapse
Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA.
| | - John R Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA
| |
Collapse
|
2
|
Sims KD, Wei PC, Penko JM, Hennessy S, Coxson PG, Mukand NH, Bellows BK, Kazi DS, Zhang Y, Boylan R, Moran AE, Bibbins-Domingo K. Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults. Hypertension 2024; 81:1758-1765. [PMID: 38881463 PMCID: PMC11254541 DOI: 10.1161/hypertensionaha.124.22704] [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: 01/07/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified. METHODS We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy. RESULTS Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities. CONCLUSIONS Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.
Collapse
Affiliation(s)
- Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Pengxiao Carol Wei
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joanne M. Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Susan Hennessy
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Nita H. Mukand
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Brandon K. Bellows
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Yiyi Zhang
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ross Boylan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
- Editorial Board, Journal of the American Medical Association, Chicago, Illinois
| |
Collapse
|
3
|
Owens S, Seto E, Hajat A, Fishman P, Koné A, Jones-Smith JC. Assessing the Influence of Redlining on Intergenerational Wealth and Body Mass Index Through a Quasi-experimental Framework. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02044-7. [PMID: 38849692 DOI: 10.1007/s40615-024-02044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Higher levels of body mass index (BMI), particularly for those who have obesity defined as class II and III, are correlated with excess risk of all-cause mortality in the USA, and these risks disproportionately affects marginalized communities impacted by systemic racism. Redlining, a form of structural racism, is a practice by which federal agencies and banks disincentivized mortgage investments in predominantly racialized minority neighborhoods, contributing to residential segregation. The extent to which redlining contributes to current-day wealth and health inequities, including obesity, through wealth pathways or limited access to health-promoting resources, remains unclear. Our quasi-experimental study aimed to investigate the generational impacts of redlining on wealth and body mass index (BMI) outcomes. METHODS We leveraged the Panel Study of Income Dynamics (PSID) and Home Owners' Loan Corporation (HOLC) maps to implement a geographical regression discontinuity design, where treatment assignment is randomly based on the boundary location of PSID grandparents in yellowlined vs. redlined areas and used outcome measures of wealth and mean BMI of grandchildren. To estimate our effects, we used a continuity-based approach and applied data-driven procedures to identify the most appropriate bandwidths for a valid estimation and inference. RESULTS In our fully adjusted model, grandchildren with grandparents living in redlined areas had lower average household wealth (β = - $35,419; 95% CIrbc - $37,423, - $7615) and a notably elevated mean BMI (β = 7.47; 95% CIrbc - 4.00, 16.60), when compared to grandchildren whose grandparents resided in yellowlined regions. CONCLUSION Our research supports the idea that redlining, a historical policy rooted in structural racism, is a key factor contributing to disparities in wealth accumulation and, conceivably, body mass index across racial groups.
Collapse
Affiliation(s)
- Shanise Owens
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA.
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
| | - Ahoua Koné
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jessica C Jones-Smith
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15Th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
4
|
Bear Don't Walk OJ, Paullada A, Everhart A, Casanova-Perez R, Cohen T, Veinot T. Opportunities for incorporating intersectionality into biomedical informatics. J Biomed Inform 2024; 154:104653. [PMID: 38734158 PMCID: PMC11146624 DOI: 10.1016/j.jbi.2024.104653] [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: 11/18/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.
Collapse
Affiliation(s)
- Oliver J Bear Don't Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, United States.
| | - Amandalynne Paullada
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Avery Everhart
- Department of Geography, Faculty of Arts, University of British Columbia, Canada
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, United States
| |
Collapse
|
5
|
Xu M, Wilson JP, Bruine de Bruin W, Lerner L, Horn AL, Livings MS, de la Haye K. New insights into grocery store visits among east Los Angeles residents using mobility data. Health Place 2024; 87:103220. [PMID: 38492528 DOI: 10.1016/j.healthplace.2024.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
In this study, we employed spatially aggregated population mobility data, generated from mobile phone locations in 2021, to investigate patterns of grocery store visits among residents east and northeast of Downtown Los Angeles, in which 60% of the census tracts had previously been designated as "food deserts". Further, we examined whether the store visits varied with neighborhood sociodemographics and grocery store accessibility. We found that residents averaged 0.4 trips to grocery stores per week, with only 13% of these visits within home census tracts, and 40% within home and neighboring census tracts. The mean distance from home to grocery stores was 2.2 miles. We found that people visited grocery stores more frequently when they lived in neighborhoods with higher percentages of Hispanics/Latinos, renters and foreign-born residents, and a greater number of grocery stores. This research highlights the utility of mobility data in elucidating grocery store use, and factors that may facilitate or be a barrier to store access. The results point to limitations of using geographically constrained metrics of food access like food deserts.
Collapse
Affiliation(s)
- Mengya Xu
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, 3616 Trousdale Parkway AHF B55, Los Angeles, CA 90089, USA.
| | - John P Wilson
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, 3616 Trousdale Parkway AHF B55, Los Angeles, CA 90089, USA; Department of Sociology, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, 851 Downey Way HSH 314, Los Angeles, CA 90089, USA; Department of Civil & Environmental Engineering and Computer Science, Viterbi School of Engineering, University of Southern California, 3650 McClintock Avenue, Los Angeles, CA 90089, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto Street, Los Angeles, CA 90032, USA; School of Architecture, University of Southern California, 850 Bloom Walk WAH 204, Los Angeles, CA 90089, USA.
| | - Wändi Bruine de Bruin
- Sol Price School of Public Policy, University of Southern California, 650 Childs Way RGL 311, Los Angeles, CA 90089, USA; Department of Psychology, Dornsife College of Letters, Arts and Sciences, University of Southern California, 3620 S McClintock Avenue SGM 501, Los Angeles, CA 90089, USA; Center for Economic and Social Research, University of Southern California, Los Angeles, 635 Downey Way VPD, Los Angeles, CA 90089, USA.
| | - Leo Lerner
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, 3616 Trousdale Parkway AHF B55, Los Angeles, CA 90089, USA.
| | - Abigail L Horn
- Information Sciences Institute and Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, 3650 McClintock Avenue, Los Angeles, CA 90089, USA.
| | - Michelle Sarah Livings
- Center for Research on Child and Family Wellbeing, School of Public & International Affairs, Princeton University, Princeton, NJ 08544, USA.
| | - Kayla de la Haye
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, 3616 Trousdale Parkway AHF B55, Los Angeles, CA 90089, USA; Center for Economic and Social Research, University of Southern California, Los Angeles, 635 Downey Way VPD, Los Angeles, CA 90089, USA.
| |
Collapse
|
6
|
Scott VP, Rhee KE. Using the lens of trauma informed care to inform pediatric obesity management. Curr Opin Pediatr 2024; 36:49-56. [PMID: 37965895 DOI: 10.1097/mop.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Summarize the evolution of the trauma-informed care (TIC) approach in pediatrics, highlight the importance of using this lens in pediatric obesity management and treating the whole patient and family, and suggest recommendations for providers to incorporate TIC into their practice. RECENT FINDINGS Implementing TIC in pediatric obesity management is recommended and offers an approach to address trauma-related symptoms associated with obesity. The TIC framework creates a safe, nurturing space to have open conversations with patients and families to promote resilience and reduce stigma related to obesity without re-traumatization. Screening tools may expose symptoms related to trauma, but are limited. Provider training is available and development of TIC related skills may be improved through using the arts and humanities. Success of TIC requires a tailored, integrated healthcare system approach with commitment from all levels. SUMMARY The TIC approach offers providers skills to uncover trauma-related symptoms and address obesity-related health disparities while reducing stigma. Collaboration across all levels of the healthcare system and community partners is essential. Further research is warranted on the effectives of this approach in pediatric obesity prevention and management.
Collapse
Affiliation(s)
- Vanessa P Scott
- UC San Diego School of Medicine, Department of Pediatrics, UC San Diego Health, Academic General Pediatrics, La Jolla, California, USA
| | | |
Collapse
|
7
|
Sims KD, Wei PC, Penko JM, Hennessy S, Coxson PG, Mukand NH, Bellows BK, Kazi DS, Zhang Y, Boylan R, Moran AE, Bibbins-Domingo K. Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.26.23300563. [PMID: 38234772 PMCID: PMC10793531 DOI: 10.1101/2023.12.26.23300563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines newly classified 31 million US adults as having stage 1 hypertension. The ACC/AHA guidelines recommend behavioral change without pharmacology for the low-risk portion of this group. However, the nationwide reduction in cardiovascular disease (CVD) and associated healthcare expenditures achievable by evidence-based dietary improvements, sustained weight loss, adequate physical activity, and alcohol moderation remain unquantified. We estimated the effect of systolic BP (SBP) control and behavioral changes on 10-year CVD outcomes and costs. Methods We used the CVD Policy Model to simulate CVD events, mortality, and healthcare costs among US adults aged 35-64. We simulated interventions on a target population, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: defined as untreated SBP 130-139 mmHg and diastolic BP <90 mmHg; no history of CVD, diabetes, or chronic kidney disease; and low 10-year risk of CVD. We used published meta-analyses and trials to estimate the effects of behavior modification on SBP. We assessed the extent to which intermittent healthcare utilization or partial uptake of nonpharmacologic therapy would decrease CVD events prevented. Results Controlling SBP to <130 mmHg among the estimated 8.8 million U.S. adults (51% women) in the target population could prevent 26,100 CVD events, avoid 2,900 deaths, and save $1.6 billion in healthcare costs over 10 years. The Dietary Approaches to Stop Hypertension (DASH) diet could prevent 16,000 CVD events among men and 12,000 among women over a decade. Other nonpharmacologic interventions could avert between 3,700 and 19,500 CVD events. However, only 5.5 million (61%) of the target population regularly utilized healthcare where recommended clinician counseling could occur. Conclusions As only two-thirds of U.S. adults with Stage 1 hypertension regularly receive medical care, substantial benefits to cardiovascular health and associated costs may only stem from policies that promote widespread adoption and sustained adherence of nonpharmacologic therapy. Future work should quantify the population-level costs, benefits, and efficacy of improving the food system and local infrastructure on health behavior change.
Collapse
Affiliation(s)
- Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Pengxiao Carol Wei
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joanne M. Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Susan Hennessy
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Nita H. Mukand
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Brandon K. Bellows
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts
| | - Yiyi Zhang
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ross Boylan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
- Editorial Board, Journal of the American Medical Association, Chicago, Illinois
| |
Collapse
|
8
|
Siegel M, Rieders M, Rieders H, Moumneh J, Asfour J, Oh J, Oh S. Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide. J Racial Ethn Health Disparities 2023; 10:3115-3130. [PMID: 36508134 PMCID: PMC9744051 DOI: 10.1007/s40615-022-01485-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools to measure structural racism. In addition, the few measures that have been employed have only considered structural racism at the neighborhood level. To expand upon previous studies, this paper uses a novel measure to measure structural racism at the county level for the non-Hispanic Black population. METHODS We used confirmatory factor analysis to create a model to measure the latent construct of structural racism for 1181 US counties. The model included five indicators across five dimensions: racial segregation, incarceration, educational attainment, employment, and economic status/wealth. Structural equation modeling and factor analysis were used to generate factor scores that weighted the indicators in order to produce the best model fit. The resulting factor scores represented the level of structural racism in each county. We demonstrated the utility of this measure by demonstrating its strong correlation with Black-White disparities in firearm homicide rates. RESULTS Our calculations revealed striking geographic differences across counties in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Structural racism was significantly associated with higher Black firearm homicide rates, lower White homicide rates, and a higher Black-White racial disparity in firearm homicide. CONCLUSIONS These new measures can be utilized by researchers to relate structural racism to racial health disparities at the county level.
Collapse
Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA.
| | - Madeline Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Hannah Rieders
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinan Moumneh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Julia Asfour
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Jinseo Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| | - Seungjin Oh
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 636 Harrison Avenue, Boston, MA, 02111, USA
| |
Collapse
|
9
|
Greene M, Houghtaling B, Sadeghzadeh C, De Marco M, Bryant D, Morgan R, Holston D. African Americans' perceptions of nutrition interventions: a scoping review. Nutr Res Rev 2023; 36:320-339. [PMID: 35514108 DOI: 10.1017/s0954422422000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.
Collapse
Affiliation(s)
- Matthew Greene
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Bailey Houghtaling
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Claire Sadeghzadeh
- Nutrition Department, Gillings School of Global Public Health & Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - Molly De Marco
- Nutrition Department, Gillings School of Global Public Health & Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA
| | - De'Jerra Bryant
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| | - Randa Morgan
- Agriculture Librarian, LSU Libraries, Louisiana State University, Baton Rouge, LA70803, USA
| | - Denise Holston
- School of Nutrition & Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA70803, USA
| |
Collapse
|
10
|
Woo JM, Bookwalter DB, Green GY, Sandler DP. Early life socioeconomic position contributes to adult obesity independent of adult socioeconomic factors: Findings from the sister study cohort. SSM Popul Health 2023; 24:101556. [PMID: 38053627 PMCID: PMC10694340 DOI: 10.1016/j.ssmph.2023.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 12/07/2023] Open
Abstract
Low socioeconomic position (SEP) has been associated with obesity within life stages; however, life course SEP may also alter downstream obesity risk. Research is needed to understand the impact of childhood SEP, independent of adult SEP, as well as SEP trajectories over the life course on adult obesity risk. We use data from the Sister Study, a prospective U.S. cohort of women aged 35-74 years (N = 50,884; enrollment: 2003-2009). Relative risks (RR) for adult obesity associated with childhood SEP (latent variable) and five latent life course SEP profiles were estimated in overall and race and ethnicity-stratified log binomial regression models. We estimated the direct effect of childhood SEP on adult obesity and mediation by adult SEP. Lower childhood SEP was associated with greater obesity risk (RR = 1.16, 95% CI: 1.15-1.17). In stratified models, RRs were elevated across groups though lower for Black and Hispanic/Latina participants, despite greater prevalence of obesity among Black participants. The direct effect of childhood SEP on adult obesity persisted in mediation models independent of adult SEP (RR = 1.10, 95% CI: 1.08-1.12) with adult SEP mediating approximately 40% of the total effect of childhood SEP on adult obesity. Furthermore, adult obesity risk was elevated for all life course SEP profiles compared to persistent high advantage. Life course SEP profiles indicating greater advantage in adulthood than childhood were not associated with reduced adult obesity risk among those experiencing less than high advantage in childhood. In conclusion, lower childhood SEP, independent of adult SEP, may be an important risk factor for adult obesity.
Collapse
Affiliation(s)
- Jennifer M.P. Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, NC, 27709, USA
| | | | | | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., Research Triangle Park, NC, 27709, USA
| |
Collapse
|
11
|
Hadley M, Oppong AY, Coleman J, Powell AM. Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome. Obstet Gynecol 2023; 142:911-919. [PMID: 37678901 PMCID: PMC10510805 DOI: 10.1097/aog.0000000000005345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
Microbiome science offers a glimpse into personalized medicine by characterizing health and disease states according to an individual's microbial signatures. Without a critical examination of the use of race as a variable, microbiome studies may be susceptible to the same pitfalls as other areas of science grounded in racist biology. We will examine the use of race as a biological variable in pregnancy-related microbiome research. Emerging data from studies that investigate the intestinal microbiome in pregnancy suggest strong influence of a poor diet on adverse pregnancy outcomes. Differences in the vaginal microbiome implicated in adverse pregnancy outcomes are frequently attributed to race. We review evidence that links systemic racism to pregnancy health outcome differences with a focus on the vaginal and intestinal microbiomes as well as diet. We also review how structural racism ultimately contributes to inequitable access to healthy food and higher risk environmental exposures among pregnant people of lower socioeconomic status and exacerbates common pregnancy comorbidities.
Collapse
Affiliation(s)
- Megan Hadley
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and the University of Chicago School of Medicine, Chicago, Illinois
| | | | | | | |
Collapse
|
12
|
Cohen SA, Brown MJ, Xu F, Nash CC, Greaney ML. Geographic differences in the magnitude of black-white disparities in having obesity. Obes Sci Pract 2023; 9:516-528. [PMID: 37810524 PMCID: PMC10551120 DOI: 10.1002/osp4.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background Obesity disparities in the United States are well documented, but the limited body of research suggests that geographic factors may alter the magnitude of these disparities. A growing body of evidence has identified a "rural mortality penalty" where morbidity and mortality rates are higher in rural than urban areas, even after controlling for other factors. Black-White differences in health and mortality are more pronounced in rural areas than in urban areas. Objective Therefore, the purpose of this study was to explore how rural-urban status and region moderate Black-White health disparities in obesity. Methods Data were abstracted from the 2012 Behavioral Risk Factor Surveillance System, with the sample being restricted to Black and White respondents (n = 403,231). Respondents' county of residence was linked to US Census information to obtain the county-level Index of Relative Rurality (IRR) and Census division. Crude and adjusted logistic regression models were utilized to assess the magnitude of Black-White disparities in having obesity (yes/no) by IRR quartile and by Census division. Results Overall, Black-White differences in obesity were wider in rural than in urban counties, with a significant linear trend (p < 0.001). Furthermore, when stratified by US Census division, results revealed that disparities were significantly wider in rural than urban areas for respondents living in the Middle Atlantic and South Atlantic divisions. In contrast, the association was reversed for the remaining divisions (New England, East North Central, West North Central, Mountain, and Pacific), where the magnitude of the Black-White difference was the largest in urban areas. Conclusion Findings highlight the need to understand and account for critical place-based factors that exacerbate racial obesity disparities to develop and maximize the effectiveness of policies and programs designed to reduce racial inequalities and improve population health.
Collapse
Affiliation(s)
- Steven A. Cohen
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Monique J. Brown
- Department of Epidemiology and BiostatisticsArnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Furong Xu
- School of EducationAlan Shawn Feinstein College of Education and Professional StudiesUniversity of Rhode IslandChafee Social Science CenterKingstonRhode IslandUSA
| | - Caitlin C. Nash
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Mary L. Greaney
- Department of Health StudiesUniversity of Rhode IslandKingstonRhode IslandUSA
| |
Collapse
|
13
|
Abella MKIL, Angeles JPM, Finlay AK, Amanatullah DF. Does Operative Time Modify Obesity-related Outcomes in THA? Clin Orthop Relat Res 2023; 481:1917-1925. [PMID: 37083564 PMCID: PMC10499082 DOI: 10.1097/corr.0000000000002659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/22/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Most orthopaedic surgeons refuse to perform arthroplasty on patients with morbid obesity, citing the higher rate of postoperative complications. However, that recommendation does not account for the relationship of operative time (which is often longer in patients with obesity) to obesity-related arthroplasty outcomes, such as readmission, reoperation, and postoperative complications. If operative time is associated with these obesity-related outcomes, it should be accounted for and addressed to properly assess the risk of patients with obesity undergoing THA. QUESTIONS/PURPOSES We therefore asked: (1) Is the increased risk seen in overweight and obese patients, compared with patients in a normal BMI class, associated with increased operative time? (2) Is increased operative time independent of BMI class a risk factor for readmission, reoperation, and postoperative medical complications? (3) Does operative time modify the direction or strength of obesity-related adverse outcomes? METHODS This retrospective, comparative study examined 247,108 patients who underwent THA between January 2014 and December 2020 in the National Surgical Quality Improvement Project (NSQIP). Of those, emergency cases (1% [2404]), bilateral procedures (1% [1605]), missing and/or null data (1% [3280]), extreme BMI and operative time outliers (1% [2032]), and patients with comorbidities that are not typical of an elective procedure, such as disseminated cancer, open wounds, sepsis, and ventilator dependence (1% [2726]), were excluded, leaving 95% (235,061) of elective, unilateral THA cases for analysis. The NSQIP was selected due to its inclusion of operative time, which is not found in any other national database. BMI was subdivided into underweight, normal weight, overweight, Class I obesity, Class II obesity, and Class III obesity. Of the patients with a normal weight, 69% (30,932 of 44,556) were female and 36% (16,032 of 44,556) had at least one comorbidity, with a mean operative time of 86 ± 32 minutes and a mean age of 68 ± 12 years. Patients with obesity tend to be younger, male, more likely to have preoperative comorbidities, with longer operative times. Multivariable logistic regression models examined the effects of obesity on 30-day readmission, reoperation, and medical complications, while adjusting for age, sex, race, smoking status, and number of preoperative comorbidities. After we repeated this analysis after adjusting for operative time, an interaction model was conducted to test whether operative time changes the direction or strength of the association of BMI class and adverse outcomes. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were calculated, and the interaction effects were plotted. RESULTS A comparison of patients with Class III obesity to patients with normal weight showed that the odds of readmission went from 45% (AOR 1.45 [95% CI 1.32 to 1.59]; p < 0.001) to 27% after adjusting for operative time (AOR 1.27 [95% CI 1.01 to 1.62]; p = 0.04), the odds of reoperation went from 93% (AOR 1.93 [95% CI 1.72 to 2.17]; p < 0.001) to 81% after adjusting for operative time (AOR 1.81 [95% CI 1.61 to 2.04]; p < 0.001), and the odds of a postoperative complication went from 96% (AOR 1.96 [95% CI 1.58 to 2.43]; p < 0.001) to 84% after adjusting for operative time (AOR 1.84 [95% CI 1.48 to 2.28]; p < 0.001). Each 15-minute increase in operative time was associated with a 7% increase in the odds of a readmission (AOR 1.07 [95% CI 1.06 to 1.08]; p < 0.001), a 10% increase in the odds of a reoperation (AOR 1.10 [95% CI 1.09 to 1.12]; p < 0.001), and 10% increase in the odds of a postoperative complication (AOR 1.10 [95% CI 1.08 to 1.13]; p < 0.001). There was a positive interaction effect of operative time and BMI for readmission and reoperation, which suggests that longer operations accentuate the risk that patients with obesity have for readmission and reoperation. CONCLUSION Operative time is likely a proxy for surgical complexity and contributes modestly to the adverse outcomes previously attributed to obesity alone. Hence, focusing on modulating the accentuated risk associated with lengthened operative times rather than obesity is imperative to increasing the accessibility and safety of THA. Surgeons may do this with specific surgical techniques, training, and practice. Future studies looking at THA outcomes related to obesity should consider the association with operative time to focus on independent associations with obesity to facilitate more equitable access. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Maveric K. I. L. Abella
- Stanford University Department of Orthopaedic Surgery, Stanford, CA, USA
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - John P. M. Angeles
- Stanford University Department of Orthopaedic Surgery, Stanford, CA, USA
- Wright State University Boonshoft School of Medicine, Fairborn, OH, USA
| | - Andrea K. Finlay
- Stanford University Department of Orthopaedic Surgery, Stanford, CA, USA
| | | |
Collapse
|
14
|
Singleton CR, Wright LA, McDonald M, Archer IG, Bell CN, McLoughlin GM, Houghtaling B, Cooksey Stowers K, Anderson Steeves E. Structural racism and geographic access to food retailers in the United States: A scoping review. Health Place 2023; 83:103089. [PMID: 37557002 DOI: 10.1016/j.healthplace.2023.103089] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.
Collapse
Affiliation(s)
- Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Laura A Wright
- Rudolph Matas Library of the Health Sciences, Tulane University, New Orleans, LA, USA
| | - Meredith McDonald
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Isabel G Archer
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Implementation Science Center for Cancer Control, Washington University in St. Louis, St. Louis, MO, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, College of Agriculture, Health, And Natural Resources, University of Connecticut, Storrs, CT, USA
| | | |
Collapse
|
15
|
Ivey Henry P, Spence Beaulieu MR, Bradford A, Graves JL. Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health. Evol Med Public Health 2023; 11:112-125. [PMID: 37197590 PMCID: PMC10184440 DOI: 10.1093/emph/eoad007] [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: 10/10/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.
Collapse
Affiliation(s)
- Paula Ivey Henry
- Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Angelle Bradford
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph L Graves
- Department of Biology, North Carolina A&T State University, Greensboro, NC, USA
| |
Collapse
|
16
|
MEHTA NEILK. Obesity as a Main Threat to Future Improvements in Population Health: Policy Opportunities and Challenges. Milbank Q 2023; 101:460-477. [PMID: 37096602 PMCID: PMC10126978 DOI: 10.1111/1468-0009.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Obesity has emerged as a main threat to future improvements in population health, and there is little evidence that the epidemic is retreating. The traditional model of "calories in, calories out," which has guided public health policy for decades, is increasingly viewed as far too simple a framing to explain the evolution of the epidemic or guide public policy. Advances in the science of obesity, coming from many fields, highlight the structural nature of the risk, which has provided an evidence base to justify and guide policies toward addressing the social and environmental drivers of obesity. Societies and researchers need to play the long game in that widespread reductions in obesity in the short run are unlikely. Nonetheless, there are opportunities. Policies specifically targeting the food environment such as taxing high-calorie beverages and foods, restricting the marketing of junk foods to children, enhancing food labeling, and improving the dietary environment at schools may yield long-run benefits.
Collapse
Affiliation(s)
- NEIL K. MEHTA
- School of Public and Population HealthThe University of Texas Medical Branch
| |
Collapse
|
17
|
Tu B, Patel R, Pitalua M, Khan H, Gittner LS. Building effective intervention models utilizing big data to prevent the obesity epidemic. Obes Res Clin Pract 2023; 17:108-115. [PMID: 36870867 DOI: 10.1016/j.orcp.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The exposome consists of factors an individual is exposed to across the life course. The exposome is dynamic, meaning the factors are constantly changing, affecting each other and individuals in different ways. Our exposome dataset includes social determinants of health as well as policy, climate, environment, and economic factors that could impact obesity development. The objective was to translate spatial exposure to these factors with the presence of obesity into actionable population-based constructs that could be further explored. METHODS Our dataset was constructed from a combination of public-use datasets and the Center of Disease Control's Compressed Mortality File. Spatial Statistics using Queens First Order Analysis was performed to identify hot- and cold-spots of obesity prevalence; followed by Graph Analysis, Relational Analysis, and Exploratory Factor Analysis to model the multifactorial spatial connections. RESULTS Areas of high and low presence of obesity had different factors associated with obesity. Factors associated with obesity in areas of high obesity propensity were: poverty / unemployment; workload, comorbid conditions (diabetes, CVD) and physical activity. Conversely, factors associated in areas where obesity was rare were: smoking, lower education, poorer mental health, lower elevations, and heat. DISCUSSION The spatial methods described within the paper are scalable to large numbers of variables without issues of multiple comparisons lowering resolution. These types of spatial structural methods provide insights into novel variable associations or factor interactions that can then be studied further at the population or policy levels.
Collapse
Affiliation(s)
- Brittany Tu
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| | - Radha Patel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mario Pitalua
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Hafiz Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Lisaann S Gittner
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| |
Collapse
|
18
|
Siegel M, Wiklund E. The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes. J Natl Med Assoc 2023; 115:207-222. [PMID: 36801076 DOI: 10.1016/j.jnma.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
AIMS While several studies have examined the impact of individual indicators of structural racism on single health outcomes, few have explicitly modeled racial disparities in a wide range of health outcomes using a multidimensional, composite structural racism index. This paper builds on the previous research by examining the relationship between state-level structural racism and a wider array of health outcomes, focusing on racial disparities in mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, and kidney disease. METHODS We used a previously developed state structural racism index that consists of a composite score derived by averaging eight indicators across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; and (5) education. Indicators were obtained for each of the 50 states using Census data from 2020. We estimated the Black-White disparity in each health outcome in each state by dividing the age-adjusted mortality rate for the non-Hispanic Black population by the age-adjusted mortality rate for the non-Hispanic White population. These rates were obtained from the CDC WONDER Multiple Cause of Death database for the combined years 1999-2020. We conducted linear regression analyses to examine the relationship between the state structural racism index and the Black-White disparity in each health outcome across the states. In multiple regression analyses, we controlled for a wide range of potential confounding variables. RESULTS Our calculations revealed striking geographic differences in the magnitude of structural racism, with the highest values generally being observed in the Midwest and Northeast. Higher levels of structural racism were significantly associated with greater racial disparities in mortality for all but two of the health outcomes. CONCLUSIONS There is a robust relationship between structural racism and Black-White disparities in multiple health outcomes across states. Programs and policies to reduce racial heath disparities must include strategies to help dismantle structural racism and its consequences.
Collapse
Affiliation(s)
- Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Emma Wiklund
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
19
|
Sisson SB, Malek-Lasater A, Ford TG, Horm D, Kwon KA. Predictors of Overweight and Obesity in Early Care and Education Teachers during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2763. [PMID: 36768129 PMCID: PMC9915895 DOI: 10.3390/ijerph20032763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (β = 2.467 SE = 1.206) and sedentary hours/day (β = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging.
Collapse
Affiliation(s)
- Susan B. Sisson
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave, Oklahoma City, OK 73117, USA
| | - Adrien Malek-Lasater
- Department of Teaching, Learning, and Curriculum, College of Education and Human Services, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
| | - Timothy G. Ford
- Department of Educational Leadership and Policy Studies, The University of Oklahoma, 4502 E. 41st Street, 4W101, Tulsa, OK 74135, USA
| | - Diane Horm
- Early Childhood Education Institute, The University of Oklahoma-Tulsa, 4502 E. 41st Street, Tulsa, OK 74135, USA
- Department of Instructional Leadership and Academic Curriculum, University of Oklahoma, 820 Van Vleet, Norman, OK 73019, USA
| | - Kyong-Ah Kwon
- Department of Instructional Leadership and Academic Curriculum, University of Oklahoma, 820 Van Vleet, Norman, OK 73019, USA
| |
Collapse
|
20
|
Wang ML, Narcisse MR, McElfish PA. Higher walkability associated with increased physical activity and reduced obesity among United States adults. Obesity (Silver Spring) 2023; 31:553-564. [PMID: 36504362 PMCID: PMC9877111 DOI: 10.1002/oby.23634] [Citation(s) in RCA: 1] [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: 07/14/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined associations among perceived neighborhood walkability, physical activity (PA), and obesity among United States adults. METHODS Data from the 2020 National Health Interview Survey were analyzed. Walkability was assessed using a summative scale and was categorized as low, medium, or high. PA was categorized as insufficient (0-149 min/wk) or sufficient (150+ min/wk). Multivariable regressions estimated an association between obesity and BMI and PA/walkability. Mediation analysis was used to partition contribution of PA as a mediator. Effect modification by race and ethnicity in the association between walkability and BMI was explored. RESULTS The sample included N = 31,568 adults. Compared with those in low-walkability neighborhoods, participants in high-walkability neighborhoods had increased odds of sufficient PA (odds ratio [OR] = 1.48; 95% CI: 1.30-1.69) and decreased obesity odds (OR = 0.76; 95% CI: 0.66-0.87). PA partially mediated the association between walkability and BMI (23.4%; 95% CI: 14.6%-62.7%). The association between walkability and BMI was modified by race and ethnicity (F[5,567] = 2.75; p = 0.018). Among White, Black, Hispanic, and Asian adults, BMI decreased with increasing walkability; among American Indian/Alaska Native and multiracial/other adults, BMI increased with increasing walkability. CONCLUSIONS The findings highlight the importance of investing in the built environment to improve perceptions of walkability and promote PA and healthy weight, as well as developing interventions to target racial and ethnic disparities in these outcomes.
Collapse
Affiliation(s)
- Monica L. Wang
- Boston University School of Public Health, Department of Community Health Sciences, 715 Albany St., Boston, MA 02118, USA
- Boston University Center for Antiracist Research, 1 Silber Way, Boston, MA 02215, USA
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Ave., Boston, MA 02115, USA
| | - Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 2708 S. 48 St., Springdale, AR 72762, USA
| |
Collapse
|
21
|
Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 239] [Impact Index Per Article: 239.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
|
22
|
Smith GS, Archibald P, Thorpe RJ. Race and obesity disparities among adults living in gentrifying neighborhoods. J Racial Ethn Health Disparities 2023; 10:93-99. [PMID: 35083727 DOI: 10.1007/s40615-021-01199-x] [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: 07/13/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
There is a paucity of research seeking to understand race disparities in obesity among individuals living in a gentrifying neighborhood. American Community Survey data were used to identify gentrifying neighborhoods. In a cross-sectional analysis, these data were then linked to the 2014 Medical Expenditure Panel Survey, yielding an analytic sample of 887 Black and White adults. Obesity was based on body mass index ≥ 30 kg/m2. After controlling for potential confounders, Black adults living in gentrifying neighborhoods had a higher prevalence of obesity (PR: 1.39; 95% CI: 1.03, 1.88) than White adults living in gentrifying neighborhoods. Gentrification may have no impact on reducing Black-White obesity disparities in the US.
Collapse
Affiliation(s)
- G S Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - P Archibald
- Department of Social Work, College of Staten Island-City University of New York School of Health Science, Staten Island, NY, USA
| | - R J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Program for Research On Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
23
|
Chandrakumar H, Khatun N, Gupta T, Graham-Hill S, Zhyvotovska A, McFarlane SI. The Effects of Bariatric Surgery on Cardiovascular Outcomes and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e34723. [PMID: 36909063 PMCID: PMC9998117 DOI: 10.7759/cureus.34723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Obesity is a major public health problem that is associated with serious comorbidities and premature mortality. Cardiovascular disease (CVD) is the major cause of morbidity and mortality associated with obesity. Lifestyle modifications, pharmacological therapy, and weight reduction surgery are the major interventions to date available for obesity management. Bariatric surgery has been increasingly utilized as a therapeutic option for obesity. In this meta-analysis, we aim to assess the effects of bariatric surgery on CVD outcomes and cardiovascular mortality. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science were searched until 03/01/2022. Our search included three types of bariatric surgery: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and gastric banding (GB). All were searched in conjunction with "coronary artery disease," "ischemic heart disease," "myocardial infarction," "cerebrovascular accident," "stroke," "atrial fibrillation," "heart failure," "arrhythmias," and "mortality." We included 49 studies meeting the study criteria. Bariatric surgery showed a beneficial effect on coronary artery disease (CAD) (hazard ratio (HR) of 0.68 {95% confidence interval (CI): 0.52-0.91}, p = 0.008), myocardial infarction (MI) (HR of 0.53 {95% CI: 0.44-0.64}, p < 0.01) heart failure (HF) (HR of 0.45 {95% CI: 0.37-0.55}, p < 0.01), cerebrovascular accident (CVA) (HR of 0.68 {95% CI: 0.59-0.78}, p < 0.01), and cardiovascular mortality (HR of 0.48 {95% CI: 0.40-0.57}, p < 0.01). The effect on atrial fibrillation (AF) did not reach statistical significance: HR of 0.81 (95% CI: 0.65-1.01), p = 0.07. Our study, that is, an updated meta-analysis, including the three types of procedure, confirms beneficial effects on the major CVD outcomes, including coronary artery disease, myocardial infarction, cerebrovascular accident, and heart failure, and on CVD mortality. This study provides updated insights into the long-term CV effects of bariatric surgery, an increasingly common intervention for obesity.
Collapse
Affiliation(s)
- Harshith Chandrakumar
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | - Nazima Khatun
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | - Tanuj Gupta
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| | | | | | - Samy I McFarlane
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University Hospital, Brooklyn, USA
| |
Collapse
|
24
|
Leslie IS, Carson J, Bruce A. LGBTQ+ food insufficiency in New England. AGRICULTURE AND HUMAN VALUES 2022; 40:1-16. [PMID: 36530207 PMCID: PMC9735207 DOI: 10.1007/s10460-022-10403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
As a group, LGBTQ+ people experience food insecurity at a disproportionately high rate, yet food security scholars and practitioners are only beginning to uncover patterns in how food insecurity varies by subgroups of this diverse community. In this paper, we use data from the U.S. Census Bureau's Household Pulse Survey-which added measures of gender identity and sexuality for the first time in 2021-to analyze New Englanders' food insufficiency rates by gender, sexuality, race, and ethnicity. We find that (1) in the past seven days, 13.0 percent of LGB + (lesbian, gay, bisexual, and other non-heterosexual) New Englanders experience food insufficiency-which is nearly twice the rate of heterosexual people-and 19.8 percent of transgender+ (transgender, genderqueer, gender non-binary, and other non-cisgender people) New Englanders experience food insufficiency-which is two to three times the rate of cisgender men and women. (2) Whereas cisgender New Englanders experience food insufficiency at a lower rate than their counterparts in the rest of the nation (about two percentage points lower for both cisgender men and women), transgender+ New Englanders experience no such New England advantage compared to transgender+ people in the country as a whole. (3) LGBTQ+ New Englanders of color experience devastatingly high rates of food insufficiency, with, for example, one in three Black transgender+ New Englanders not having enough food to eat in the past seven days. These findings suggest that addressing food insecurity in New England demands approaching the problem with an intersectional queer lens, with attention to the ways in which racism, cissexism, and heterosexism are creating a systemic, ongoing food crisis for LGBTQ+ New Englanders, especially those who are transgender+ and/or people of color.
Collapse
Affiliation(s)
- Isaac Sohn Leslie
- University of Vermont Extension, 130 Austine Dr. #300, Brattleboro, VT 05301 USA
| | - Jessica Carson
- Carsey School of Public Policy, University of New Hampshire, 73 Main Street, Durham, NH 03824 USA
| | - Analena Bruce
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, 129 Main Street, Durham, NH 03824 USA
| |
Collapse
|
25
|
Chaparro MP, Cruthirds S, Bell CN, Wallace ME. State-Level Socioeconomic Racial Inequity and Food Insecurity in the U.S. Am J Prev Med 2022; 63:971-978. [PMID: 35961812 DOI: 10.1016/j.amepre.2022.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Racial inequities in food insecurity have been documented for the past 2 decades in the U.S., with the prevalence of food insecurity among Black households being 2-3 times higher than that among White households across time. The purpose of this study was to determine the association between socioeconomic indicators of structural racism at the state level and food insecurity among White and Black households in the U.S. METHODS This study is a secondary analysis of pooled, cross-sectional data from the Current Population Survey and the American Community Survey, 2015-2019 (N=158,551 Black and White households). Data analysis occurred in 2021-2022. The outcome was household food insecurity, and the exposure was structural racism indicators, operationalized as state-level racial inequities in income, earnings, education, unemployment, and home ownership. Individual-, household-, and state-level sociodemographic covariates were included. RESULTS Among Black households, state-level racial inequities in income, unemployment, and home ownership were associated with 34% (OR=1.34; 95% CI=1.05, 1.70), 14% (OR=1.14; 95% CI=1.02, 1.28), and 11% (OR=1.11; 95% CI=1.05, 1.16) higher odds of food insecurity, respectively. For White households, state-level racial inequities in income, education, unemployment, and home ownership were associated with 21% (OR=0.79; 95% CI=0.63, 0.98), 27% (OR=0.73; 95% CI=0.66, 0.85), 10% (OR=0.90; 95% CI=0.82, 0.98), and 8% (OR=0.92; 95% CI=0.89, 0.95) lower odds of food insecurity, respectively. CONCLUSIONS Structural racism may be a key driver of food insecurity among Black households and may be protective against food insecurity among White households. Implementing policies addressing state-level racial inequity in socioeconomic indicators could be effective at reducing racial inequities in food insecurity.
Collapse
Affiliation(s)
- M Pia Chaparro
- Department of Social, Behavioral, and Population Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana.
| | - Sarah Cruthirds
- Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Maeve E Wallace
- Department of Social, Behavioral, and Population Sciences, School of Public Health & Tropical Medicine, Tulane University, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, Louisiana
| |
Collapse
|
26
|
Aris IM, Perng W, Dabelea D, Padula AM, Alshawabkeh A, Vélez-Vega CM, Aschner JL, Camargo CA, Sussman TJ, Dunlop AL, Elliott AJ, Ferrara A, Zhu Y, Joseph CLM, Singh AM, Hartert T, Cacho F, Karagas MR, North-Reid T, Lester BM, Kelly NR, Ganiban JM, Chu SH, O’Connor TG, Fry RC, Norman G, Trasande L, Restrepo B, James P, Oken E. Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children. JAMA Netw Open 2022; 5:e2247957. [PMID: 36547983 PMCID: PMC9857328 DOI: 10.1001/jamanetworkopen.2022.47957] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Importance Physical and social neighborhood attributes may have implications for children's growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. Objective To examine associations of neighborhood-level measures of opportunity and social vulnerability with trajectories of BMI and obesity risk from birth to adolescence. Design, Setting, and Participants This cohort study used data from 54 cohorts (20 677 children) participating in the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to January 1, 2022. Participant inclusion required at least 1 geocoded residential address and anthropometric measure (taken at the same time or after the address date) from birth through adolescence. Data were analyzed from February 1 to June 30, 2022. Exposures Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) linked to geocoded residential addresses at birth and in infancy (age range, 0.5-1.5 years), early childhood (age range, 2.0-4.8 years), and mid-childhood (age range, 5.0-9.8 years). Main Outcomes and Measures BMI (calculated as weight in kilograms divided by length [if aged <2 years] or height in meters squared) and obesity (age- and sex-specific BMI ≥95th percentile). Based on nationwide distributions of the COI and SVI, Census tract rankings were grouped into 5 categories: very low (<20th percentile), low (20th percentile to <40th percentile), moderate (40th percentile to <60th percentile), high (60th percentile to <80th percentile), or very high (≥80th percentile) opportunity (COI) or vulnerability (SVI). Results Among 20 677 children, 10 747 (52.0%) were male; 12 463 of 20 105 (62.0%) were White, and 16 036 of 20 333 (78.9%) were non-Hispanic. (Some data for race and ethnicity were missing.) Overall, 29.9% of children in the ECHO program resided in areas with the most advantageous characteristics. For example, at birth, 26.7% of children lived in areas with very high COI, and 25.3% lived in areas with very low SVI; in mid-childhood, 30.6% lived in areas with very high COI and 28.4% lived in areas with very low SVI. Linear mixed-effects models revealed that at every life stage, children who resided in areas with higher COI (vs very low COI) had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographic and prenatal characteristics. For example, among children with obesity at age 10 years, the risk ratio was 0.21 (95% CI, 0.12-0.34) for very high COI at birth, 0.31 (95% CI, 0.20-0.51) for high COI at birth, 0.46 (95% CI, 0.28-0.74) for moderate COI at birth, and 0.53 (95% CI, 0.32-0.86) for low COI at birth. Similar patterns of findings were observed for children who resided in areas with lower SVI (vs very high SVI). For example, among children with obesity at age 10 years, the risk ratio was 0.17 (95% CI, 0.10-0.30) for very low SVI at birth, 0.20 (95% CI, 0.11-0.35) for low SVI at birth, 0.42 (95% CI, 0.24-0.75) for moderate SVI at birth, and 0.43 (95% CI, 0.24-0.76) for high SVI at birth. For both indices, effect estimates for mean BMI difference and obesity risk were larger at an older age of outcome measurement. In addition, exposure to COI or SVI at birth was associated with the most substantial difference in subsequent mean BMI and risk of obesity compared with exposure at later life stages. Conclusions and Relevance In this cohort study, residing in higher-opportunity and lower-vulnerability neighborhoods in early life, especially at birth, was associated with a lower mean BMI trajectory and a lower risk of obesity from childhood to adolescence. Future research should clarify whether initiatives or policies that alter specific components of neighborhood environment would be beneficial in preventing excess weight in children.
Collapse
Affiliation(s)
- Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts
| | - Carmen M. Vélez-Vega
- UPR Medical Sciences Campus, University of Puerto Rico Graduate School of Public Health, San Juan
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, University of Wisconsin–Madison, Madison
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ferdinand Cacho
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Tiffany North-Reid
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Barry M. Lester
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, University of Oregon, Eugene
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia
| | - Su H. Chu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Gwendolyn Norman
- Institute for Environmental Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Bibiana Restrepo
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento
- MIND Institute, University of California Davis, Sacramento, California
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
27
|
Pollock S, Swamy MR, Tremblay ES, Shen L. Acanthosis nigricans in the pediatric population: a narrative review of the current approach to management in primary care. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2022; 5:42. [PMID: 36420374 PMCID: PMC9678372 DOI: 10.21037/pm-21-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective This narrative review aims to provide readers with a comprehensive overview of the current literature of acanthosis nigricans (AN) in the pediatric and adolescent population, including best practices for identifying the condition, with a focus on the recommended management in the primary care setting to enable early and enhanced intervention. Background AN is frequently seen in obese and overweight children and adolescents. Current research suggests an association with insulin resistance, type 2 diabetes mellitus, and obesity, and often primary care physicians are the first point of contact for individuals with this dermatologic condition. However, identifying the condition at an early stage may be difficult. Methods We identified case and cross-sectional studies, clinical trials, and literature reviews of pediatric AN for ages 0 to 18 years in the United States and internationally. We considered publications for background from before the year 2000 and publications for approach to management from after the year 2000. Conclusions AN in the pediatric population can be a harbinger for underlying metabolic syndrome and insulin resistance. A thorough investigation and appropriate screening of children at risk, with a focus on early identification of the dermatologic condition and its associated comorbidities in the primary care setting, and early treatment is recommended to prevent long term consequences and decrease the risk of cardiovascular complications.
Collapse
Affiliation(s)
- Samara Pollock
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Lisa Shen
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
28
|
Zare H, Gilmore DR, Meyerson NS, Thorpe RJ. Income Inequality, Race/Ethnicity, and Obesity in U.S. Men 20 Years and Older: 1999 to 2016. Am J Mens Health 2022; 16:15579883221123852. [PMID: 36305637 PMCID: PMC9619283 DOI: 10.1177/15579883221123852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Obesity is a significant public health problem globally and within the United States. It varies by multiple factors, including but not limited to income. The literature indicates little evidence of the association between income and obesity. We examined the association between income and obesity in U.S. adult men ages 20 years and older and tested racial and ethnic differences. We used data from the 1999 to 2016 National Health and Nutrition Examination Surveys for analyses. Obesity was determined using body mass index ≥30 kg/m2. We used poverty income ratio (PIR) as a proxy for income and calculated the Gini coefficient (GC) to measure income inequality. We then categorized low-, medium-, and high PIR to examine the relationship between income inequality and obesity. We used Modified Poisson regression in a sample of 17,238 adult men, including 9,511 White Non-Hispanic White (NHW), 4,166 Non-Hispanic Black (NHB), and 3,561 Mexican Americans (MA). We controlled the models for age category, racial and ethnic groups, marital status, education, health behaviors, health insurance coverage, self-reported health, comorbidity, and household structure. Results of our adjusted models suggested a positive and significant association between PIR and obesity among NHWs and NHBs in medium and high PIR; this association was not significant in MAs. Results of our analyses using GC in obese men indicate that compared with NHWs (GC: 0.306, SE: 0.004), MAs (GC: 0.368, SE: 0.005), and NHBs (GC: 0.328, SE: 0.005) had experienced higher-income inequality. In treating obesity, policymakers should consider race/ethnicity strategies to reduce inequality in income.
Collapse
Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,The School of Business, University of Maryland Global Campus, Adelphi, MD, USA,Hossein Zare, Assistant Scientist, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 337, Baltimore, MD 21205, USA.
| | - Danielle R. Gilmore
- Trachtenberg School of Public Policy & Administration, The George Washington University, Washington, DC, USA,Department of Health, Behavior, and Society Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Meyerson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
29
|
Suppakittpaisarn P, Charoenlertthanakit N, Yaipimol E, Surinseng V, Wanitchayapaisit C, Kim G. Relationship between the Duration of Urban Nature and a Lower Waist-Hip Ratio. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11606. [PMID: 36141879 PMCID: PMC9517536 DOI: 10.3390/ijerph191811606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Obesity is a prevalent health issue. Evidence suggests that the availability of urban nature may reduce the risks of obesity. However, several knowledge gaps remain. This study explores the relationships between the dose (distance, duration and frequency) of urban nature and demographic factors towards obesity risks among people in Thailand. A total of 111 participants in three urban and peri-urban nature locations answered a survey regarding their distance from green spaces, frequency of visits, and duration of their typical stay, as well as their socio-demographics, and waist-hip ratio (WHR). The results suggested that at least 1-2 h per typical visit to nature predicted low-risk WHR in women. Male participants are more likely to have a high-risk WHR. Increasing age predicted low-risk WHR. Spending more time in green spaces predicted lower odds of high-risk WHR, while distance did not predict the odds. This research is one of the first to study the relationship between time spent in nature and obesity, and one of the first nature and health studies conducted in Thailand. Given that Thailand is one of the countries most affected by obesity in Southeast Asia, this study is relevant and essential. Future research should explore the quality factors of the park with longer duration of stay.
Collapse
Affiliation(s)
- Pongsakorn Suppakittpaisarn
- Landscape Design and Environmental Management Studio, Faculty of Agriculture, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
| | - Nadchawan Charoenlertthanakit
- Landscape Design and Environmental Management Studio, Faculty of Agriculture, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
- Department of Biology, Faculty of Sciences, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
| | - Ekachai Yaipimol
- Landscape Design and Environmental Management Studio, Faculty of Agriculture, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
| | - Vipavee Surinseng
- Landscape Design and Environmental Management Studio, Faculty of Agriculture, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
| | - Chulalux Wanitchayapaisit
- Landscape Design and Environmental Management Studio, Faculty of Agriculture, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
- Department of Environmental Engineering, Faculty of Engineering, Chiang Mai University, Mueang Chiang Mai, Chiang Mai 50200, Thailand
| | - Gunwoo Kim
- Graduate School of Urban Studies, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| |
Collapse
|
30
|
Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01381-9. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
Collapse
Affiliation(s)
- Belinda L Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kristi L Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA, USA
| | - Jana L Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
31
|
Qiu Y, Liao K, Zou Y, Huang G. A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10069. [PMID: 36011701 PMCID: PMC9408714 DOI: 10.3390/ijerph191610069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.
Collapse
Affiliation(s)
- Yanrong Qiu
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Kaihuai Liao
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Yanting Zou
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou 510060, China
| | - Gengzhi Huang
- School of Geography and Planning, Sun Yat-sen University, Guangzhou 510275, China
| |
Collapse
|
32
|
Fornander MJ, Roberts T, Egan AM, Moser CN. Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth. Child Obes 2022; 18:228-236. [PMID: 34762510 DOI: 10.1089/chi.2021.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the association of weight status with medication use and recreational activities among treatment-naïve, pediatric TGD patients. Methods: This study is a chart review of 277 patients [aged 9-18 years, 79.1% female sex assigned at birth (SAB), and 86.3% white] seen at a medical center from 2017 to 2020. BMI was calculated by age and SAB using CDC growth charts. BMI percentile (BMI%) and BMI z-score (BMIz) were used to define weight status. Results: By BMI% category, 3.6% patients were in the underweight range (BMI <5%); 50.5% had BMI >85%; and 30.3% had BMI >95%. Overweight and obesity rates were higher than national norms (χ2 = 15.152, p < 0.01). Female SAB participants had higher BMIz values than male SAB participants. Youth who reported watching/listening to media (t = 3.50, p < 0.01) and parent-reported creative arts involvement (t = 1.97, p = 0.05) were associated with higher BMIz values. Conversely, spending time with friends and family was associated with a lower BMIz. Over half of the patients were prescribed medications, and those patients taking medications had higher BMIz values than those not taking medications (t = -1.96, p < 0.05). Female SAB, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal conditions were associated with elevated BMIz. Conclusions: Overweight/obesity is a common problem among TGD youth. TGD youth should be considered a high-risk group and targeted in obesity prevention and treatment efforts. Interventions to decrease sedentary activities and improve connections with friends and family are promising strategies to address overweight and obesity among TGD youth.
Collapse
Affiliation(s)
- Mirae J Fornander
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Timothy Roberts
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Anna M Egan
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christine N Moser
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
33
|
Dombrowski RD, Hill AB, Bode B, Knoff KAG, Dastgerdizad H, Kulik N, Mallare J, Blount-Dorn K, Bynum W. Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting. Nutrients 2022; 14:2130. [PMID: 35631271 PMCID: PMC9145022 DOI: 10.3390/nu14102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit's healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.
Collapse
Affiliation(s)
- Rachael D. Dombrowski
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Alex B. Hill
- Center for Urban Studies, College of Liberal Arts and Science, Urban Health, Wayne State University, Detroit, MI 48202, USA;
| | - Bree Bode
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Kathryn A. G. Knoff
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Hadis Dastgerdizad
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Noel Kulik
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - James Mallare
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | | | - Winona Bynum
- Detroit Food Policy Council, Detroit, MI 48226, USA; (K.B.-D.); (W.B.)
| |
Collapse
|
34
|
Gaglioti AH, Rivers D, Ringel JB, Judd S, Safford MM. Individual and Neighborhood Influences on the Relationship Between Waist Circumference and Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke Study. Prev Chronic Dis 2022; 19:E20. [PMID: 35446759 PMCID: PMC9044900 DOI: 10.5888/pcd19.210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of this study was to describe how the relationship between waist circumference and incident coronary heart disease (CHD) is influenced by individual and neighborhood factors in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. METHODS REGARDS is a cohort study of 30,239 US adults. The primary exposure was sex-specific quartiles of waist circumference. Individual covariates included sociodemographic characteristics, health status, health behavior, and usual source of care. Neighborhood (ie, zip code-level) covariates included access to primary care, poverty, rurality, and racial segregation. The main outcome was incident CHD from baseline (2003) through 2017. We used descriptive statistics, Kaplan-Meier curves, and Cox proportional hazard models to analyze the overall sample and race-sex subgroups. RESULTS During the study period, 23,042 study participants had 1,499 CHD events. We found a higher risk of incident CHD in the upper quartile of waist circumference compared with the first quartile in all 4 race-sex subgroups except African American men, among whom we found no relationship between waist circumference and incident CHD. Covariates did not attenuate these relationships. CONCLUSION In all groups except African American men, waist circumference in the highest quartile was associated with increased risk of incident CHD. Individual and neighborhood factors did not influence the relationship between waist circumference and development of CHD but differentially influenced incident CHD among race-sex subgroups.
Collapse
Affiliation(s)
- Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr SW; Atlanta, GA 30310.
| | - Desiree Rivers
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Joanna Bryan Ringel
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell School of Medicine, New York, New York
| |
Collapse
|
35
|
Mackey ER, Burton ET, Cadieux A, Getzoff E, Santos M, Ward W, Beck AR. Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth. Child Obes 2022; 18:75-83. [PMID: 34491828 DOI: 10.1089/chi.2021.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.
Collapse
Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Center for Translational Research, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adelle Cadieux
- Department of Behavioral Health, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing MI, USA
| | - Elizabeth Getzoff
- Department of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children's, Hartford, CT, USA
| | - Wendy Ward
- Department of Pediatrics, College of Medicine, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Amy R Beck
- Center for Children's Healthy Lifestyles and Nutrition and Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
| |
Collapse
|
36
|
Responding to Health Disparities in Behavioral Weight Loss Interventions and COVID-19 in Black Adults: Recommendations for Health Equity. J Racial Ethn Health Disparities 2022; 9:739-747. [PMID: 35192179 PMCID: PMC8862701 DOI: 10.1007/s40615-022-01269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022]
Abstract
COVID-19 has disproportionately impacted Black adults with high prevalence and mortality rates. Obesity is a central factor in the severity of COVID-19 and related treatment. Behavioral weight loss interventions are an efficacious treatment for obesity, but consistently, Black men and women are minimally represented, and weight loss outcomes are less than clinically significant thresholds. This commentary draws parallels between COVID-19 racial disparities, disparate obesity rates, weight loss treatment outcomes, and underlying systemic racial context. This paper also indicates paths forward to address racialized societal norms in obesity treatment to advance health equity in obesity and reduce acute disease vulnerability. Recommendations for behavioral medicine practice and policy include (1) expanding the research lens to prioritize Black scholars and institutions to generate innovative research questions, (2) creating trustworthy relationships with Black community members to bolster recruitment and retention, (3) employing qualitative methods to facilitate better intervention design and uncover influences of racialized social context, (4) centering Black adults in weight loss interventions, and (5) using multilevel approaches that integrate policy into interventions. Moving forward, this commentary aims to make plain the multilayered form and function of racism, its impact on COVID-19 and obesity, and offer pathways to improve behavioral weight loss interventions that can produce more equitable outcomes.
Collapse
|
37
|
Differential impact of telehealth extended-care programs for weight-loss maintenance in African American versus white adults. J Behav Med 2022; 45:580-588. [DOI: 10.1007/s10865-022-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
|
38
|
Larrabee Sonderlund A, Charifson M, Schoenthaler A, Carson T, Williams NJ. Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction. PLoS One 2022; 17:e0262962. [PMID: 35089963 PMCID: PMC8797220 DOI: 10.1371/journal.pone.0262962] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.
Collapse
Affiliation(s)
- Anders Larrabee Sonderlund
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mia Charifson
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Traci Carson
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York, New York, United States of America
| |
Collapse
|
39
|
Kurani SS, Heien HC, Sangaralingham LR, Inselman JW, Shah ND, Golden SH, McCoy RG. Association of Area-Level Socioeconomic Deprivation With Hypoglycemic and Hyperglycemic Crises in US Adults With Diabetes. JAMA Netw Open 2022; 5:e2143597. [PMID: 35040969 PMCID: PMC8767428 DOI: 10.1001/jamanetworkopen.2021.43597] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Social determinants of health play a role in diabetes management and outcomes, including potentially life-threatening complications of severe hypoglycemia and diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS). Although several person-level socioeconomic factors have been associated with these complications, the implications of area-level socioeconomic deprivation are unknown. OBJECTIVE To examine the association between area-level deprivation and the risks of experiencing emergency department visits or hospitalizations for hypoglycemic and hyperglycemic crises (ie, DKA or HHS). DESIGN, SETTING, AND PARTICIPANTS This cohort study used deidentified administrative claims data for privately insured individuals and Medicare Advantage beneficiaries across the US. The analysis included adults with diabetes who met the claims criteria for diabetes between January 1, 2016, and December 31, 2017. Data analyses were performed from November 17, 2020, to November 11, 2021. EXPOSURES Area deprivation index (ADI) was derived for each county for 2016 and 2017 using 17 county-level indicators from the American Community Survey. ADI values were applied to patients who were living in each county based on their index dates and were categorized according to county-level ADI quintile (with quintile 1 having the least deprivation and quintile 5 having the most deprivation). MAIN OUTCOMES AND MEASURES The numbers of emergency department visits or hospitalizations related to the primary diagnoses of hypoglycemia and DKA or HHS (ascertained using validated diagnosis codes in the first or primary position of emergency department or hospital claims) between 2016 and 2019 were calculated for each ADI quintile using negative binomial regression models and adjusted for patient age, sex, health plan type, comorbidities, glucose-lowering medication type, and percentage of White residents in the county. RESULTS The study population included 1 116 361 individuals (563 943 women [50.5%]), with a mean (SD) age of 64.9 (13.2) years. Of these patients, 343 726 (30.8%) resided in counties with the least deprivation (quintile 1) and 121 810 (10.9%) lived in counties with the most deprivation (quintile 5). Adjusted rates of severe hypoglycemia increased from 13.54 (95% CI, 12.91-14.17) per 1000 person-years in quintile 1 counties to 19.13 (95% CI, 17.62-20.63) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.41 (95% CI, 1.29-1.54; P < .001). Adjusted rates of DKA or HHS increased from 7.49 (95% CI, 6.96-8.02) per 1000 person-years in quintile 1 counties to 8.37 (95% CI, 7.50-9.23) per 1000 person-years in quintile 5 counties, corresponding to an incidence rate ratio of 1.12 (95% CI, 1.00-1.25; P = .049). CONCLUSIONS AND RELEVANCE This study found that living in counties with a high area-level deprivation was associated with an increased risk of severe hypoglycemia and DKA or HHS. The concentration of these preventable events in areas of high deprivation signals the need for interventions that target the structural barriers to optimal diabetes management and health.
Collapse
Affiliation(s)
- Shaheen Shiraz Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Herbert C. Heien
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Lindsey R. Sangaralingham
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
- OptumLabs, Eden Prairie, Minnesota
| | - Jonathan W. Inselman
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Nilay D. Shah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
- Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
40
|
Abstract
Social and political policy, human activities, and environmental change affect the ways in which microbial communities assemble and interact with people. These factors determine how different social groups are exposed to beneficial and/or harmful microorganisms, meaning microbial exposure has an important socioecological justice context. Therefore, greater consideration of microbial exposure and social equity in research, planning, and policy is imperative. Here, we identify 20 research questions considered fundamentally important to promoting equitable exposure to beneficial microorganisms, along with safeguarding resilient societies and ecosystems. The 20 research questions we identified span seven broad themes, including the following: (i) sociocultural interactions; (ii) Indigenous community health and well-being; (iii) humans, urban ecosystems, and environmental processes; (iv) human psychology and mental health; (v) microbiomes and infectious diseases; (vi) human health and food security; and (vii) microbiome-related planning, policy, and outreach. Our goal was to summarize this growing field and to stimulate impactful research avenues while providing focus for funders and policymakers.
Collapse
|
41
|
Maudrie TL, Nguyen CJ, Jernigan VBB, Lessard KH, Richardson D, Gittelsohn J, O’Keefe VM. Impacts of COVID-19 on a Food Security Study with the Baltimore Native Community. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:8-31. [PMID: 35881979 PMCID: PMC9351982 DOI: 10.5820/aian.2902.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urban American Indian/Alaska Native peoples experience disproportionate levels of food insecurity when compared to the general US population. Through a collaborative research partnership between Native American Lifelines of Baltimore, an Urban Indian Health Program, and a Johns Hopkins Bloomberg School of Public Health student-led research team, food security was identified as a priority issue. A sequential explanatory mixed methods study was planned to explore food security and food sovereignty in the Baltimore Native community prior to the COVID-19 pandemic. Due to the local impact of COVID-19, a community-based participatory research approach guided the community-academic team to revise the original study and increase understanding of how the pandemic impacted food security in the community. This article highlights the lessons learned and strengths of using a community-based participatory approach to guide adaptations made due to COVID-19 to this research study. By utilizing a co-learning approach and emphasizing flexibility, we were able to collaboratively collect meaningful data to drive future community solutions to food insecurity while building an evidence base for policy changes to better support urban Native food security.
Collapse
Affiliation(s)
- Tara L. Maudrie
- Center for American Indian Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Cassandra J. Nguyen
- Institute for Research and Education to Advance Community Health in the Department of Medical Education and Clinical Sciences at Washington State University in Spokane, WA
| | | | | | | | - Joel Gittelsohn
- Center for Human Nutrition in the Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Victoria M. O’Keefe
- Center for American Indian Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| |
Collapse
|
42
|
Nair SS, Chakravarty D, Dovey ZS, Zhang X, Tewari AK. Why do African-American men face higher risks for lethal prostate cancer? Curr Opin Urol 2022; 32:96-101. [PMID: 34798639 PMCID: PMC8635247 DOI: 10.1097/mou.0000000000000951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW African-American men in the USA have a higher incidence of and mortality from prostate cancer (PCa), with a longstanding debate about the cause for these worse outcomes. This review examines differences in tumour biology and socioeconomics for African-American and Non-Hispanic White (NHW) men to answer the question 'why AA men face higher risks for lethal PCa' and draw a management consensus to redress the imbalance. RECENT FINDINGS Recent evidence from over the past 2 years suggests the reasons why African-American men face a higher risk of lethal PCa are multifactorial, with contributions from differences in tumour biology as well as socioeconomic and healthcare access factors. Regarding tumour biology, genomic and transcriptome profiling suggests African-American men have upregulated expression of genes related to inflammatory pathways with downregulation of DNA repair genes. In contrast, NHW men have higher DNA repair pathways and metabolic pathways involving glycolysis and cell cycle activity. In addition, epidemiological evidence suggests equal healthcare access ensures equal PCa specific outcomes, implying African-American men's disease is not inherently more lethal. However, differences in tumour biology remain, which may explain specific differences in PCa incidence and the clinical findings of African-American men's increased response to immunotherapy and radiotherapy in recent trials. SUMMARY Regardless of racial differences in disease outcomes and the factors causing them, African-American and NHW men seem to have diseases unique to their ancestry. This supports the exploration of personalized PCa treatment approaches, leveraging translational basic science research to uncover these differences and devise specific individualized methods therapeutic regimes to address them.
Collapse
Affiliation(s)
- Sujit S Nair
- The Department of Urology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York, USA
| | | | | | | | | |
Collapse
|
43
|
Examining the influence of positive childhood experiences on childhood overweight and obesity using a national sample. Prev Med 2022; 154:106907. [PMID: 34864065 DOI: 10.1016/j.ypmed.2021.106907] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/08/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022]
Abstract
Positive childhood experiences (PCEs) promote healthy social development, improve overall wellness, and help to moderate and prevent exposure to adverse childhood experiences. There has been limited research examining the association between positive childhood experiences and overweight or obesity status in children. The purpose of this study was to examine whether experiencing positive childhood experiences are associated with lower rates of overweight or obesity status in children between 10 and 17 years of age, using cross-sectional data from the 2018-2019 National Survey of Children's Health (n = 28,771), a nationally representative mail and online survey. Frequencies, proportions, and unadjusted associations for each variable were calculated using descriptive statistics and bivariate analyses. To examine the association between overweight or obesity and PCEs, multivariable regression models were used. Compared to children who were underweight or had a healthy weight, children who were overweight or obese were less likely to: participate after school activities (78.1%, p < 0.0001), volunteer in their community, school, or church (45.6%, p < 0.0001), have a mentor they feel comfortable going to for guidance (87.0%, p = 0.02), live in a safe neighborhood (61.3%, p < 0.0001), live in a supportive neighborhood (50.4%, p < 0.0001), and to live with a resilient family (78.3%; p = 0.0099). In adjusted analysis, among children exposed to two or more ACEs, children residing in a supportive neighborhood were less likely to be overweight or obese (aOR 0.87; 0.77-0.98). Our findings suggest that certain PCEs may mitigate overweight and obesity when children have experienced at least some childhood trauma.
Collapse
|
44
|
Logan AC, Berman BM, Prescott SL. Earth Dreams: Reimagining ARPA for Health of People, Places and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12788. [PMID: 34886514 PMCID: PMC8657388 DOI: 10.3390/ijerph182312788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022]
Abstract
Bold new approaches are urgently needed to overcome global health challenges. The proposed Advanced Research Projects Agency for Health (ARPA-H) is intended to provide rapid health breakthroughs. While new technologies for earlier disease detection and more effective treatment are critical, we urge equal attention be given to the wider (physical, emotional, social, political, and economic) environmental ecosystems driving the non-communicable disease (NCD) crisis in the first place. This requires an integrated, cross-sectoral vision that spans the interwoven connections affecting health across the scales of people, places, and planet. This wider "exposome" perspective considers biopsychosocial factors that promote resilience and reduce vulnerabilities of individuals and communities over time-the many variables driving health disparities. Since life course health is strongly determined by early life environments, early interventions should be prioritized as a matter of effectiveness and social justice. Here, we explore the origins of the Advanced Research Project Agency and point to its potential to build integrated solutions, with wisdom and ethical value systems as a compass. Since the planned ARPA-H is anticipated to spawn international collaborations, the imagined concept is of relevance to a broad audience of researchers. With appropriate input, the quest for health equity through personalized, precision medicine while deconstructing unacceptable structural inequities may be accelerated.
Collapse
Affiliation(s)
- Alan C. Logan
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
| | - Brian M. Berman
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Susan L. Prescott
- Nova Institute for Health of People, Places and Planet, 1407 Fleet Street, Baltimore, MD 21231, USA; (A.C.L.); (B.M.B.)
- Center for Integrative Medicine, Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- inVIVO Planetary Health, Worldwide Universities Network (WUN), Baltimore, MD 21231, USA
- ORIGINS Project, Telethon Kids Institute, Perth Children’s Hospital, University of Western Australia, 15 Hospital Avenue, Nedlands, WE 6009, Australia
| |
Collapse
|
45
|
Do DP, Zheng C. Examining the impacts of neighborhood poverty on bodyweight across the BMI distribution: a quantile and MSM modeling approach. Ann Epidemiol 2021; 64:33-40. [PMID: 34500084 PMCID: PMC11321882 DOI: 10.1016/j.annepidem.2021.08.024] [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: 02/10/2021] [Revised: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Given that the relationships between higher BMI and adverse health outcomes are nonconstant and most pronounced at either ends of the BMI distribution, we assess the association between neighborhood poverty and BMI at multiple points along the BMI distribution. METHODS Using data from the 1999 to 2015 Panel Study of Income Dynamics of Black and White adults in the United States, we estimate quantile regression models while jointly applying a marginal structural modeling approach to account for time-varying individual-level factors that may be simultaneously mediators as well as confounders. RESULTS Neighborhood poverty was not found to be associated with bodyweight at any point along the BMI distribution for Black or White males. However, high neighborhood poverty, compared to low neighborhood poverty, predicted increases in bodyweight for Black females at the lower end of the BMI distribution and for White females at the higher end of the BMI distribution. No association was found between neighborhood poverty and BMI at the mean. CONCLUSIONS Results identify the most vulnerable subgroups, suggesting that White females at the higher end of the BMI distribution as well as Black females at the lower end of the BMI distribution are particularly sensitive to obesogenic environments.
Collapse
Affiliation(s)
- D Phuong Do
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI.
| | - Cheng Zheng
- University of Nebraska Medical Center, Department of Biostatistics, Omaha, NE 68198
| |
Collapse
|
46
|
Zare H, Gilmore DR, Creighton C, Azadi M, Gaskin DJ, Thorpe RJ. How Income Inequality and Race/Ethnicity Drive Obesity in U.S. Adults: 1999-2016. Healthcare (Basel) 2021; 9:1442. [PMID: 34828490 PMCID: PMC8618490 DOI: 10.3390/healthcare9111442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 02/08/2023] Open
Abstract
Obesity is a major public health problem both globally and within the U.S. It varies by multiple factors, including but not limited to income and sex. After controlling for potential covariates, there is little evidence to determine the association between income and obesity and how obesity may be moderated by sex and family income. We examined the association between income and obesity in U.S. adults aged 20 years and older, and tested whether this relationship differs by race or ethnicity groups. For this analysis, we used data from the 1999-2016 National Health and Nutrition Examination Surveys (NHANES). Obesity was determined using Body Mass Index ≥ 30 kg/m2; the Gini coefficient (GC) was calculated to measure income inequality using the Poverty Income Ratio (PIR). We categorized the PIR into five quintiles to examine the relationship between income inequality and obesity. For the first set of analyses, we used a modified Poisson regression in a sample of 36,665 adults, with an almost equal number of men and women (women's ratio was 50.6%), including 17,303 white non-Hispanics (WNH), 7475 black non-Hispanics (BNHs), and 6281 Mexican Americans. The models included age, racial/ethnic groups, marital status, education, health behaviors (smoking and drinking status and physical activities), health insurance coverage, self-reported health, and household structure (live alone and size of household). Adjusting for potential confounders, our findings showed that the association between PIR and obesity was positive and significant more frequently among WNH and BNH in middle and top PIR quintiles than among lower-PIR quintiles; this association was not significant in Mexican Americans (MAs). Results of GC in obese women showed that in comparison with WNHs (GC: 0.34, S.E.: 0.002), BNHs (GC: 0.38, S.E.: 0.004) and MAs (GC: 0.41, S.E.: 0.006) experienced higher income inequality, and that BNH obese men experienced the highest income inequality (GC: 0.45, S.E.: 0.011). The association between PIR and obesity was significant among WNHs and BNHs men in the 3rd, 4th and 5th PIR quintiles. The same association was not found for women. In treating obesity, policymakers should consider not only race/ethnicity and sex, but also strategies to reduce inequality in income.
Collapse
Affiliation(s)
- Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Global Health Services and Administration, University of Maryland Global Campus (UMGC), Largo, MD 20774, USA
| | - Danielle R Gilmore
- Trachtenberg School of Public Policy and Administration, George Washington University, Washington, DC 20052, USA
| | - Ciana Creighton
- Office of the Deputy Mayor for Health and Human Services, DC Government, Washington, DC 20004, USA
| | - Mojgan Azadi
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
- Health Services Management, University of Maryland Global Campus (UMGC), Adelphi, MD 20774, USA
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
47
|
Hanna DB, Hua S, Gonzalez F, Kershaw KN, Rundle AG, Van Horn LV, Wylie-Rosett J, Gellman MD, Lovasi GS, Kaplan RC, Mossavar-Rahmani Y, Shaw PA. Higher Neighborhood Population Density Is Associated with Lower Potassium Intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010716. [PMID: 34682466 PMCID: PMC8535329 DOI: 10.3390/ijerph182010716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022]
Abstract
Current U.S. dietary guidelines recommend a daily potassium intake of 3400 mg/day for men and 2600 mg/day for women. Sub-optimal access to nutrient-rich foods may limit potassium intake and increase cardiometabolic risk. We examined the association of neighborhood characteristics related to food availability with potassium intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). 13,835 participants completed a 24-h dietary recall assessment and had complete covariates. Self-reported potassium intake was calibrated with an objective 24-h urinary potassium biomarker, using equations developed in the SOL Nutrition & Physical Activity Assessment Study (SOLNAS, N = 440). Neighborhood population density, median household income, Hispanic/Latino diversity, and a retail food environment index by census tract were obtained. Linear regression assessed associations with 24-h potassium intake, adjusting for individual-level and neighborhood confounders. Mean 24-h potassium was 2629 mg/day based on the SOLNAS biomarker and 2702 mg/day using multiple imputation and HCHS/SOL biomarker calibration. Compared with the lowest quartile of neighborhood population density, living in the highest quartile was associated with a 26% lower potassium intake in SOLNAS (adjusted fold-change 0.74, 95% CI 0.59–0.94) and a 39% lower intake in HCHS/SOL (adjusted fold-change 0.61 95% CI 0.45–0.84). Results were only partially explained by the retail food environment. The mechanisms by which population density affects potassium intake should be further studied.
Collapse
Affiliation(s)
- David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Correspondence:
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Franklyn Gonzalez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Andrew G. Rundle
- Department of Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Linda V. Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA;
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics and Urban Health Collective, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Pamela A. Shaw
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA;
| |
Collapse
|
48
|
Mercado CI, McKeever Bullard K, Gregg EW, Ali MK, Saydah SH, Imperatore G. Differences in U.S. Rural-Urban Trends in Diabetes ABCS, 1999-2018. Diabetes Care 2021; 44:1766-1773. [PMID: 34127495 PMCID: PMC8686758 DOI: 10.2337/dc20-0097] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/08/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine changes in and the relationships between diabetes management and rural and urban residence. RESEARCH DESIGN AND METHODS Using National Health and Nutrition Examination Survey (1999-2018) data from 6,372 adults aged ≥18 years with self-reported diagnosed diabetes, we examined poor ABCS: A1C >9% (>75 mmol/mol), Blood pressure (BP) ≥140/90 mmHg, Cholesterol (non-HDL) ≥160 mg/dL (≥4.1 mmol/L), and current Smoking. We compared odds of urban versus rural residents (census tract population size ≥2,500 considered urban, otherwise rural) having poor ABCS across time (1999-2006, 2007-2012, and 2013-2018), overall and by sociodemographic and clinical characteristics. RESULTS During 1999-2018, the proportion of U.S. adults with diabetes residing in rural areas ranged between 15% and 19.5%. In 1999-2006, there were no statistically significant rural-urban differences in poor ABCS. However, from 1999-2006 to 2013-2018, there were greater improvements for urban adults with diabetes than for rural for BP ≥140/90 mmHg (relative odds ratio [OR] 0.8, 95% CI 0.6-0.9) and non-HDL ≥160 mg/dL (≥4.1 mmol/L) (relative OR 0.45, 0.4-0.5). These differences remained statistically significant after adjustment for race/ethnicity, education, poverty levels, and clinical characteristics. Yet, over the 1999-2018 time period, minority race/ethnicity, lower education attainment, poverty, and lack of health insurance coverage were factors associated with poorer A, B, C, or S in urban adults compared with their rural counterparts. CONCLUSIONS Over two decades, rural U.S. adults with diabetes have had less improvement in BP and cholesterol control. In addition, rural-urban differences exist across sociodemographic groups, suggesting that efforts to narrow this divide may need to address both socioeconomic and clinical aspects of care.
Collapse
Affiliation(s)
- Carla I Mercado
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- School of Public Health, Imperial College London, London, U.K
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sharon H Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
49
|
Rosenfield PJ, Pauselli L, Jiang D, Malaspina D. Letter to the Editor Regarding Concept of Race. Schizophr Bull 2021; 47:884-885. [PMID: 34128057 PMCID: PMC8266593 DOI: 10.1093/schbul/sbab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| |
Collapse
|
50
|
Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e984-e1010. [PMID: 33882682 PMCID: PMC8493650 DOI: 10.1161/cir.0000000000000973] [Citation(s) in RCA: 975] [Impact Index Per Article: 325.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
Collapse
|