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Introduction: Around 23% of adults worldwide are insufficiently active. Wearable devices paired with virtual coaching software could increase physical activity. The effectiveness of 3 minimal contact interventions (paper-based physical activity diaries, activity trackers, and activity trackers coupled with virtual coaching) in increasing physical activity energy expenditure and cardiorespiratory fitness were compared over 12 weeks among inactive adults.Methods: This was an open label, parallel-group RCT. Inactive adults (aged ≥18 years, N=488) were randomized to no intervention (Control; n=121), paper-based diary (Diary; n=124), activity tracker (Activity Band; n=122), or activity tracker plus virtual coaching (Activity Band PLUS; n=121) groups. Coprimary outcomes included 12-week changes in physical activity energy expenditure and fitness (May 2012-January 2014). Analyses were conducted in 2019-2020.Results: There were no differences between groups overall (physical activity energy expenditure: p=0.114, fitness: p=0.417). However, there was a greater increase in physical activity energy expenditure (4.21 kJ/kg/day, 95% CI=0.42, 8.00) in the Activity Band PLUS group than in the Diary group. There were also greater decreases in BMI and body fat percentage in the Activity Band PLUS group than in the Control group (BMI= -0.24 kg/m2, 95% CI= -0.45, -0.03; body fat= -0.48%, 95% CI= -0.88, -0.08) and in theActivity Band PLUS group than in the Diary group (BMI= -0.30 kg/m2, 95% CI= -0.50, -0.09; body fat= -0.57%, 95% CI= -0.97, -0.17).Conclusions: Coupling activity trackers with virtual coaching may facilitate increases in physical activity energy expenditure compared with a traditional paper‒based physical activity diary intervention and improve some secondary outcomes compared with a traditional paper‒based physical activity diary intervention or no intervention.Trial Registration: This study is registered at www.clinicaltrials.gov ISRCTN31844443. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history-based education and services to the general public. The authors developed the first cancer family history-based genomics training program in cancer prevention tailored for community health workers. This paper details the development and pilot testing findings of the training. Specifically, a multidisciplinary research team of geneticists, genetic counselors, health educators, community health workers, and community health worker instructors developed a 7-module, 6-hour, bilingual (English and Spanish) cancer family history-based training focusing on cancer family history-based risk assessment, lifestyle recommendations, and genetic evaluation and testing. The curriculum was based on an integrated theoretical framework, the National Comprehensive Cancer Network guidelines, the community health worker core competencies, and the 4MAT instructional model. The Texas Department of State Health Services approved and certified the curriculum with 2 delivery formats: in-person/face-to-face workshops and online training. A total of 34 community health workers completed the pilot training in person (n=17) and online (n=17) in 2018 and 2019. Participating community health workers' knowledge, attitudes, self-efficacy, and intention in delivering basic cancer family history-based genomics education and services significantly increased on the immediate post-test measures compared with their pretest data. Positive ratings and feedback were also reported by the community health workers. Findings from this pilot study suggest that wider training is warranted for educating more community health workers in the U.S. [ABSTRACT FROM AUTHOR]

Given the dangers posed by tobacco use and tobacco smoke exposure, pediatricians should address tobacco use and exposure with patients and parents at every opportunity, but this is not consistently done in practice. One reason may be that many medical residents do not receive education on how to address tobacco use and tobacco smoke exposure with patients and their parents. In a 2012 survey of U.S. pediatric program directors, 65% of programs reported covering tobacco control in their curricula, but most training programs focused on tobacco's health effects and not intervention strategies for clinical practice. Since that survey, electronic health records have been implemented broadly nationwide and utilized to address tobacco smoke exposure. Investigators surveyed U.S. program directors in 2018 and residents in 2019 to explore the ways in which the residents learn about tobacco use and tobacco smoke exposure, components and use of the electronic record specific to tobacco use and tobacco smoke exposure, and perceived resident effectiveness in this area. All the program directors and 85% of the residents valued training, but 21% of the residents reported receiving none. Moreover, a minority of the residents assessed themselves as effective at counseling parents (19%) or adolescents (23%), and their perceived effectiveness was related to small group learning and active learning workshops, modalities that were infrequently implemented in training. Respondents also reported infrequent use of electronic health record prompts regarding tobacco and the absence of prompts about critical issues (e.g., addressing tobacco smoke exposure in vehicles or other settings or offering treatment or referrals to parents who smoke). This paper provides recommendations about augmenting pediatric resident training in simple ways. [ABSTRACT FROM AUTHOR]

Introduction: Rapidly urbanizing communities in middle-income countries could be sources of vaccine hesitancy, and may create hot spots of low vaccination coverage. This study characterizes vaccine hesitancy in Shanghai and identifies disparities in vaccine safety and efficacy concerns by residency status-a marker for recent migration into the city.Methods: Parents of children aged ≤18 years from immunization clinics in Shanghai were enrolled in summer 2019, with the data analyzed during winter 2019-2020. The paper questionnaire used the Parental Attitudes towards Childhood Vaccines scale, which included questions about vaccine safety and efficacy concerns. The primary independent variable was residency-whether an individual was a Shanghai local or a recent migrant (i.e., non-local). Linear regression models assessed the relationship between residency and vaccine safety and efficacy concerns.Results: Among 1,021 participants, 65.4% had local residency, and the remainder were urban non-locals (13.1%) or rural non-locals (21.5%). A majority of parents expressed concerns about vaccine side effects (73.8%), vaccine safety (63.9%), and vaccine effectiveness (52.4%). Compared with locals, rural non-locals were more concerned about vaccine side effects (β=0.26, 95% CI=0.07, 0.46), vaccine safety (β=0.42, 95% CI=0.19, 0.65), and vaccine effectiveness (β=0.37, 95% CI=0.16, 0.58).Conclusions: Differences in vaccine hesitancy by residency could lead to geographical and sociodemographic disparities in vaccination coverage and outbreaks of vaccine-preventable disease.Supplement Information: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health. [ABSTRACT FROM AUTHOR]

Introduction: Previously, a web-based, patient-facing decision aid for lung cancer screening, shouldiscreen.com, was developed and evaluated. An initial evaluation was completed before the Medicare coverage decision and recruited a nondiverse sample of mostly former smokers, limiting the understanding of the potential effectiveness of the tool among diverse populations. This study evaluates shouldiscreen.com among African Americans in Metro Detroit.Methods: Using insights obtained from participatory workshops in this population, content changes to shouldiscreen.com were implemented, and this modified version was evaluated with a before-after study. Measures included knowledge of lung cancer screening, decisional conflict, and concordance between individual preference and screening eligibility. Surveys occurred between April and July 2018. Participants were contacted 6 months after the survey to assess subsequent screening behaviors. Analysis took place in 2019.Results: Data were collected from 74 participants aged 45-77 years, who were current/former smokers with no history of lung cancer. The average knowledge score increased by 25% from 5.7 (SD=1.94) before to 7.1 (SD=2.30) after (out of 13 points). Decisional conflict was halved between before and after. Concordance between individual preference and eligibility for screening increased from 22% (SD=41) to 35% (SD=47). Half of the participants felt uncomfortable answering surveys electronically and requested paper versions.Conclusions: The use of the tool led to small improvements in lung cancer screening knowledge and increased concordance with current recommendations. Additional design modifications and modes of information delivery of these decision aids should be considered to increase their efficacy in helping populations with lower educational attainment and computer literacy. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility.Study Design: This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015-February 2017 and analyzed in 2017.Setting/participants: A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%).Intervention: The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity.Main Outcome Measures: Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring.Results: The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (-1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs -14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity.Conclusions: Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy.Trial Registration: This study is registered at www.clinicaltrials.gov NCT03307187. [ABSTRACT FROM AUTHOR]

Introduction: Low levels of physical activity are associated with several noncommunicable diseases. In Mexico, 39.5% of adolescents do not meet WHO physical activity guidelines. Previous literature suggests an association between perception of safety and physical activity. This paper examines the association between perceived crime and pedestrian safety and physical activity in Mexican adolescents.Methods: This cross-sectional study used data from 4,079 adolescents aged 15-18 years in Mexico. Physical activity was measured with the Youth Physical Activity Questionnaire and was grouped into the following 5 domains: (1) moderate-to-vigorous physical activity, (2) sports activity, (3) leisure time activity, (4) physical education class, and (5) active commuting to school. Perception of safety was measured as pedestrian safety and crime safety, using the Neighborhood Environment Walkability Scale-Youth. Confirmatory factor analysis was performed to examine the construct validity of this scale on the Mexican population. Data were collected in 2017 and analyzed in 2018. Associations between physical activity and perception of safety were examined using linear regression models.Results: Low perception of pedestrian safety was associated with lower moderate-to-vigorous physical activity per week (coefficient= -0.12, 95% CI= -0.19, -0.05) and lower sports activity per week (coefficient= -0.13, 95% CI= -0.23, -0.03) in female adolescents. There was no association between perception of safety and physical activity among male adolescents.Conclusions: Pedestrian safety was negatively associated with moderate-to-vigorous physical activity and sports participation in female youth. Environments with better lighting, crosswalks, and walking/cycle trails could increase physical activity in female youth. [ABSTRACT FROM AUTHOR]

Introduction: Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida.Study Design: This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018.Setting/participants: Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex.Intervention: Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages.Main Outcome Measures: Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status.Results: Significant time effects only were found for daily fruit and vegetable intake (p<0.001), fat intake (p<0.001), and the Fat Screener (p<0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time (p<0.001) and the interaction between time and treatment (p<0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 (p=0.03).Conclusions: Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants.Trial Registration: This study is registered at www.clinicaltrials.govNCT03339050. [ABSTRACT FROM AUTHOR]

Introduction: Communities That Care, refined and tested for more than 25years, offers a step-by-step coalition-based approach to promote well-being and prevent risk behaviors among youth. Communities That Care guides coalitions to identify and prioritize underlying risk and protective factors; set specific, measurable community goals; adopt tested, effective prevention programs to target selected factors; and implement chosen programs with fidelity. Communities That Care has been implemented in a variety of communities, but has only recently begun to be systematically evaluated in diverse, urban communities.Methods: This paper presents a process evaluation of Communities That Care implementation within a Midwestern ethnically diverse, urban community. In-depth surveys of 25 black male youth aged 8-14years and their caregivers were conducted to determine the degree to which coalition-selected priorities aligned with the experience of black families. Implementation and survey data were collected in 2014-2017 and analyzed in 2017-2018.Results: Roughly 30% of youth reported ever being bullied or bullying someone else on school property; this aligned with the coalition's decision to focus on positive social skills and bullying prevention. Additional data aligned with the coalition's intent to expand its community action plan to encompass other priorities, including family transitions and mobility. For example, roughly one third of caregivers went on welfare and one third of families moved to a new home or apartment in the past year.Conclusions: In communities whose residents have experienced historical and current inequities, an effective community prevention plan may need to address structural as well as social determinants of well-being among youth and their families.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: Validity of research linking built environments to health relies on the availability and reliability of data used to measure exposures. As cities transform, it is important to track when and where urban changes occur, to provide detailed information for urban health intervention research. This paper presents an online observation method of the implementation of traffic-calmingfeatures using Google Street View Time Machine. The method is used to validate an existingadministrative database detailing the implementation of curb extensions and speed bumps.Methods: Online observation of curb extensions and speed bumps was conducted for four boroughsin Montreal, Canada, in autumn 2016, and compared with administrative data documenting traffic-calming measures implemented between 2008 and 2014. All images available through the Time Machine function between 2007 and 2016 for 708 intervention sites were visualized online. Records in the administrative database were compared to real-world Google Street View observations and tested in terms of sensitivity, specificity, and positive predicted value.Results: Google Street View Time Machine allowed the visualization of a median of seven different dates per street intersection and six dates per street segment. This made it possible to analyze built environment changes within 3,973 distinct time periods at 708 locations. Validation of the administrative data regarding presence of an intervention showed 99% (95% CI=97%, 99%) sensitivity, 58% (95% CI=51%, 64%) specificity, and 77% (95% CI=73%, 81%) positive predictive value.Conclusions: Google Street View Time Machine allowed past (2007-2016) online documentation of microscale urban interventions-curb extensions and speed bumps. The proposed method offers a new way to document historic changes to the built environment, which will be useful for urban health intervention research. [ABSTRACT FROM AUTHOR]

Background: Over the last few years an increasing number of studies investigating the association between the physical environment and physical activity have been published. Many reviews have also summarized this emerging body of research, and such review papers are frequently used by public health policymakers and researchers themselves to inform decision making.Methods: This paper systematically appraises methodologic aspects of literature reviews examining the relationship between physical activity and the physical environment published in peer-reviewed journals between 2000 and 2005. Eleven reviews and their antecedent source papers were examined.Results: The majority of these reviews omitted between one third and two thirds of the studies that could have been eligible for inclusion at the time they conducted the review. Methodologic information on how the review was conducted was not always provided. Furthermore, in some cases results of a study were reported incorrectly, or physical environmental aspects were conflated with social environmental or cognitive factors. Moreover, when results were reported incorrectly, physical environmental variables were almost always reported as significantly associated with physical activity, when these associations were nonsignificant, or were not assessed as part of the primary study.Conclusions: Users of reviews in this field should be aware that there are significant methodologic variations among them, and that some reviews may include only a sample of the relevant primary studies. However, this is difficult to determine given the frequent incompleteness of review method reporting. Greater standardization in the reporting of review methods may assist with future efforts to summarize studies of the relationship between physical environments and physical activity. [ABSTRACT FROM AUTHOR]

Shared decision making is a process in which patients are involved as active partners with the clinician in clarifying acceptable medical options and in choosing a preferred course of clinical care. Shared decision making offers a way of individualizing recommendations, according to patients'' special needs and preferences, when some patients may benefit from an intervention but others may not. This paper clarifies how the U.S. Preventive Services Task Force (USPSTF) envisions the application of shared decision making in the execution of screening and chemoprevention. Unlike conventional USPSTF reports, this paper is neither a systematic review nor a formal recommendation. Instead, it is a concept paper that includes a commentary on the current thinking and evidence regarding shared decision making.Although the USPSTF does not endorse a specific style of decision making, it does encourage informed and joint decisions. This means that patients should be informed about preventive services before they are performed, and that the patient–clinician partnership is central to decision making. The USPSTF suggests that clinicians inform patients about preventive services for which there is clear evidence of net benefit, and, if time permits, about other services with high visibility or special individual importance. Clinicians should make sure that balanced, evidence-based information about the service (including the potential benefits and harms, alternatives, and uncertainties) is available to the patient if needed. For preventive services for which the balance of potential benefits and harms is a close call, or for which the evidence is insufficient to guide a decision for or against screening, clinicians should additionally assist patients in determining whether individual characteristics and personal preferences favor performing or not performing the preventive service.The USPSTF believes that clinicians generally have no obligation to initiate discussion about services that have either no benefit or net harm. Nonetheless, clinicians should be prepared to explain why these services are discouraged and should consider a proactive discussion for services with high visibility or special individual importance or for services for which new evidence has prompted withdrawal of previous recommendations. [Copyright &y& Elsevier]

Rising rates of childhood obesity over the past 2 decades have spurred a number of public- and private-sector initiatives aimed at halting or even reversing this trend. Recognizing common interests in this issue, the Centers for Disease Control and Prevention, NIH, and the Robert Wood Johnson Foundation began conversations about creating a formal collaboration aimed at accelerating efforts to address childhood obesity by coordinating research agendas and providing support for evidence-building activities. The National Collaborative on Childhood Obesity Research (NCCOR) was launched in February 2009, and the U.S. Department of Agriculture joined in 2010. Using the model provided by other previously successful collaborations, such as the Youth Tobacco Cessation Collaborative, NCCOR has emphasized several principles suggested by Petrovich as key elements for successful partnerships: (1) delineate a common purpose by identifying key knowledge gaps in the field; (2) create a shared identity around that common purpose; (3) develop structures for democratic and respectful collaboration so as to strategically coordinate efforts for maximum national impact; (4) identify effective leaders capable of articulating challenges in the field and inspiring a commitment of minds and the resolve to address identified needs; (5) facilitate continuous knowledge exchange and synthesis to keep the field informed; and (6) support assessment of progress and feedback loops for ensuring continual progress. This paper examines how NCCOR has used these principles to help build the field of research, evaluation, and surveillance for childhood obesity prevention and management. [ABSTRACT FROM AUTHOR]

Introduction: Few interventions have been successful in reducing the physical activity decline typically observed among adolescents. The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention (Physical Activity 4 Everyone) in reducing the decline in moderate to vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of New South Wales, Australia.Study Design: A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-randomization.Setting/participants: The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales, Australia.Intervention: A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented. The intervention consisted of seven physical activity promotion strategies that targeted the curriculum (teaching strategies to increase physical activity in physical education lessons, student physical activity plans, and modification of school sport program); school environment (recess/lunchtime activities, school physical activity policy); parents (parent newsletters); and community (community physical activity provider promotion). Six additional strategies supported school implementation of the physical activity intervention strategies.Main Outcome Measure: Minutes per day spent in MVPA, objectively measured by accelerometer.Results: Participants (N=1,150, 49% male) were a cohort of students aged 12 years (Grade 7) at baseline (March-June 2012) and 14 years (Grade 9) at follow-up (March-July 2014). At 24-month follow-up, there were significant effects in favor of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes (95% CI=2.7, 11.4, p<0.002) (analysis conducted December 2014-February 2015). Sensitivity analyses based on multiple imputation were consistent with the main analysis (6.0 minutes, 95% CI=0.6, 11.3, p<0.031).Conclusions: The intervention was effective in increasing adolescents' minutes of MVPA, suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000382875. [ABSTRACT FROM AUTHOR]

: PurposeTo calculate the cost structure of a suite of immunization improvement interventions recommended by the Centers for Disease Control and Prevention (CDC).: MethodsA determination was made of the cost to clinics and agencies that implement a suite of CDC-recommended practice improvement interventions to fully immunize a child for diphtheria–tetanus–attenuated pertussis (DTaP), inactivated poliovirus (IPV), and measles–mumps–rubella (MMR) vaccines. Patient data were collected through chart analysis of 16-month-old children in clinics participating in this study''s interventions between May 1997 and August 2000. The study began on October 1, 1996, and was funded for 5 years (until September 30, 2002).: ResultsStudy calculations suggest that an additional $0.013/per patient per month would be needed to cover these activities.: ConclusionsIdentifiable cost structures are associated with the practice improvement strategies recommended by the CDC. The method of implementation may be as important as the interventions themselves. Present compensation for immunization may not actually cover the cost of service provision, and it is unlikely to cover the costs of practice improvement, as described in this paper. [Copyright &y& Elsevier]

Aging is associated with a number of physiologic and functional declines that can contribute to increased disability, frailty, and falls. Contributing factors are the loss of muscle mass and strength as age increases, a phenomenon called sarcopenia. Sarcopenia can result or be exacerbated by certain chronic conditions, and can also increase the burden of chronic disease. Current research has demonstrated that strength-training exercises have the ability to combat weakness and frailty and their debilitating consequences. Done regularly (e.g., 2 to 3 days per week), these exercises build muscle strength and muscle mass and preserve bone density, independence, and vitality with age. In addition, strength training also has the ability to reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and type 2 diabetes, while also improving sleep and reducing depression. This paper reviews the current research on strength training and older adults, evaluating exercise protocols in a variety of populations. It is clear that a variety of strength-training prescriptions from highly controlled laboratory-based to minimally supervised home-based programs have the ability to elicit meaningful health benefits in older adults. The key challenges as this field of exercise science moves forward are to best identify the most appropriate strength-training recommendations for older adults and to greatly increase the access to safe and effective programs in a variety of settings. [ABSTRACT FROM AUTHOR]

Family history of chronic disease is rapidly becoming a research tool for targeting participants at increased risk. Its current usefulness in clinical practice remains unknown. This paper details the possible utility and complications in using family history in a primary care setting, using colorectal cancer risk as the health issue. Where available, we cite data to support the issues that could arise. Where there are no studies, we invite further research. The potential of family history as a health improvement tool is still under review. [Copyright &y& Elsevier]

Background: Features of the local fast food environment have been hypothesized to contribute to the greater prevalence of obesity in deprived neighborhoods. However, few studies have investigated whether fast food outlets are more likely to be found in poorer areas, and those that have are local case studies. In this paper, using national-level data, we examine the association between neighborhood deprivation and the density of McDonald’s restaurants in small census areas (neighborhoods) in Scotland and England. Methods: Data on population, deprivation, and the location of McDonald’s Restaurants were obtained for 38,987 small areas in Scotland and England (6505 “data zones” in Scotland, and 32,482 “super output areas” in England) in January 2005. Measures of McDonald’s restaurants per 1000 people for each area were calculated, and areas were divided into quintiles of deprivation. Associations between neighborhood deprivation and outlet density were examined during February 2005, using one-way analysis of variance in Scotland, England, and both countries combined. Results: Statistically significant positive associations were found between neighborhood deprivation and the mean number of McDonald’s outlets per 1000 people for Scotland (p<0.001), England (p<0.001), and both countries combined (p<0.001). These associations were broadly linear with greater mean numbers of outlets per 1000 people occurring as deprivation levels increased. Conclusions: Observed associations between presence or absence of fast food outlets and neighborhood deprivation may provide support for environmental explanations for the higher prevalence of obesity in poor neighborhoods. [Copyright &y& Elsevier]