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The article highlights the negative affects of obesity upon children's health as its associations with cardiovascular disease risk factors, type 2 diabetes, fatty liver disease, and victimization stemming from social stigma and poor mental health. It mentions the role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

OBJECTIVES: To examine the prevalence and trends in severe obesity among 16.6 million children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2010 to 2020. METHODS: Severe obesity was defined as a sex-specific BMI for age ≥120% of the 95th percentile on the Centers for Disease Control and Prevention growth charts or BMI ≥35 kg/m°. Joinpoint regression was used to identify when changes occurred in the overall trend. Logistic regression was used to compute the adjusted prevalence differences between years controlling for sex, age, and race and ethnicity. RESULTS: The prevalence of severe obesity significantly decreased from 2.1% in 2010 to 1.8% in 2016 and then increased to 2.0% in 2020. From 2010 to 2016, the prevalence decreased significantly among all sociodemographic subgroups except for American Indian/Alaska Native (AI/AN) children. The largest decreases were among 4-year-olds, Asian/Pacific Islander and Hispanic children, and children from higher-income households. However, from 2016 to 2020, the prevalence increased significantly overall and among sociodemographic subgroups, except for AI/AN and non-Hispanic white children. The largest increases occurred in 4-year-olds and Hispanic children. Among 56 WIC agencies, the prevalence significantly declined in 17 agencies, and 1 agency (Mississippi) showed a significant increase from 2010 to 2016. In contrast, 21 agencies had significant increases, and only Alaska had a significant decrease from 2016 to 2020. CONCLUSIONS: Although severe obesity prevalence in toddlers declined from 2010 to 2016, recent trends are upward. Early identification and access to evidence-based family healthy weight programs for at-risk children can support families and child health. [ABSTRACT FROM AUTHOR]

Purpose: This study examined associations between sugar-sweetened beverage (SSB) intake and acculturation among a sample representing civilian noninstitutionalized U.S. adults.Design: Quantitative, cross-sectional study.Setting: National.Subjects: The 2010 National Health Interview Survey data for 17,142 Hispanics and U.S.-born non-Hispanic whites (≥18 years).Measures: The outcome variable was daily SSB intake (nondiet soda, fruit drinks, sports drinks, energy drinks, and sweetened coffee/tea drinks). Exposure variables were Hispanic ethnicity and proxies of acculturation (language of interview, birthplace, and years living in the United States).Analysis: We used multivariate logistic regression to estimate adjusted odds ratios (ORs) for the exposure variables associated with drinking SSB ≥1 time/d after controlling for covariates.Results: The adjusted odds of drinking SSB ≥1 time/d was significantly higher among Hispanics who completed the interview in Spanish (OR = 1.65) than U.S.-born non-Hispanic whites. Compared with those who lived in the United States for <5 years, the adjusted odds of drinking SSB ≥1 time/d was higher among adults who lived in the United States for 5 to <10 years (OR = 2.72), those who lived in the United States for 10 to <15 years (OR = 2.90), and those who lived in the United States for ≥15 years (OR = 2.41). However, birthplace was not associated with daily SSB intake.Conclusion: The acculturation process is complex and these findings contribute to identifying important subpopulations that may benefit from targeted intervention to reduce SSB intake. [ABSTRACT FROM AUTHOR]

There is growing interest in the use of physical activity and nutrition environmental measures by both researchers and practitioners. Built environment assessment methods and tools range from simple to complex and encompass perceived, observed, and geographic data collection. Even though challenges in tool selection and use may exist for non-researchers, there are opportunities to incorporate these measures into practice. The aims of this paper are to (1) describe examples of built environment assessment methods and tools in the practice context; (2) present case studies that outline successful approaches for the use of built environment assessment tools and data among practitioners; and (3) make recommendations for both research and practice. As part of the Built Environment Assessment Training Think Tank meeting in July 2013, experts who work with community partners gathered to provide input on conceptualizing recommendations for collecting and analyzing built environment data in practice and research. The methods were summarized in terms of perceived environment measures, observational measures, and geographic measures for physical activity and food environment assessment. Challenges are outlined and case study examples of successful use of assessments in practice are described. Built environment assessment tools and measures are important outside the research setting. There is a need for improved collaboration between research and practice in forming partnerships for developing tools, collecting and analyzing data, and using the results to work toward positive environmental changes. [ABSTRACT FROM AUTHOR]

Objective: To examine associations of problem behaviors and victimization with nondiet soda intake among a na­tional sample of 16,188 US high school students. Methods: We used the 2009 national Youth Risk Behavior Survey. The outcome measure was daily nondiet soda intake. Results: Smoking, having any sex partners, not always wearing a seat belt, being bullied/threatened/ injured on school property, and being physically hurt by their boyfriend/girl­friend were significantly associated with daily nondiet soda intake after adjust­ment for age, sex, race/ethnicity, and weight status. Conclusions: Our findings suggest a need to examine why nondiet soda intake is associated with these be­haviors to understand potential mecha­nisms. [ABSTRACT FROM AUTHOR]

Limited research shows an inconclusive association between soda intake and asthma, potentially attributable to certain preservatives in sodas. This cross-sectional study examined the association between regular (nondiet)-soda intake and current asthma among a nationally representative sample of high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 15,960 students (grades 9 through 12) with data for both regular-soda intake and current asthma status. The outcome measure was current asthma (ie, told by doctor/nurse that they had asthma and still have asthma). The main exposure variable was regular-soda intake (ie, drank a can/bottle/glass of soda during the 7 days before the survey). Multivariable logistic regression was used to estimate the adjusted odds ratios for regular-soda intake with current asthma after controlling for age, sex, race/ethnicity, weight status, and current cigarette use. Overall, 10.8% of students had current asthma. In addition, 9.7% of students who did not drink regular soda had current asthma, and 14.7% of students who drank regular soda three or more times per day had current asthma. Compared with those who did not drink regular soda, odds of having current asthma were higher among students who drank regular soda two times per day (adjusted odds ratio=1.28; 95% CI 1.02 to 1.62) and three or more times per day (adjusted odds ratio=1.64; 95% CI 1.25 to 2.16). The association between high regular-soda intake and current asthma suggests efforts to reduce regular-soda intake among youth might have benefits beyond improving diet quality. However, this association needs additional research, such as a longitudinal examination. [Copyright &y& Elsevier]

The article presents the discussion on federal guidelines supporting a dietary pattern with daily fruit and vegetable consumption and limited added sugars. Topics include Government-published dietary intake estimates for young children being outdated at the national level and unavailable at the state level; and availability of fruits and vegetables and healthy beverages in places where young children live, learn, and play.

Abstract: Drinking plain water instead of sugar-sweetened beverages is one approach for reducing energy intake. Only a few studies have examined characteristics associated with plain water intake among US youth. The purpose of our cross-sectional study was to examine associations of demographic characteristics, weight status, dietary habits, and other behavior-related factors with plain water intake among a nationally representative sample of US high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,049 students in grades 9 through 12 were used. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95% CIs for variables associated with low water intake (<3 times/day). Nationwide, 54% of high school students reported drinking water <3 times/day. Variables significantly associated with a greater odds for low water intake were age ≤15 years (OR 1.1), consuming <2 glasses/day of milk (OR 1.5), nondiet soda ≥1 time/day (OR 1.6), other sugar-sweetened beverages ≥1 time/day (OR 1.4), fruits and 100% fruit juice <2 times/day (OR 1.7), vegetables <3 times/day (OR 2.3), eating at fast-food restaurants 1 to 2 days/week and ≥3 days/week (OR 1.3 and OR 1.4, respectively), and being physically active ≥60 minutes/day on <5 days/week (OR 1.6). Being obese was significantly associated with reduced odds for low water intake (OR 0.7). The findings of these significant associations of low water intake with poor diet quality, frequent fast-food restaurant use, and physical inactivity may be used to tailor intervention efforts to increase plain water intake as a substitute for sugar-sweetened beverages and to promote healthy lifestyles. [ABSTRACT FROM AUTHOR]

Abstract: Drinking plain water instead of sugar-sweetened beverages is one approach for reducing energy intake. Only a few studies have examined characteristics associated with plain water intake among US youth. The purpose of our cross-sectional study was to examine associations of demographic characteristics, weight status, dietary habits, and other behavior-related factors with plain water intake among a nationally representative sample of US high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,049 students in grades 9 through 12 were used. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95% CIs for variables associated with low water intake (<3 times/day). Nationwide, 54% of high school students reported drinking water <3 times/day. Variables significantly associated with a greater odds for low water intake were age ≤15 years (OR 1.1), consuming <2 glasses/day of milk (OR 1.5), nondiet soda ≥1 time/day (OR 1.6), other sugar-sweetened beverages ≥1 time/day (OR 1.4), fruits and 100% fruit juice <2 times/day (OR 1.7), vegetables <3 times/day (OR 2.3), eating at fast-food restaurants 1 to 2 days/week and ≥3 days/week (OR 1.3 and OR 1.4, respectively), and being physically active ≥60 minutes/day on <5 days/week (OR 1.6). Being obese was significantly associated with reduced odds for low water intake (OR 0.7). The findings of these significant associations of low water intake with poor diet quality, frequent fast-food restaurant use, and physical inactivity may be used to tailor intervention efforts to increase plain water intake as a substitute for sugar-sweetened beverages and to promote healthy lifestyles. [Copyright &y& Elsevier]

This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks[. Nationwide, 64.9% of high school students drank SSB ⩾ 1 time/d, 35.6% drank SSB ⩾ 2 times/d, and 22.2% drank SSB ⩾ 3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (⩾ 3 times/dl were male gender [OR = 1.66 (95% CI = 1.41,1.95); P< 0.05), being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P< 0.05], eating atfast-food restaurants 1-2 d/wk or eating there ⩾ 3 d/wk [OR = 1.25(95% CI = 1.05, 1.50); P< 0.05 and OR = 2.94)95% CI = 2.31, 3.75); P < 0.05, respectively[ and watching television >2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P< 0.051. Non-Hispanic other/multiracial [OR = 0.67(95% CI = 0.47, 0.95); P< 0.05] and being physically active ⩾ 60 min/d on <5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P< 0.05[. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe perceptions of health risk from excess body weight among adults, and assess if lack of perceived risk was associated with trying to lose weight. Methods: Sex-specific logistic regression models were used to determine odds of disagreement that one''s weight is a health risk and odds of trying to lose weight among overweight (BMI=25.0–29.9 kg/m2, n =1296) and obese (BMI≥30 kg/m2, n =1335) adult participants in the 2004 Styles'' surveys. Results: Men were more likely than women to disagree their body weight was a health risk (among the overweight, 62% vs. 43%; the obese 20% vs. 14% obese). Disagreement with risk was associated with good health status and race/ethnicity among both sexes and lower education and income among women. Odds of currently trying to lose weight were significantly lower among obese men who disagreed, and overweight men and women who were neutral or disagreed that their body weight was a health risk. Conclusions: Many overweight and obese adults do not perceive their weight to be a health risk; this perception was associated with lower prevalence of trying to lose weight, particularly among men. Discussion by clinicians about the health risks of excess weight may alter perceived risk and help promote weight loss efforts. [Copyright &y& Elsevier]

Objectives: The purpose was to assess the prevalence and correlates of complementary and alternative medicine use for weight control. Design: A list-assisted random-digit-dialed telephone survey of adults was conducted in the fall of 2002 ( n = 11,211). The focus of the study was complementary and alternative medicine (CAM) use, other than dietary supplements, in the previous 12 months. Settings/location: The sample of respondents was drawn from the total noninstitutionalized U.S. adult population residing in telephone-equipped locations. Subjects: The sampling procedures were designed to obtain adequate representation of Hispanic and non-Hispanic black respondents. Data from the total sample of 11,211 were weighted to achieve an estimate of the U.S. population. Analyses focused on 372 people who had used CAM within the previous 12 months. Results: Of the total, 3.3% ( n = 372) had used a CAM therapy in the previous 12 months. Higher adjusted odds ratios for CAM use were found among respondents who were exercising for weight control; using a lower carbohydrate, higher protein diet; using a nonprescription weight-loss product(s); overweight; physically active; and not satisfied with one's body (adjusted for age, race, gender, education, and city size). The most often used therapies were yoga (57.4%), meditation (8.2%), acupuncture (7.7%), massage (7.5%), and Eastern martial arts (5.9%). CAM users used CAM therapies on their own (62.6%), in a group setting (26.8%) or with a CAM practitioner (10.6%). Conclusions: The use of CAM therapies other than dietary supplements for weight loss was relatively low. The most popular therapy was yoga, and the majority of CAM users used CAM therapies on their own. Persons who had used other weight loss methods had greater odds for using CAM in the previous 12 months, suggesting that CAM use is often added to other weight-loss strategies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality. Design: Cross-sectional, nationally representative survey. Subjects: 7,500 adults (older than 19 years) in the 1994-1996 Continuing Survey of Food Intakes by Individuals. Statistical Analysis: Energy density values were calculated from reported food intake. Subjects were classified as consuming a low-energy-density diet, medium-energy-density diet, or high-energy-density diet using tertile cutoffs. For each group, the percentage consuming various foods/beverages and the mean amount of foods/beverages they consumed was determined along with mean nutrient intakes. Results: Compared with participants consuming a high-energy-density diet, those with a low-energy-density diet had a lower energy intake but consumed more food, by weight, from most food groups. A low-energy-density diet included a relatively high proportion of foods high in micronutrients and water and low in fat, such as fruits and vegetables. Subjects with a low-energy-density diet consumed fewer (nonwater) beverages such as caloric carbonated beverages. They also consumed less fat and had higher intakes of several important micronutrients, including vitamins A, C, and B-6, folate, iron, calcium, and potassium. Conclusions: These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives. [Copyright &y& Elsevier]

Dietary energy density [kcal/g (kJ/g)] influences energy intake under controlled laboratory conditions. Little is known about the energy density of the diets of free-living persons. Because energy density investigations are a relatively new endeavor, there are neither standard calculation methods nor published nationally representative values. This paper examines the calculation of energy density based on systematic exclusion of beverage categories, presents data on variability, and compares values by sex, age, and race/ethnicity in a representative sample of U.S. adults. Mean daily dietary energy density values for adults (aged >19 y) were calculated using two 24-h recalls from the Continuing Survey of Food Intakes by Individuals 1994-1996 based on food, food and liquid meal replacements, food and alcohol, food and juice, food and milk, food and juice and milk, food and energy-containing beverages, and food and all beverages. Energy density varied by calculation method, ranging from 0.94 to 1.85 kcal/g (3.93-7.74 kJ/g). Intraindividual-to-interindividual CV ratios were highest for the food and energy-containing beverages calculation. Men reported diets with a higher energy density than women for all calculation methods (P < 0.0001). There were differences by race/ethnicity and an inverse linear trend for age. These data indicate that beverage inclusion schemes should be clearly defined when reporting energy density values. In epidemiologic studies, calculations based on food and all beverages and food and energy-containing beverages may diminish associations with outcome variables. These nationally representative data, which provide an important frame of reference for other studies, indicate that dietary energy density differs by sex, age, and race/ethnicity. [ABSTRACT FROM AUTHOR]

Summary: Given the high and growing prevalence of obesity among adults in the United States, obesity treatment and prevention are important topics in biomedical and public health research. Although researchers recognize the significance of this problem, much remains unknown about safe and effective prevention and treatment of obesity in adults. In response to the worsening obesity epidemic and the many unknowns regarding the disease, a group of key scientific and program staff members of the National Institutes of Health (NIH) and other federal and non‐government agencies gathered virtually in September 2021 to discuss the current state of obesity research, research gaps, and opportunities for future research in adult obesity prevention and treatment. The current article synthesizes presentations given by attendees and shares their organizations' current initiatives and identified gaps and opportunities. By integrating the information discussed in the meeting and current initiatives, we identify potential targets and overlapping priorities for future research, including health equity and disparities in obesity, the heterogeneity of obesity, and the use of technological and innovative approaches in interventions. [ABSTRACT FROM AUTHOR]

The article focuses on a study which reveals the trends associated with the prevalence of extreme obesity among U.S. preschool-aged children living in low-income families. It states that the study included 27.5 million children aged two to four years from 30 states in the U.S. According to the study, the prevalence of obesity increased from 13.05 percent in 1998 to 15.21 percent in 2003 but extreme obesity decreased to 2.07 percent in 2010. It mentions that obesity can cause heart diseases and other health related problems. It further presents two tables which list the prevalence of obesity among African American children and American children in the U.S. from 1998 to 2010.

The 2015-2020 Dietary Guidelines for Americans recommend that Americans consume more fruits and vegetables as part of an overall dietary pattern to reduce the risk for diet-related chronic diseases such as cardiovascular disease, type 2 diabetes, some cancers, and obesity (1). Adults should consume 1.5-2.0 cup equivalents of fruits and 2.0-3.0 cups of vegetables per day.* Overall, few adults in each state met intake recommendations according to 2013 Behavioral Risk Factor Surveillance System (BRFSS) data; however, sociodemographic characteristics known to be associated with fruit and vegetable consumption were not examined (2). CDC used data from the 2015 BRFSS to update the 2013 report and to estimate the percentage of each state's population meeting intake recommendations by age, sex, race/ethnicity, and income-to-poverty ratio (IPR) for the 50 states and District of Columbia (DC). Overall, 12.2% of adults met fruit recommendations ranging from 7.3% in West Virginia to 15.5% in DC, and 9.3% met vegetable recommendations, ranging from 5.8% in West Virginia to 12.0% in Alaska. Intake was low across all socioeconomic groups. Overall, the prevalence of meeting the fruit intake recommendation was highest among women (15.1%), adults aged 31-50 years (13.8%), and Hispanics (15.7%); the prevalence of meeting the vegetable intake recommendation was highest among women (10.9%), adults aged ≥51 years (10.9%), and persons in the highest income group (11.4%). Evidence-based strategies that address barriers to fruit and vegetable consumption such as cost or limited availability could improve consumption and help prevent diet-related chronic disease. [ABSTRACT FROM AUTHOR]

Objectives: Examine differences in perceptions of tap water (TW) and bottled water (BW) safety and TW taste and their associations with plain water (PW) and sugar-sweetened beverage (SSB) intake. Design: Quantitative, cross-sectional study. Setting: United States. Subjects: 4,041 U.S. adults (≥18 years) in the 2018 SummerStyles survey data. Measures: Outcomes were intake of TW, BW, PW (tap and bottled water), and SSB. Exposures were perceptions of TW and BW safety and TW taste (disagree, neutral, or agree). Covariates included sociodemographics. Analysis: We used chi-square analysis to examine sociodemographic differences in perceptions and multivariable logistic regressions to estimate adjusted odds ratios (AOR) for consuming TW ≤ 1 cup/day, BW > 1 cup/day, PW ≤ 3 cups/day, and SSB ≥ 1 time/day by water perceptions. Results: One in 7 (15.1%) of adults did not think their home TW was safe to drink, 39.0% thought BW was safer than TW, and 25.9% did not think their local TW tasted good. Adults who did not think local TW was safe to drink had higher odds of drinking TW ≤ 1 cup/day (AOR = 3.12) and BW >1 cup/day (AOR = 2.69). Adults who thought BW was safer than TW had higher odds of drinking TW ≤ 1 cup/day (AOR = 2.38), BW > 1 cup/day (AOR = 5.80), and SSB ≥ 1 time/day (AOR = 1.39). Adults who did not think TW tasted good had higher odds of drinking TW ≤ 1 cup/day (AOR = 4.39) and BW > 1 cup/day (AOR = 2.91). Conclusions: Negative perceptions of TW safety and taste and a belief BW is safer than TW were common and associated with low TW intake. Perceiving BW is safer than TW increased the likelihood of daily SSB intake. These findings can guide programs and services to support water quality to improve perceptions of TW safety and taste, which might increase TW intake and decrease SSB intake. [ABSTRACT FROM AUTHOR]

Purpose: Food service guidelines (FSG) policies can impact the nutritional quality of millions of meals sold or served to government employees, citizens in public places, or institutionalized persons. This study examines state FSG policies adopted January 1, 2015 to April 1, 2019, and uses a FSG Classification Tool (FSG Tool) to quantify alignment with nutrition recommendations for public health impact. Design: Quantitative Content Analysis Setting: State Government Worksites and Facilities Participants: 50 states and District of Columbia (D.C.) in the United States. Measures: Frequency of policies and percent alignment to FSG tool. Analysis: FSG policies were identified using legal databases to assess state statutes, regulations, and executive orders. Content analysis and coding determined attributes of policies across 4 FSG Tool domains, (1) nutrition standards referenced; (2) behavioral design strategies encouraging selection of healthier offerings; (3) facility efficiency and environmental sustainability; and (4) FSG implementation supports. Results: From 2015-2019, 5 FSG policies met study inclusion criteria. Four out of 5 policies earned a perfect nutrition score (100%) by referencing nutrition standards that align with the Dietary Guidelines for Americans (DGA) and are operationalized for use in food service venues. Four out of 5 policies included at least 1 implementation supports provision, such as naming an implementing agency, and 2 included provisions that encourage local food sourcing. Conclusion: From 2015-2019, overall FSG policy comprehensiveness scores ranged from 24% to 73%, with most policies referencing food and nutrition standards that align to national nutrition recommendations. Public health practitioners can educate decision makers on the potential impact of FSG policies on diet-related health outcomes and associated cost savings, as well as other important co-benefits that support locally grown products and environmental sustainability practices. [ABSTRACT FROM AUTHOR]

Introduction: Addressing nutrition disparities and preventing obesity require multi-level interventions, including policies that address the nutrition environment and other social determinants of health. The Nutrition and Obesity Policy Research Evaluation Network (NOPREN) was established in 2009 to conduct transdisciplinary research and accelerate the translation and implementation of science-based policy interventions. This study examined NOPREN's collaborative practices and identified opportunities to improve network impact. Methods: Using a mixed-methods approach, we combined quantitative survey data (n = 106) and in-depth, qualitative interviews (n = 18) to evaluate the experiences of NOPREN members and understand the extent to which NOPREN was achieving its goals. Results: Using the Consolidated Framework for Collaborative Research (CFCR), quantitative and qualitative results were organized into 11 themes. We find that NOPREN's structure and standardized processes facilitate connections to individuals and resources, foster relationships, and support effective cross-sector collaborations. Areas of improvement include capacity building and a more intentional approach towards recruitment of a diverse membership. Conclusion: A collaborative research network can build synergy across sectors and accelerate knowledge transfer. These findings will be used to inform the network's strategic priorities to maximize impact. Findings may also inform similar collaborative efforts for addressing complex public health problems. [ABSTRACT FROM AUTHOR]

Abstract: Childhood obesity is a major threat to individual health and society overall. Policies that support healthier food and beverage choices have been endorsed by many decision makers. These policies may reach a large proportion of the population or in some circumstances aim to reduce nutrition disparities to ensure health equity. The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) evaluates policy as a tool to improve food and beverage environments where Americans live, work, play, and learn. The network aspires to address research and evaluation gaps related to relevant policies, create standardized research tools, and help build the evidence base of effective policy solutions for childhood obesity prevention with a focus on reach, equity, cost effectiveness, and sustainability. [Copyright &y& Elsevier]

The authors provide strategies to support early care and education (ECE) providers' use of early child nutrition and feeding (ECNF) best practices. Topics discussed include federal agencies in the U.S. that support early childhood efforts, information on the Child and Adult Care Food Program (CACFP), a federal nutrition program, and use of evidence-based interventions.

Introduction Racial/ethnic differences in recent obesity trends have not been reported among young low-income children. The purpose of this study is to examine trends in obesity prevalence from 1998 through 2011 by race/ethnicity among low-income children aged 2–4 years. Methods The study was based on measured weight and height records of 29,040,851 participants of federally funded health and nutrition programs from 30 states and the District of Columbia, which provided data each year from 1998 through 2011. More than 80% of data were collected through the Special Supplemental Nutrition Program for Women, Infants, and Children, and about 50% of eligible children were included. In 2014, joinpoint regression was used to identify the inflection years when significant changes in obesity trends occurred and piecewise logistic regression was used to examine annual changes in obesity prevalence before and after the inflection years controlling for age, sex, and race/ethnicity. Results The overall obesity prevalence increased from 13.05% in 1998 to 15.21% in 2003, and decreased slightly to 14.74% in 2011. The increasing trends among non-Hispanic white, non-Hispanic black, and Hispanic children began decreasing in 2003. Asian/Pacific Islander was the only racial/ethnic group with a continual decreasing trend in obesity prevalence from 1998 (14.34%) through 2011 (11.66%). Among American Indian/Alaska Native children, obesity prevalence consistently increased from 16.32% in 1998 to 21.11% in 2011, although the annual increases slowed since 2001. Conclusions The study findings indicate modest recent declines in obesity prevalence for most racial/ethnic groups of low-income children aged 2–4 years. However, obesity prevalence remains high. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with water filter use (WFU) for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages (SSBs). Design: Quantitative, cross-sectional study. Setting: The 2018 SummerStyles survey data. Subjects: U.S. adults (≥18 years; N=4042). Measures: Outcomes were intake of plain water (tap/bottled water) and SSBs. Exposure was WFU (yes, no, not drinking tap water at home). Covariates included sociodemographics, weight status, Census regions, and home ownership status. Analysis: We used multivariable logistic regressions to estimate adjusted odds ratios (AOR) and 95% confidence interval (CI) for consuming tap water, bottled water, or total plain water >3 cups/day (vs. ≤3 cups) and SSBs ≥1 time/day (vs. <1 time) by WFU. Results: Overall, 36% of adults reported using a filter for drinking tap water at home; 14% did not drink tap water at home. Hispanics had significantly higher odds of using a water filter (AOR=1.50, 95% CI=1.14-1.98) vs non-Hispanic White. Factors significantly associated with lower odds of WFU were lower education (AOR=.69, 95% CI=.55-.86 for ≤high school; AOR=.78, 95% CI=.64-.95 for some college, vs college graduate), not being married (AOR=.81, 95% CI=.66-.98, vs married/domestic partnership), and lower household income (AOR=.68, 95% CI=.68-.90 for <$35,000, vs ≥$100,000). Using a water filter was associated with higher odds of drinking >3 cups/day of tap water (AOR=1.33, 95% CI=1.13-1.56) and lower odds of SSBs ≥1 time/day (AOR=.76, 95% CI=.62-.92). Not drinking tap water at home was associated with higher odds of drinking >3 cups/day bottled water (AOR=3.46, 95% CI=2.70-4.44). Conclusions: WFU was associated with higher tap water intake and lower SSB intake among U.S. adults. WFU was higher among Hispanics, but lower among those with lower education and income and not married adults. Although WFU was associated with healthful beverage habits, additional considerations for WFU may include source water quality, oral health, cost, and proper use. [ABSTRACT FROM AUTHOR]

The article discusses the findings of the 2019 Behavioral Risk Factor Surveillance system (BRFSS) data which estimated the percentage of adults in the U.S. who met fruit and vegetable intake recommendations. Topics covered include the low percentage of U.S. adults meeting the recommendations, the state-specific percentage of respondents meeting federal recommendations, by sex, age, race/ethnicity, and income-to-poverty ratio, and the implications of the report for public health practice.

Sales of sports and energy drinks have increased dramatically, but there is limited information on regular consumers of sports and energy drinks. Characteristics associated with sports and energy drink intake were examined among a sample representing the civilian noninstitutionalized US adult population. The 2010 National Health Interview Survey data for 25,492 adults (18 years of age or older; 48% males) were used. Nationwide, 31.3% of adults were sports and energy drink consumers during the past 7 days, with 21.5% consuming sports and energy drinks one or more times per week and 11.5% consuming sports and energy drinks three or more times per week. Based on multivariable logistic regression, younger adults, males, non-Hispanic blacks and Hispanics, not-married individuals, adults with higher family income, those who lived in the South or West, adults who engaged in leisure-time physical activity, current smokers, and individuals whose satisfaction with their social activities/relationships was excellent had significantly higher odds for drinking sports and energy drinks one or more times per week. In this model, the factor most strongly associated with weekly sports and energy drink consumption was age (odds ratio [OR]=10.70 for 18- to 24-year-olds, OR=6.40 for 25- to 39-year-olds, OR=3.17 for 40- to 59-year-olds vs 60 years or older). Lower odds for consuming sports and energy drinks one or more times per week were associated with other/multiracial (OR=0.80 vs non-Hispanic white) and obesity (OR=0.87 vs underweight/normal weight). Separate modeling of the association between other beverage intake and sports and energy drink intake showed that higher intake of regular soda, sweetened coffee/tea drinks, fruit drinks, milk, 100% fruit juice, and alcohol were significantly associated with greater odds for drinking sports and energy drinks one or more times per week. These findings can help medical care providers and public health officials identify adults most in need of encouragement to reduce sports and energy drink intake and increase healthier beverage intake. [Copyright &y& Elsevier]

Few studies take into account the influence of family size on household resources when assessing income disparities in fruit and vegetable (F/V) consumption. Poverty income ratio (PIR) is a measure that utilizes both reported income and household size. We sought to examine state-specific disparities in meeting Healthy People 2010 objectives for F/V consumption by percent PIR. This analysis included 353,005 adults in 54 states and territories reporting data to the 2009 Behavioral Risk Factor Surveillance System in the United States. Percent PIR was calculated using the midpoint of self-reported income range and family size. The prevalences consuming at least two fruits and at least three vegetables per day were examined by percent PIR (<130% [greatest poverty], 130% to <200%, 200% to <400%, and ≥400% [least poverty]). The percent of adults consuming vegetables at least three times daily was significantly lower (21.3%) among those living at greatest poverty (<130% PIR) compared with 30.7% among those with least poverty (≥400% PIR). Daily consumption of vegetables at least three times was significantly lower among those with greatest poverty in a majority of states and territories surveyed (43 of 54). The overall percent of adults consuming fruits at least 2 times daily was also lower among those living at greatest vs least poverty, but the difference was smaller (32.0% vs 34.2%), with 14 states reporting a difference that was significantly lower among those with greatest poverty. Our study revealed that in 2009 a significantly lower proportion of US adults living at greatest poverty consumed fruits at least two times daily or vegetables at least three times daily compared with those with the least poverty, with greater disparity in vegetable intake. Policy and environmental strategies for increased affordability, access, availability, and point-of-decision information are approaches that may help disparate households purchase and consume F/V. [Copyright &y& Elsevier]

The authors respond to comments on their research which showed a decline in obesity among low-income children between 2010 and 2016. Topics discussed include limitations of body mass index (BMI) as a surrogate of adiposity, the association between height and excess weight among children, unadjusted correlation between height and BMI and association of childhood height with body fatness assessed by dual-energy x-ray absorptiometry.

ABSTRACT. Objective. We quantified maternal misclassification of child weight status and examined determinants associated with maternal perceptions of child weight status. Methods. Data from the Third National Health and Nutrition Examination Survey (1988--1994) were used. The sample included 5500 children (aged 2--11 years) with maternal interview data. Maternal perceptions of children's weight status were compared with measured weights and statures from which body mass index (BMI; weight/stature² kg/m²) percentiles and z scores were determined. Frequency analyses determined the percentages of mothers considering their child to be "over-weight," "underweight," or "about the right weight." Multivariable logistic regression analyses determined predictors of maternal misclassification of overweight children (≥95th BMI-for-age percentile) and those at risk for overweight (≥85th to <95th BMI-for-age percentile). Results. Nearly one third (32.1%) of mothers reported their overweight child as "about the right weight." Younger children and those with lower BMI-for-age z scores had significantly greater odds of maternal under-classification of child overweight status. For children at risk for overweight, 14.0% of mothers reported sons to be "overweight," whereas 29.0% considered daughters to be "overweight." Odds of maternal misclassification of at-risk children as "overweight" were significantly greater for daughters, older children, children with higher BMI-for-age z scores, and children whose mothers had a lower BMI. Race/ethnicity was not a significant predictor in either model. Conclusions. Nearly one third of mothers misclassify overweight children as being lower than their measured weight status. Mothers are more likely to identify daughters who are at risk of overweight as being "overweight" than they are sons. Pediatrics 2003;111:1226 -1231; maternal perception, child, overweight, obesity, weight status, body weight, mother-child relations. [ABSTRACT FROM AUTHOR]

The article examines longitudinal trends in body mass index (BMI) among children and adolescents aged 2–19 years before and during the COVID-19 pandemic in the United States. The study shows that during the COVID-19 pandemic, there was a significant increase in BMI among this age group, particularly among those with overweight or obesity, emphasizing the need for efforts to prevent excess weight gain and promote healthy behaviors during public health emergencies.

Obesity* is a recognized risk factor for severe COVID-19 (1,2), possibly related to chronic inflammation that disrupts immune and thrombogenic responses to pathogens (3) as well as to impaired lung function from excess weight (4). Obesity is a common metabolic disease, affecting 42.4% of U.S. adults (5), and is a risk factor for other chronic diseases, including type 2 diabetes, heart disease, and some cancers.† The Advisory Committee on Immunization Practices considers obesity to be a high-risk medical condition for COVID-19 vaccine prioritization (6). Using data from the Premier Healthcare Database Special COVID-19 Release (PHD-SR),§ CDC assessed the association between body mass index (BMI) and risk for severe COVID-19 outcomes (i.e., hospitalization, intensive care unit [ICU] or stepdown unit admission, invasive mechanical ventilation, and death). Among 148,494 adults who received a COVID-19 diagnosis during an emergency department (ED) or inpatient visit at 238 U.S. hospitals during March-December 2020, 28.3% had overweight and 50.8% had obesity. Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years. Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, respectively, and then increased sharply with higher BMIs. Risk for invasive mechanical ventilation increased over the full range of BMIs, from 15 kg/m2 to 60 kg/m2. As clinicians develop care plans for COVID-19 patients, they should consider the risk for severe outcomes in patients with higher BMIs, especially for those with severe obesity. These findings highlight the clinical and public health implications of higher BMIs, including the need for intensive COVID-19 illness management as obesity severity increases, promotion of COVID-19 prevention strategies including continued vaccine prioritization (6) and masking, and policies to ensure community access to nutrition and physical activities that promote and support a healthy BMI. [ABSTRACT FROM AUTHOR]

Purpose: Determine prevalence of overweight and obesity as reported in Head Start Program Information Reports. Design: Serial cross-sectional census reports from 2012–2018. Setting: Head Start programs countrywide, aggregated from program level to state and national level. Subjects: Population of children enrolled in Head Start with reported weight status data. Measures: Prevalence of overweight (body mass index [BMI] ≥85th percentile to <95th percentile) and obesity (BMI ≥95th percentile). Analysis: Used descriptive statistics to present the prevalence of overweight and obesity by state. Performed unadjusted regression analysis to examine annual trends or average annual changes in prevalence. Results: In 2018, the prevalence of overweight was 13.7% (range: 8.9% in Alabama to 20.4% in Alaska). The prevalence of obesity was 16.6% (range: 12.5% in South Carolina to 27.1% in Alaska). In the unadjusted regression model, 34 states and the District of Columbia did not have a linear trend significantly different from zero. There was a statistically significant positive trend in obesity prevalence for 13 states and a negative trend for 3 states. Conclusion: The prevalence of obesity and overweight in Head Start children remained stable but continues to be high. Head Start reports may be an additional source of surveillance data to understand obesity prevalence in low-income young children. [ABSTRACT FROM AUTHOR]

Purpose: During a pandemic, persons might experience worry because of threats (real or perceived), or as part of stress-related reactions. We aimed to provide insight into Americans' worry about food during COVID-19. Design, Subjects, Measures: Online survey data from June 2020 (n = 4,053 U.S. adults; 62.7% response rate) was used to assess 2 outcomes: worry about food availability (FA); food safety (FS). Adults with missing information about FA and FS were excluded from analysis (final n = 3,652). Analysis: We used descriptive statistics and multivariable logistic regression to examine characteristics associated with the outcomes and estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for associations between sociodemographic variables and outcomes. Results: 58.3% of respondents reported worry about FA; 57.5% about FS, with higher odds of worry for FA and FS (versus referents) in lower income households (FA: aOR = 1.76 95%CI [1.30, 2.39]; FS: 1.84[1.35, 2.51]); unemployed (1.54[1.05, 2.28]; 1.90[1.26,2.81]); non-Hispanic Black (1.55[1.14,2.12]); 2.25[1.65,3.07]); Hispanic (1.39[1.06,1.82]; 1.94[1.46,2.56]). Conclusion: Findings highlight the importance of strategies to reduce consumer worry about FA and FS and negative food behaviors, and the need for continued access to hunger safety net programs, which could have positive effects on nutrition security. [ABSTRACT FROM AUTHOR]

Objectives: Frequent sugar-sweetened beverage (SSB) intake is associated with weight gain in women, and pre-pregnancy overweight and excessive gestational weight gain are linked to adverse pregnancy outcomes. SSB intake information for women of reproductive age (WRA) is limited. We described SSB intake among non-pregnant and pregnant WRA and identified correlates of daily intake. Methods: Using 2017 Behavioral Risk Factor Surveillance System data, we analyzed SSB intake (regular soda, fruit drinks, sweet tea, sports/energy drinks) for 11,321 non-pregnant and 392 pregnant WRA (18–49 years) in 12 states and D.C. Adjusted odds ratios (aOR) for daily (≥ 1 time/day) SSB intake (reference: < 1 time/day) by characteristics were estimated using multivariable logistic regression. Results: Overall, 27.3% of non-pregnant and 21.9% of pregnant women reported consuming SSBs ≥ 1 time/day; 12.6% and 9.7%, respectively, consumed SSBs ≥ 2 times/day. Among non-pregnant women, odds of daily SSB intake were higher for women who were non-Hispanic black (aOR 2.04, 95% CI 1.55–2.69) vs. non-Hispanic white; had ≤ high school education (aOR 2.79, CI 2.26–3.44) or some college (aOR 1.85, CI 1.50–2.27) vs. college graduates; lived in nonmetropolitan counties (aOR 1.35, CI 1.11–1.63) vs. metropolitan; had no physical activity (aOR 1.72, CI 1.43–2.07) vs. some; were former (aOR 1.51, CI 1.17–1.94) or current (aOR 3.48, CI 2.82–4.28) smokers vs. nonsmokers. Among pregnant women, those not married had higher odds (aOR 2.81, CI 1.05–7.51) for daily SSB intake than married women. Conclusions: One in five pregnant women and one in four non-pregnant women of reproductive age consumed SSBs at least once per day. Sociodemographic and behavioral correlates of daily SSB intake were identified. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors associated with frequency of plain water (ie, tap, bottled, and unflavored sparkling water) intake among US high school students.Design: Quantitative, cross-sectional study.Setting: The 2017 national Youth Risk Behavior Survey data.Subjects: US high school students with plain water intake data (N = 10 698).Measures: The outcome was plain water intake. Exposure variables were demographics, academic grades, and behavioral characteristics.Analysis: We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for factors associated with infrequent plain water intake (<3 vs ≥3 times/day).Results: Overall, 48.7% of high school students reported drinking plain water <3 times/day. Factors associated with infrequent plain water intake were younger age (≤15 years; aOR = 1.20, CI = 1.05-1.37); earning mostly D/F grades (aOR = 1.37, CI = 1.07-1.77); consuming regular soda 1 to 6 times/week (aOR = 1.92, CI = 1.67-2.20) or ≥1 time/day (aOR = 3.23, CI = 2.65-3.94), sports drinks 1 to 6 times/week (aOR = 1.30, CI = 1.14-1.49), milk <2 glasses/day (aOR = 1.51, CI = 1.31-1.73), fruits <2 times/day (aOR = 1.92, CI = 1.66-2.22), and vegetables <3 times/day (aOR = 2.42, CI = 2.04-2.89); and being physically active ≥60 minutes/day on <5 days/week (aOR = 1.83, CI = 1.60-2.08). Students with obesity were less likely to have infrequent water intake (aOR = 0.63, CI = 0.53-0.74).Conclusions: Infrequent plain water intake was associated with younger age, poor academic grades, poor dietary behaviors, and physical inactivity. These findings can inform intervention efforts to increase water intake to promote healthy lifestyles among adolescents. [ABSTRACT FROM AUTHOR]

Purpose: To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent attitudes about limiting SSB and junk food (SSB/JF) intake.Design: Quantitative, cross-sectional study.Setting: The 2014 Family Life, Activity, Sun, Health, and Eating study.Sample: Parent-adolescent dyads (N = 1555).Measures: The outcome was adolescent SSB intake. Exposure variables were parent SSB intake, sociodemographics, and parent and adolescent attitudes about SSB/JF intake (responses: agree, neither, or disagree).Analysis: Multinomial logistic regressions estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs).Results: Half (49.5%) of adolescents and 33.7% of parents consumed SSB ≥1 time/day. Parent daily SSB intake was associated with adolescent daily SSB intake (aOR = 8.9; CI = 4.6-17.3) [referent: no consumption]. Adolescents who disagreed on having confidence to limit SSB/JF intake had higher odds of daily SSB intake (aOR = 3.5; CI = 1.8-6.8), as did those who disagreed they felt bad about themselves if they did not limit SSB/JF intake (aOR = 1.9; CI=1.1-3.3), compared to adolescents who agreed with these attitudes. No parental attitudes were significant.Conclusion: Higher odds of daily SSB intake among adolescents was associated with parent SSB intake and adolescent attitudes about confidence in, and feeling bad about, limiting SSB/JF intake. Parent attitudes were not associated with daily adolescent SSB intake. Efforts to reduce adolescent SSB intake could consider strategies geared toward improving adolescent attitudes and dietary behaviors and parental SSB intake. [ABSTRACT FROM AUTHOR]

We described sociodemographic differences in perceptions of drinking water safety and examined associations between perceptions and plain water intake. We used the 2015 Estilos survey of 1,000 US Hispanic adults conducted in both Spanish and English. Outcome was water intake. Exposures were the level of agreement about water perceptions (My tap water is safe to drink; Community tap water is safe to drink; Bottled water is safer; I would buy less bottled water if my tap water was safe). Covariates were sociodemographics, region, Hispanic heritage, and acculturation. We used chi-square tests and multinomial logistic regression to examine associations of water perceptions and intake. Overall, 24% of Hispanic adults consumed water 1 time/day. Although 34% disagreed their home tap water was safe to drink, and 41% disagreed their community tap water was safe to drink, 65% agreed bottled water is safer than tap water, and 69% agreed they would buy less bottled water if they knew their tap water was safe. Perceptions differed by some covariates but were not significantly associated with plain water intake. In conclusion, negative perceptions of tap water were common among US Hispanic adults, which can inform efforts to increase awareness about safe public water systems. [ABSTRACT FROM AUTHOR]

Purpose: To examine associations between knowledge of health conditions and sugar-sweetened beverage (SSB) intake among Hispanic adults.Design: Quantitative, cross-sectional study.Setting: The 2015 Estilos survey data.Participants: One thousand US Hispanic adults (≥18 years).Measures: The outcome variable was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, and sweetened coffee/tea drink). Exposure variables were knowledge of 6 SSB-related health conditions (weight gain, diabetes, dental caries, high cholesterol, heart disease, and hypertension).Analysis: Six multinomial logistic regression models were used to estimate adjusted odds ratios for consuming SSBs ≥3 times/day (high intake), in relation to knowledge of SSB-related health conditions.Results: Overall, 58% of Hispanic adults consumed SSBs ≥2 times/day and 36% consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) were related to drinking SSBs, only half identified this relation with dental caries (57%) and hypertension (41%). Even fewer identified high cholesterol (32%) and heart disease (32%) as related. In crude analyses, SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, dental caries, and heart disease; however, after adjusting for sociodemographics and acculturation, associations were no longer significant.Conclusions: Although SSB intake was very high, knowledge of SSB-related health conditions was low and was not related to high SSB intake among US Hispanic adults. Education efforts alone may not be adequate for Hispanic adults to change their behaviors. [ABSTRACT FROM AUTHOR]

Purpose: To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent knowledge of SSB-related health risks.Design: Quantitative, cross-sectional.Setting: 2014 SummerStyles survey.Subjects: Nine hundred and ninety parent and adolescent (12-17 years) pairs.Measures: The outcome was self-reported adolescent intake (0, >0 to <1, or ≥1 time/day) of SSBs (soda, fruit drinks, sports/energy drinks, other SSBs). The exposures were self-reported parent SSB intake (0, >0 to <1, ≥1 to <2, or ≥2 times/day) and parent and adolescent knowledge of SSB-related health risks (weight gain, diabetes, and dental caries).Analysis: Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aORs) for adolescent SSB intake ≥1 time/day (ref: 0 times/day), according to (1) parent SSB intake and (2) parent and (3) adolescent knowledge.Results: About 31% of adolescents consumed SSBs ≥1 time/day, and 43.2% of parents consumed SSBs ≥2 times/day. Adolescent and parent knowledge that SSB intake is related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/day was associated with parent intake ≥2 times/day (aOR = 3.30; 95% confidence interval = 1.62-6.74) but not with parent or adolescent knowledge of health risks.Conclusion: Parental SSB intake may be an important factor in understanding adolescent behavior; knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior. [ABSTRACT FROM AUTHOR]

Purpose: To compare the performance of a 1-question survey screener measuring total sugar-sweetened beverage (SSB) intake to a screener measuring SSB types separately using 4 questions.Design: Cross-sectional.Setting: Web-based 2014 SummerStyles survey.Participants: A total of 4167 US adults (≥18 years).Measures: Frequency of SSB intake measured using a 1-question screener was compared to frequency using a 4-question screener (regular soda, fruit drinks, sports/energy drinks, sweetened coffee/tea). SSB intake (number of time/day) was categorized as 0, >0 to <1, and ≥1 time/day; difference in mean intake was calculated between 4 questions versus 1.Analysis: Paired t tests were used, and agreement was evaluated using weighted κ and Lin's concordance correlation coefficient (CCC).Results: Mean SSB intake was 1.7 (95% confidence interval [CI]: 1.65-1.79) times/day using 4 questions and 0.6 (95% CI: 0.56-0.62) times/day using 1 question ( P < .001). Intake frequency based on 4 questions versus 1 was 16.0% versus 38.5% for 0 time/day, 15.6% versus 42.5% for >0 to <1 time/day, and 68.4% versus 18.9% for ≥1 time/day. There was fair agreement for the 3 SSB intake categories (κ: .27) and poor absolute agreement between the 2 continuous measures (Lin's CCC: 0.31).Conclusion: Daily SSB intake was significantly lower using a 1-question screener versus a 4-question screener. Researchers should assess SSB types separately or consider that daily SSB intake is likely underestimated with 1 question. [ABSTRACT FROM AUTHOR]

Purpose: This study examined associations between knowledge of sugar-sweetened beverage (SSB)-related health conditions and SSB intake among US adults.Design: Quantitative, cross-sectional study.Subject: The 2014 SummerStyles survey data for 4163 US adults (≥18 years) were used.Measures: The outcome measure was frequency of SSB intake (regular soda, fruit drinks, sports or energy drinks, sweetened coffee/tea drinks). Exposure measures were knowledge of 6 SSB-related health conditions: weight gain, diabetes, cavities, high cholesterol, heart disease, and hypertension.Analysis: Six logistic regression models were used to estimate adjusted odds ratios (ORs) for consuming SSBs ≥2 times/d according to knowledge of SSB-related health conditions.Results: Overall, 37.8% of adults reported consuming SSBs ≥2 times/d. Although most adults identified that weight gain (80.2%), diabetes (73.6%), and cavities (71.8%) are related to drinking SSBs, fewer adults identified high cholesterol (24.1%), heart disease (31.5%), and hypertension (33.0%) as being related to drinking SSBs. Crude analyses indicated that lower SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, diabetes, cavities, and heart disease. However, after adjustment for covariates, only lack of knowledge of the association between heart disease and SSBs was significantly associated with consuming SSBs ≥2 times/d (OR = 1.29) than non-SSB consumers.Conclusions: The finding that knowledge of SSB-related health conditions, in general, was not associated with high SSB intake suggests that knowledge on SSB-related health conditions alone may not be sufficient for adult behavior change. [ABSTRACT FROM AUTHOR]

Approximately 46 million persons (14%) in the United States live in nonmetropolitan counties.* Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases such as diabetes (1), coronary heart disease (1), and arthritis (2). The 2005-2008 National Health and Nutrition Examination Survey (NHANES) found a significantly higher obesity prevalence among adults in nonmetropolitan (39.6%) than in metropolitan (33.4%) counties (3). However, this difference has not been examined by state. Therefore, CDC examined state-level 2016 Behavioral Risk Factor Surveillance System (BRFSS) data and found that the prevalence of obesity (body mass index [BMI] ≥30 kg/m2) was 34.2% among U.S. adults living in nonmetropolitan counties and 28.7% among those living in metropolitan counties (p<0.001). Obesity prevalence was significantly higher among nonmetropolitan county residents than among metropolitan county residents in all U.S. Census regions, with the largest absolute difference in the South (5.6 percentage points) and Northeast (5.4 percentage points). In 24 of 47 states, obesity prevalence was significantly higher among persons in nonmetropolitan counties than among those in metropolitan counties; only in Wyoming was obesity prevalence higher among metropolitan county residents than among nonmetropolitan county residents. Both metropolitan and nonmetropolitan counties can address obesity through a variety of policy and environmental strategies to increase access to healthier foods and opportunities for physical activity (4). [ABSTRACT FROM AUTHOR]

Purpose: Characteristics of parents who purchased kids' meals, reasons for the purchase, and desire for healthy options were examined.Design: Quantitative, cross-sectional study.Setting: National.Participants: The SummerStyles survey data of 1147 parents (≥18 years).Measures: Self-reported outcome variables were purchase of kids' meals (yes/no), reasons for the purchase (13 choices), and desire for healthy options (yes/no).Analysis: We used multivariable logistic regression to estimate odds ratios (ORs) for purchasing kids' meals based on parental sociodemographic and behavioral characteristics.Results: Over half (51%) of parents reported purchasing kids' meals in the past month. The adjusted OR of purchasing kids' meals were significantly higher among younger parents (OR = 3.44 vs ≥50 years) and among parents who consumed sugar-sweetened beverages (SSBs) daily (OR = 2.70 vs none). No differences were found for race/ethnicity, income, and education. Parents who purchased kids' meals reported that the top 3 reasons for purchase were (1) because their children asked for kids' meals, (2) habit, and (3) offering of healthier sides such as fruits or fruit cups. Thirty-seven percent of parents who did not purchase kids' meals expressed willingness to purchase kids' meals if healthy options were available; this willingness was highest among younger parents (47%; P < .05).Conclusions: Kids' meal purchases were somewhat common. Our findings on characteristics of parents who frequently bought kids' meals (ie, younger parents and SSB consumers), common reasons for purchasing kids' meals, and willingness to buy healthier kids' meal can be used to inform intervention efforts to improve quality of kids' meals. [ABSTRACT FROM AUTHOR]

Background:BMIz-scores (BMIz) based on the Centers for Disease Control and Prevention (CDC) growth charts among children do not accurately characterise BMI levels among children with very high BMIs. These limitations may be particularly relevant in longitudinal and intervention studies, as the large changes in the L (normality) and S (dispersion) parameters with age can influence BMIz. Aim:To compare longitudinal changes in BMIzwith BMI expressed as a percentage of the 95th percentile (%BMIp95) and a modifiedz-score calculated as log(BMI/M)/S. Subjects and methods:A total of 45 414 2–4-year-olds with severe obesity (%BMIp95 ≥ 120). Results:Changes in very high BMIzlevels differed from the other metrics. Among severely obese 2-year-old girls, for example, the mean BMIzdecreased by 0.6 SD between examinations, but there were only small changes in BMIp95 and modified BMIz. Some 2-year-old girls had BMIzdecreases of >1 SD, even though they had large increases in BMI, %BMIp95 and modified BMIz. Conclusions:Among children with severe obesity, BMIzchanges may be due to differences in the transformations used to estimate levels of BMIzrather than to changes in body size. The BMIs of these children could be expressed relative to the 95th percentile or as modifiedz-scores. [ABSTRACT FROM AUTHOR]

The National Cancer Institute developed the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to examine multiple cancer preventive behaviors within parent-adolescent dyads. The purpose of creating FLASHE was to enable the examination of physical activity, diet, and other cancer preventive behaviors and potential correlates among parent-adolescent dyads. FLASHE surveys were developed from a process involving literature reviews, scientific input from experts in the field, cognitive testing, and usability testing. This cross-sectional, web-based study of parents and their adolescent children (aged 12-17 years) was administered between April and October 2014. The nationwide sample consisted of 1,573 parent-adolescent dyads (1,699 parents and 1,581 adolescents) who returned all FLASHE surveys. FLASHE assessed parent and adolescent reports of several intrapersonal and interpersonal domains (including psychosocial variables, parenting, and the community and home environments). On a subset of example FLASHE items across these domains, responses of parents and adolescents within the same dyads were positively and significantly correlated (r =0.32-0.63). Analyses were run in 2015-2016. FLASHE data present multiple opportunities for studying research questions among individuals or dyads, including the ability to examine similarity between parents and adolescents on many constructs relevant to cancer preventive behaviors. FLASHE data are publicly available for researchers and practitioners to help advance research on cancer preventive health behaviors. [ABSTRACT FROM AUTHOR]

Childhood obesity is associated with negative health consequences in childhood (1) that continue into adulthood (2), putting adults at risk for type 2 diabetes, cardiovascular disease, and certain cancers (1). Obesity disproportionately affects children from low-income families (3). Through a collaboration with the United States Department of Agriculture (USDA), CDC has begun to use data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants and Program Characteristics (WIC PC) to replace the Pediatric Nutrition Surveillance System (PedNSS) (4,5) for obesity surveillance among young children from low-income families. CDC examined trends in obesity prevalence during 2000-2014 among WIC participants aged 2-4 years using WIC PC data. Overall obesity prevalence increased from 14.0% in 2000 to 15.5% in 2004 and 15.9% in 2010, and then decreased to 14.5% in 2014. During 2010-2014, the prevalence of obesity decreased significantly overall, among non-Hispanic whites, non-Hispanic blacks, Hispanics, American Indian/Alaska Natives and Asians/Pacific Islanders, and among 34 (61%) of the 56 WIC state agencies in states, the District of Columbia, and U.S. territories. Despite these declines, the obesity prevalence among children aged 2-4 years in WIC remains high compared with the national prevalence of 8.9% among children aged 2-5 years in 2011-2014. Continued initiatives to work with parents and other stakeholders to promote healthy pregnancies, breastfeeding, quality nutrition, and physical activity for young children in multiple settings are needed to ensure healthy child development. [ABSTRACT FROM AUTHOR]

Background Reducing added sugars intake is one of the Healthy People 2020 objectives. High added sugars intake may be associated with adverse health consequences. Objective This cross-sectional study identified sociodemographic and behavioral characteristics associated with added sugars intake among US adults (18 years and older) using the 2010 National Health Interview Survey data (n=24,967). Methods The outcome variable was added sugars intake from foods and beverages using scoring algorithms to convert dietary screener frequency responses on nine items to estimates of individual dietary intake of added sugars in teaspoons per day. Added sugars intake was categorized into tertiles (lowest, middle, highest) stratified by sex. The explanatory variables were sociodemographic and behavioral characteristics. Multinomial logistic regression was used to estimate the adjusted odds ratios for the highest and middle tertile added sugars intake groups as compared with the lowest tertile group. Results Estimated median added sugars intake was 17.6 tsp/d for men and 11.7 tsp/d for women. For men and women, those who had significantly greater odds for being in the highest tertile of added sugars intake (men: ≥22.0 tsp/d; women: ≥14.6 tsp/d) were younger, less educated, had lower income, were less physically active, were current smokers, and were former or current infrequent/light drinkers, whereas non-Hispanic other/multiracial and those living in the West had significantly lower odds for being in the highest tertile of added sugars intake. Different patterns were found by sex. Non-Hispanic black men had lower odds for being in the highest tertile of added sugars intake, whereas non-Hispanic black women had greater odds for being in the highest tertile. Conclusions One in three men consumed ≥22.0 tsp added sugars and one in three women consumed ≥14.6 tsp added sugars daily. Higher added sugars intake was associated with various sociodemographic and behavioral characteristics; this information can inform efforts to design programs and policies specific to high-intake populations. [ABSTRACT FROM AUTHOR]

Objectives: Sugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association.Methods: We analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥18years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none, <1 time/day, once/day, ≥2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier.Results: Overall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥2 times/day. There was no difference in asthma prevalence with SSB intake <1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥2 times/day (aOR=1.66, 95%CI=1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults.Conclusions: Frequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults. [ABSTRACT FROM AUTHOR]