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Background: Assess the associations between ten severe maternal hardships and food insecurity experienced during pregnancy.Methods: Data on 14,274 low-income/lower-income women (below 400% of the income to federal poverty guideline ratio) from the statewide-representative 2010-2012 California Maternal and Infant Health Assessment were used to estimate food security status prevalence. Prevalence of severe maternal hardships by food security status was estimated. Multinomial logistic regression was used to assess the associations between severe maternal hardship and food security status, adjusting for sociodemographic characteristics.Results: Food insecurity was common among low- and lower-income pregnant women in California; 23.4% food insecure and an additional 11.5% marginally secure. In adjusted analysis, nine of ten hardships were associated with food security status. Only the respondent or someone close to the respondent having a problem with alcohol or drugs was not associated with food security status after adjusting for socioeconomic factors. Husband/partner losing a job, depressive symptoms, not having practical support and intimate partner violence were consistently associated with marginal, low and very low food security status. Each additional severe maternal hardship a woman experienced during pregnancy was associated with a 36% greater risk of reporting marginal food security (Relative Risk Ratio 1.36, 95% CI: 1.27, 1.47), 54% for low food security (Relative Risk Ratio 1.54, 95% CI: 1.44, 1.64), and 99% for very low food security (Relative Risk Ratio 1.99, 95% CI: 1.83, 2.15).Conclusions: Food security status was strongly linked with several maternal hardships that could jeopardize maternal and/or infant health. Services-including prenatal care and nutritional assistance-for a large proportion of pregnant women should address a wide range of serious unmet social needs including food insecurity. [ABSTRACT FROM AUTHOR]

BACKGROUND: The National School Lunch and Breakfast Programs help to reduce food insecurity and improve nutrition. The Community Eligibility Provision (CEP) enables high‐poverty schools to offer breakfast and lunch at no cost to all students. This study examines associations between CEP and participation among students eligible for free or reduced‐price meals ("FRPM"), possibly eligible ("near‐cutoff"), or ineligible ("full‐price"). METHODS: Using data from the 2013‐2015 Healthy Communities Study, we compared school breakfast and lunch participation between 842 students in K‐8 at 80 CEP schools and 1463 students at 118 schools without CEP. Cross‐sectional difference‐in‐difference (DID) models compared meal participation among near‐cutoff and full‐price groups to that in the FRPM group. RESULTS: Overall, FRPM students had high participation in school lunch and breakfast at both types of schools. In adjusted DID models, lunch participation among near‐cutoff students was 12 points higher in CEP versus comparison schools (p <.05). Among full‐price students, breakfast participation was 20 points higher and lunch participation 19 points higher in CEP than comparison schools (p <.001). CONCLUSIONS: Community Eligibility Provision improves access to school breakfast and lunch in high‐poverty schools, particularly for students who are near or above the cutoff for FRPM eligibility. [ABSTRACT FROM AUTHOR]

Objective/Background: Poor sleep quality is common in pregnancy and associated with increased psychological distress, which has adverse consequences for families. Emerging theory suggests that mindfulness-based interventions may help reduce cognitive and emotional reactivity to stressful events. The current study examines the effects of a mindfulness-based intervention on the relationship between poor sleep quality and increased depression symptom severity and perceived stress during pregnancy. Additionally, we explored the prevalence of poor sleep quality in this unique sample and the impact of intervention on sleep quality. Participants: Participants were 215 ethnically diverse, overweight and obese, predominantly low-income pregnant women drawn from a study examining the impact of an 8-week mindfulness-based program (Mindful Moms Training; MMT) to reduce excessive gestational weight gain, stress, and depression compared to treatment as usual (TAU). Methods: Participants reported global sleep quality, depressive symptoms, and perceived stress at baseline and postintervention. Results: Most participants (63%) were categorized as poor sleepers at baseline. MMT participants did not experience significantly greater improvement in sleep quality compared to TAU participants. Baseline poor global sleep quality predicted increased depression symptom severity for all participants. Baseline poor global sleep quality predicted increased perceived stress for the TAU group only; this association was not evident in the MMT group. Conclusions: Poor sleep quality is prevalent in overweight and obese predominantly low-income pregnant women. Poor sleep quality was associated with worsening psychological distress, but mindfulness training significantly attenuated the influence of poor sleep on perceived stress. [ABSTRACT FROM AUTHOR]

Background: The current study examined if early adversity was associated with accelerated biological aging, and if effects were mediated by the timing of puberty. Methods: In early mid-life, 187 Black and 198 White (M age = 39.4, s.d.age = 1.2) women reported on early abuse and age at first menstruation (menarche). Women provided saliva and blood to assess epigenetic aging, telomere length, and C-reactive protein. Using structural equation modeling, we created a latent variable of biological aging using epigenetic aging, telomere length, and C-reactive protein as indicators, and a latent variable of early abuse using indicators of abuse/threat events before age 13, physical abuse, and sexual abuse. We estimated the indirect effects of early abuse and of race on accelerated aging through age at menarche. Race was used as a proxy for adversity in the form of systemic racism. Results: There was an indirect effect of early adversity on accelerated aging through age at menarche (b = 0.19, 95% CI 0.03–0.44), in that women who experienced more adversity were younger at menarche, which was associated with greater accelerated aging. There was also an indirect effect of race on accelerated aging through age at menarche (b = 0.25, 95% CI 0.04–0.52), in that Black women were younger at menarche, which led to greater accelerated aging. Conclusions: Early abuse and being Black in the USA may both induce a phenotype of accelerated aging. Early adversity may begin to accelerate aging during childhood, in the form of early pubertal timing. [ABSTRACT FROM AUTHOR]

Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2 ) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes. [ABSTRACT FROM AUTHOR]

The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that an increase in the neighborhood foreclosure rate could worsen glycemic control by activating stressors such as higher neighborhood crime, lower housing prices, and erosion of neighborhood social cohesion. To test this, we linked public foreclosure records at the census-block level with clinical records from 2006 to 2009 of patients with diabetes. We specified individual fixed-effects models and controlled for individual time-invariant confounders and area-level time-varying confounders, including housing prices and unemployment rate, to estimate the effect of the foreclosure rate per census-block group on glycated hemoglobin. We found no statistically significant relationship between changes in the neighborhood foreclosure rate per block group in the prior year and changes in glycated hemoglobin. There is no evidence that increased foreclosure rates worsened glycemic control in this continuously insured population with diabetes. More research is needed to inform our knowledge of the role of insurance and health-care delivery systems in protecting the health of diabetic patients during times of economic stress. [ABSTRACT FROM AUTHOR]

Food insecurity increases the risks of diet-related chronic disease and mental health outcomes in low-income adults; however, the pathways underlying these associations have not been clearly identified. Chronic, psychological distress may represent an important pathway between food insecurity and health. To identify types of psychological distress, experiential descriptions, and the array of emotional responses and coping strategies specific to food insecurity among parents with children A phenomenological qualitative study using one-on-one, in-depth interviews. Forty-eight adults (parents) were recruited from the San Francisco Bay Area in 2016-17. Eligibility criteria included any experience of household food insecurity over the past 12 months, having a child aged 7 to 14 years, and both parent and child with the ability to speak English fluently. Data were analyzed using the constant comparative method to reveal emergent themes across multiple interviews. Parents discussed six themes related to the psychological distress of food insecurity: stress from the logistical and financial balancing act of feeding one's family, frustration and lack of choice associated with the high costs of healthy foods, stigma of using community resources, shame of not being able to provide for one's family, sadness about their cyclical and chronic food situation, and guilt over their inability to adequately provide for their children. Coping responses included negative responses, such as sleeping and drinking to avoid thinking about food insecurity, and positive responses of relying on their friends and family for support, staying hopeful, and spending time with their children. The commonality of emotional responses stemming from the experience of food insecurity can increase the risk for clinical anxiety and depression. Future development of interventions and policies to alleviate food insecurity must include social support and adequate safety systems. [ABSTRACT FROM AUTHOR]

We examined whether residing within 2 miles of a new supermarket opening was longitudinally associated with a change in body mass index (BMI). We identified 12 new supermarkets that opened between 2009 and 2010 in 8 neighborhoods. Using the Kaiser Permanente Northern California Diabetes Registry, we identified members with type 2 diabetes residing continuously in any of these neighborhoods 12 months prior to the first supermarket opening until 10 months following the opening of the last supermarket. Exposure was defined as a reduction (yes/no) in travel distance to the nearest supermarket as a result of a new supermarket opening. First difference regression models were used to estimate the impact of reduced supermarket distance on BMI, adjusting for longitudinal changes in patient and neighborhood characteristics. Among patients in the exposed group, new supermarket openings reduced travel distance to the nearest supermarket by 0.7 miles on average. However, reduced distance to nearest supermarket was not associated with BMI changes. Overall, we found no evidence that reduced supermarket distance was associated with reduced levels of obesity for residents with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Obese individuals vary in their experience of food cravings and tendency to engage in reward-driven eating, both of which can be modulated by the neural reward system rather than physiological hunger. We examined two predictions in a sample of obese women: (1) whether opioidergic blockade reduced food-craving intensity, and (2) whether opioidergic blockade reduced an association between food-craving intensity and reward-driven eating, which is a trait-like index of three factors (lack of control over eating, lack of satiation, preoccupation with food).Methods: Forty-four obese, pre-menopausal women completed the Reward-Based Eating Drive (RED) scale at study start and daily food-craving intensity on 5 days on which they ingested either a pill-placebo (2 days), a 25 mg naltrexone dose (1 day), or a standard 50mg naltrexone dose (2 days).Results: Craving intensity was similar under naltrexone and placebo doses. The association between food-craving intensity and reward-driven eating significantly differed between placebo and 50mg naltrexone doses. Reward-driven eating and craving intensity were significantly positively associated under both placebo doses. As predicted, opioidergic blockade (for both doses 25mg and 50mg naltrexone) reduced the positive association between reward-driven eating and craving intensity to non-significance.Conclusions: Opioidergic blockade did not reduce craving intensity; however, blockade reduced an association between trait-like reward-driven eating and daily food-craving intensity, and may help identify an important endophenotype within obesity. [ABSTRACT FROM AUTHOR]

Background The role that environmental factors, such as neighborhood socioeconomics, food, and physical environment, play in the risk of obesity and chronic diseases is not well quantified. Understanding how spatial distribution of disease risk factors overlap with that of environmental (contextual) characteristics may inform health interventions and policies aimed at reducing the environment risk factors. We evaluated the extent to which spatial clustering of extreme body mass index (BMI) values among a large sample of adults with diabetes was explained by individual characteristics and contextual factors. Methods We quantified spatial clustering of BMI among 15,854 adults with diabetes from the Diabetes Study of Northern California (DISTANCE) cohort using the Global and Local Moran's I spatial statistic. As a null model, we assessed the amount of clustering when BMI values were randomly assigned. To evaluate predictors of spatial clustering, we estimated two linear models to estimate BMI residuals. First we included individual factors (demographic and socioeconomic characteristics). Then we added contextual factors (neighborhood deprivation, food environment) that may be associated with BMI. We assessed the amount of clustering that remained using BMI residuals. Results Global Moran's I indicated significant clustering of extreme BMI values; however, after accounting for individual socioeconomic and demographic characteristics, there was no longer significant clustering. Twelve percent of the sample clustered in extreme high or low BMI clusters, whereas, only 2.67% of the sample was clustered when BMI values were randomly assigned. After accounting for individual characteristics, we found clustering of 3.8% while accounting for neighborhood characteristics resulted in 6.0% clustering of BMI. After additional adjustment of neighborhood characteristics, clustering was reduced to 3.4%, effectively accounting for spatial clustering of BMI. Conclusions We found substantial clustering of extreme high and low BMI values in Northern California among adults with diabetes. Individual characteristics explained somewhat more of clustering of the BMI values than did neighborhood characteristics. These findings, although crosssectional, may suggest that selection into neighborhoods as the primary explanation of why individuals with extreme BMI values live close to one another. Further studies are needed to assess causes of extreme BMI clustering, and to identify any community level role to influence behavior change. [ABSTRACT FROM AUTHOR]

Objectives. We tested whether leukocyte telomere length maintenance, which underlies healthy cellular aging, provides a link between sugar-sweetened beverage (SSB) consumption and the risk of cardiometabolic disease. Methods. We examined cross-sectional associations between the consumption of SSBs, diet soda, and fruit juice and telomere length in a nationally representative sample of healthy adults. The study population included 5309 US adults, aged 20 to 65 years, with no history of diabetes or cardiovascular disease, from the 1999 to 2002 National Health and Nutrition Examination Surveys. Leukocyte telomere length was assayed from DNA specimens. Diet was assessed using 24-hour dietary recalls. Associations were examined using multivariate linear regression for the outcome of log-transformed telomere length. Results. After adjustment for sociodemographic and health-related characteristics, sugar-sweetened soda consumption was associated with shorter telomeres (b = –0.010; 95% confidence interval [CI] = –0.020, –0.001; P = .04). Consumption of 100% fruit juice was marginally associated with longer telomeres (b = 0.016; 95% CI = –0.000, 0.033; P = .05). No significant associations were observed between consumption of diet sodas or noncarbonated SSBs and telomere length. Conclusions. Regular consumption of sugar-sweetened sodas might influence metabolic disease development through accelerated cell aging. [ABSTRACT FROM AUTHOR]

Abstract: Food insecurity is linked to higher weight gain in pregnancy, as is dietary restraint. We hypothesized that pregnant women exposed to marginal food insecurity, and who reported dietary restraint before pregnancy, will paradoxically show the greatest weight gain. Weight outcomes were defined as total kilograms, observed-to-recommended weight gain ratio, and categorized as adequate, inadequate or excessive weight gain based on 2009 Institute of Medicine guidelines. A likelihood ratio test assessed the interaction between marginal food insecurity and dietary restraint and found significant. Adjusted multivariate regression and multinomial logistic models were used to estimate weight gain outcomes. In adjusted models stratified by dietary restraint, marginal insecurity and low restraint was significantly associated with lower weight gain and weight gain ratio compared to food secure and low restraint. Conversely, marginal insecurity and high restraint was significantly associated with higher weight gain and weight gain ratio compared to food secure and high restraint. Marginal insecurity with high restraint was significantly associated with excessive weight gain. Models were consistent when restricted to low-income women and full-term deliveries. In the presence of marginal food insecurity, women who struggle with weight and dieting issues may be at risk for excessive weight gain. [Copyright &y& Elsevier]

Objective: To compare associations between neighborhood deprivation and measures of BMI change among adults with type 2 diabetes.Research Design and Methods: Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures of BMI change over 3 years: 1) a continuous measure and 2) a categorical measure of clinically substantive BMI loss or gain (≥7% of baseline BMI) versus stable BMI. The sample included 13,609 adults.Results: On average, there was little change in BMI (-0.12, SD 3.07); 17.0 and 16.1% had clinically substantive BMI loss or gain, respectively, at follow-up. There was a positive association between neighborhood deprivation and BMI change for adults in the most versus least-deprived quartile of neighborhood deprivation (β = 0.22, P = 0.02) in adjusted models. In addition, relative to the least-deprived quartile (Q1), adults in more-deprived quartiles of neighborhood deprivation were more likely to experience either substantive BMI loss (Q2 relative risk ratio 1.19, 95% CI 1.00-1.41; Q3 1.20, 1.02-1.42; Q4 1.30, 1.08-1.55) or gain (Q2 1.25, 1.04-1.49; Q3 1.24, 1.04-1.49; Q4 1.45, 1.20-1.75).Conclusions: Greater neighborhood deprivation was positively associated with BMI change among adults with diabetes as well as with clinically substantive BMI loss or gain. Findings stress the importance of allowing for simultaneous associations with both gain and loss in future longitudinal studies of neighborhood deprivation and weight change, which may be particularly true for studies of patients with diabetes for whom both weight loss and gain have health implications. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To compare associations between neighborhood deprivation and measures of d BMI change among adults with type 2 diabetes. RESEARCH DESIGN AND METHODS -- Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures of BMI change over 3 years: 1) a continuous measure and 2 ) a categorical measure of clinically substantive BMI loss or gain (≥7% of baseline BMI) versus stable BMI. The sample included 13,609 adults. RESULTS -- On average, there was little change in BMI (20.12, SD 3.07); 17.0 and 16.1% had d clinically substantive BMI loss or gain, respectively, at follow-up. There was a positive association between neighborhood deprivation and BMI change for adults in the most versus least-deprived quartile of neighborhood deprivation (β= 0.22 , P = 0.02) in adjusted models. In addition, P relative to the least-deprived quartile (Q1), adults in more-deprived quartiles of neighborhood deprivation were more likely to experience either substantive BMI loss (Q2 relative risk ratio 1.19, 95%CI 1.00--1.41; Q3 1.20, 1.02--1.42; Q4 1.30, 1.08--1.55) or gain (Q2 1.25, 1.04--1.49; Q3 1.24, 1.04--1.49; Q4 1.45, 1.20--1.75). CONCLUSIONS -- Greater neighborhood deprivation was positively associated with BMI d change among adults with diabetes as well as with clinically substantive BMI loss or gain. Findings stress the importance of allowing for simultaneous associations with both gain and loss in future longitudinal studies of neighborhood deprivation and weight change, which may be particularly true for studies of patients with diabetes for whom both weight loss and gain have health implications. [ABSTRACT FROM AUTHOR]

Abstract: While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n = 19,804) from the Diabetes Study of Northern California (DISTANCE) cohort study, an ethnically-stratified, random sample of members of Kaiser Permanente Northern California (KPNC), an integrated managed care consortium, with type 2 diabetes who completed a survey between 2005 and 2007 and who lived in a 19 county study area were included in the analyses. We estimated the association between a validated neighborhood deprivation index (NDI) and four cardiometabolic risk factors: body mass index (BMI = kg/m2), glycosylated hemoglobin (A1c), low density lipoproteins (LDL) and systolic blood pressure (SBP) using multi-level models. Outcomes were modeled in their continuous form and as binary indicators of poor control (severe obesity: BMI ≥35, poor glycemic control: A1c ≥9%, hypercholesterolemia: LDL ≥130 mg/dL, and hypertension: SBP ≥140 mmHg). BMI, A1c and SBP increased monotonically across quartiles of NDI (p < 0.001 in each case); however, LDL was significantly associated with NDI only when comparing the most to the least deprived quartile. NDI remained significantly associated with BMI and A1c after adjusting for individual level factors including income and education. A linear trend (p < 0.001) was observed in the relative risk ratios for dichotomous indicators of severe obesity, poor glycemic control, and 2 or more poorly controlled cardiometabolic risk factors across NDI quartile. In adjusted models, higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes. However, longitudinal data are needed to test the causal direction of these relationships. [ABSTRACT FROM AUTHOR]

Abstract: While neighborhood deprivation is associated with prevalence of chronic diseases, it is not well understood whether neighborhood deprivation is also associated with cardiometabolic risk factors among adults with chronic disease. Subjects (n = 19,804) from the Diabetes Study of Northern California (DISTANCE) cohort study, an ethnically-stratified, random sample of members of Kaiser Permanente Northern California (KPNC), an integrated managed care consortium, with type 2 diabetes who completed a survey between 2005 and 2007 and who lived in a 19 county study area were included in the analyses. We estimated the association between a validated neighborhood deprivation index (NDI) and four cardiometabolic risk factors: body mass index (BMI = kg/m2), glycosylated hemoglobin (A1c), low density lipoproteins (LDL) and systolic blood pressure (SBP) using multi-level models. Outcomes were modeled in their continuous form and as binary indicators of poor control (severe obesity: BMI ≥35, poor glycemic control: A1c ≥9%, hypercholesterolemia: LDL ≥130 mg/dL, and hypertension: SBP ≥140 mmHg). BMI, A1c and SBP increased monotonically across quartiles of NDI (p < 0.001 in each case); however, LDL was significantly associated with NDI only when comparing the most to the least deprived quartile. NDI remained significantly associated with BMI and A1c after adjusting for individual level factors including income and education. A linear trend (p < 0.001) was observed in the relative risk ratios for dichotomous indicators of severe obesity, poor glycemic control, and 2 or more poorly controlled cardiometabolic risk factors across NDI quartile. In adjusted models, higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes. However, longitudinal data are needed to test the causal direction of these relationships. [Copyright &y& Elsevier]

Background: As the prevalence of childhood obesity has risen in past decades, more attention has been given to how the neighborhood food environment affects children''s health outcomes. Purpose: This exploratory study examined the relationship between the presence of neighborhood food stores within a girl''s neighborhood and 3-year risk of overweight/obesity and change in BMI, in girls aged 6 or 7 years at baseline. Methods: A longitudinal analysis of participants in the Cohort Study of Young Girls'' Nutrition, Environment and Transitions (CYGNET) was conducted from 2005 to 2008. Neighborhood food stores were identified from a commercial database and classified according to industry codes in 2006. Generalized linear and logistic models were used to examine how availability of food stores within 0.25-mile and 1.0-mile network buffers of a girl''s residence were associated with BMI z-score change and risk of overweight or obesity, adjusting for baseline BMI/weight and family sociodemographic characteristics. Data were analyzed in 2010. Results: Availability of convenience stores within a 0.25-mile network buffer of a girl''s residence was associated with greater risk of overweight/obesity (OR=3.38, 95% CI=1.07, 10.68) and an increase in BMI z-score (β=0.13, 95% CI=0.00, 0.25). Availability of produce vendors/farmer''s markets within a 1.0-mile network buffer of a girl''s residence was inversely associated with overweight/obesity (OR=0.22, 95% CI=0.05, 1.06). A significant trend was observed between availability of produce vendors/farmer''s markets and lower risk of overweight/obesity after 3 years. Conclusions: Although food store inventories were not assessed and food store indices were not created, the availability of neighborhood food stores may affect a young girl''s weight trajectory over time. [Copyright &y& Elsevier]

Objective. To determine the relative importance of familial, dietary, behavioral, psychological and social risk factors for predicting body mass index (BMI) change, and onset of overweight and obesity among adolescent girls. Methods. Data from the NHLBI Growth and Health Study (n = 2 150), a longitudinal cohort of girls, were used to identify the most important predictors of change in BMI percentile between the ages of 9 and 19 years, and second, risk for becoming overweight and obese. Forty-one baseline predictors were assessed using a tree-based regression method (Random forest) to rank the relative importance of risk factors. Results. The five factors that best predicted change in BMI percentile (p < 0.05) were related to family socio-economic position (income and parent education) and drive to restrict eating and weight (body dissatisfaction, drive for thinness and unhappiness with physical appearance). The factors that were statistically significant (p < 0.05) predictors of both onset of overweight and obesity were income, ineffectiveness and race. Conclusions. Family socio-economic position and emotion regulation appeared as the top predictors of both BMI change and onset of overweight and obesity. Our results build upon prior findings that policies to prevent the onset of obesity during adolescence be targeted towards girls from lower socio-economic position households. Our findings also suggest several novel psychological factors including ineffectiveness as predictors of obesity during adolescence. These predictive findings offer a direction for future inquiry into adolescent obesity etiology using causal methods. [ABSTRACT FROM AUTHOR]

Abstract: Background: Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy-related weight gain and complications is not well understood. Objective: To identify whether an independent association exists between household food insecurity and pregnancy-related complications. Design: Data from the Pregnancy, Infection, and Nutrition prospective cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes ≤400% of the income/poverty ratio, recruited between January 2001 and June 2005 and followed through pregnancy. Main outcome measures: Self-reported pregravid body mass index, gestational weight gain, second trimester anemia, pregnancy-induced hypertension, and gestational diabetes mellitus. Statistical analyses performed: Multivariate linear, multinomial logistic, and logistic regression analyses. Results: Among 810 pregnant women, 76% were from fully food secure, 14% were from marginally food secure, and 10% were from food insecure households. In adjusted models, living in a food insecure household was significantly associated with severe pregravid obesity (adjusted odds ratio 2.97, 95% confidence intervals [CIs] 1.44 to 6.14), higher gestational weight gain (adjusted β coefficient 1.87, 95% CI 0.13 to 3.62), and with a higher adequacy of weight gain ratio (adjusted β .27, 95% CI 0.07 to 0.50). Marginal food security was significantly associated with gestational diabetes mellitus (adjusted odds ratio 2.76, 95% CI 1.00 to 7.66). Conclusions: This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications. [Copyright &y& Elsevier]

Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity lassessed by the Food Security Survey Modulel and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% Cl, 1.04-1 .38) and hyperlipidemia (ARR 1.30; 95% Cl, 1.09-1.55), but not diabetes (ARR 1.19; 95% Cl, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% Cl, 1.04-1.41) and diabetes (ARR 1.48; 95% Cl, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (AAR 2.42; 95% Cl, 1.44- 4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease. [ABSTRACT FROM AUTHOR]

Abstract: African Americans experience household food insecurity, ie, the limited availability of nutritionally adequate and safe food, or ability to acquire acceptable foods in socially acceptable ways, at three times the rate of non-Hispanic whites. Thirty percent of all African-American children live in food-insecure households. The purpose of this study was to identify characteristics associated with household food insecurity among a high-risk postpartum population. Two-hundred six low-income, African-American mother−infant dyads were recruited through the Special Supplemental Nutrition Program for Women, Infants, and Children clinics. The six-item US Department of Agriculture food security scale was used to classify households as food secure, marginally food secure, or food insecure. Multinomial logistic regression was used to estimate the association between selected maternal/household characteristics and household food-security status. Fifty-three percent of households were food secure, 34% were marginally food secure, and 13% were food insecure. Maternal education less than college (relative risk ratio [RRR]=0.46; 95% confidence interval [CI]: 0.22 to 0.98) was inversely associated with marginal food security. Depressive symptoms (RRR=1.09; 95% CI: 1.02 to 1.16) and having the baby''s father in the household (RRR=3.46; 95% CI: 1.22 to 9.82) were associated with household food insecurity, while having a grandmother in the household (RRR=0.15; 95% CI: 0.03 to 0.80) was inversely associated with experiencing household food insecurity. Findings from this study suggest that young, low-income, African-American families with only one child are particularly susceptible to experiencing household food insecurity. Intergenerational support and transfer of knowledge can be a key protective attribute among low-income African-American households. [Copyright &y& Elsevier]

Introduction: Qualitative research on food choice has rarely focused on individuals' perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined. Methods: We recruited 28 low- and moderate-income, midlife (37-67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews. Results: Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources. Discussion: While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult. [ABSTRACT FROM AUTHOR]

Objective: To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). Design: Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. Setting: The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition master's (MPH) degree curriculum using distance education (DE) strategies. Analysis: Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. Results: Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. Conclusions and Implications: The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development. [ABSTRACT FROM AUTHOR]

The increasing prevalence of overweight and obesity among women of childbearing age is a growing public health concern in the United States. The average body mass index (BMI) is increasing among all age categories and women enter pregnancy at higher weights. Women are also more likely to retain gestational weight with each pregnancy. Women who are overweight (BMI 25–30) and obese (BMI ≥30) are at greater risk of adverse reproductive health outcomes compared to women of normal weight status (BMI 19.8–25). This article provides an overview of the complications associated with maternal overweight and obesity including diabetes, pre-eclampsia, c-sections, and birth defects. We present updated information on the weight trends among women. Finally, we present an overview of the prevention studies aimed at adolescents and women prior to pregnancy. [ABSTRACT FROM AUTHOR]

Background: Neighborhood characteristics have been associated with poor maternal and child health outcomes, yet conceptualization of potential mechanisms is still needed. Census data have long served as proxies for area level socioeconomic influences. Unique information captured by neighborhood inventories, mostly conducted in northern US and Canadian urban areas, has shown important aspects of the community environment that are not captured by the socioeconomic and demographic aggregated individual statistics of census data. In this paper, we describe a neighborhood data collection effort tailored to a southern urban area. Methods: This study used data from the Pregnancy, Nutrition and Infection (PIN) prospective cohort study to describe neighborhoods where low- and moderate-income pregnant women reside. Women who participated in the PIN study and who resided in Raleigh, NC and its surrounding suburbs were included (n = 703). Neighborhood attributes captured by the inventory included litter, housing condition, road condition, and social interactions that informed theoretical constructs of physical incivility, territoriality and social spaces. US Housing and Population Census 2000 data at the block group level were also assessed to identify the unique contribution of directly observed data. We hypothesize that neighborhood environments can influence health through psychosocial mediated pathways that lead to increased stress, or through disadvantage leading to poor neighborhood resources, or by protective attributes through increased social control. Results: Findings suggest that directly observed neighborhood attributes distinguished between different types of areas in which low-income pregnant non-Hispanic white and non-Hispanic black women lived. Theoretically informed scales of physical incivilities, territoriality and social spaces were constructed and found to be internally consistent. Scales were weakly associated indicating that these constructs capture distinct information about these neighborhoods. Physical incivilities, territoriality and social spaces scales were poorly explained by traditional census variables used to proxy neighborhood environment. Conclusion: If neighborhoods influence health through psychosocial mediated pathways then careful detailing of neighborhood attributes that contribute to stress or deterioration, beyond traditional socioeconomic status, are needed. We believe that measuring physical incivility, territoriality and social spaces as expressions of underlying issues of maintenance and social communication make important contributes to this field. [ABSTRACT FROM AUTHOR]

Household food insecurity has been associated with several negative health outcomes, yet little is known about the prevalence and correlates of household food insecurity during pregnancy. This study was conducted as part of the Pregnancy, Infection, and Nutrition prospective cohort study to identify risk factors of preterm birth. The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes

Objectives. To investigate the association between distance to the closest supermarket and a composite measure of diet, the diet quality index for pregnancy (DQI-P) was constructed.Methods. Data from the Pregnancy, Infection and Nutrition (PIN) cohort, a prospective study of determinants of preterm birth, were analyzed. Food frequency questionnaires were used to construct DQI-P which includes: servings of grains, vegetables, fruits, folate, iron and calcium intake, percentage of calories from fat, and meal pattern score. Street address of residence, supermarkets, grocery and convenience stores were geocoded. Participants with complete food frequency and address data were included (n = 918). Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality, controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics.Results. Women living greater than 4 miles from a supermarket were more than twice the odds (adjusted odds ratio = 2.16; 95% confidence interval = 1.2, 4.0) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket, after controlling for individual characteristics, other food retail outlets.Conclusion. These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women. [Copyright &y& Elsevier]

Background. A causal relationship between hunger and obesity has been postulated. Two cross-sectional studies have found evidence to suggest an association between obesity and food insecurity among adult women, and a third study suggests an association between underweight and food insecurity among men. The purpose of this study was to investigate the association between concern about enough food and obesity in an adult population at the state level.Methods. A cross-sectional analysis was conducted using 1999 data from the Behavioral Risk Factor Surveillance System (BRFSS), Social Context Module (n = 3,945).Results. An 8.0% prevalence of concern about enough food was found in Louisiana, and an 11.8% prevalence was found in New York, and was positively associated with morbid obesity, RR = 2.20 (95% CI = 1.24, 3.90) and RR = 2.23 (95% CI = 1.30, 3.84), respectively. However, this association became nonsignificant after controlling for education, income, race/ethnicity, marital status, and general health.Conclusion. A very strong apparent relationship between concern about enough food and obesity could be entirely accounted for by the influences of socioeconomic variables. This emphasizes the need for longitudinal research studies using precise measures of weight, height, and food security. [Copyright &y& Elsevier]

The Professional Practice Program in Nutrition (PPPN) uses distance education to offer a master''s degree in public health (MPH) nutrition designed for practitioners who desire to maintain their employment and develop new skills. Public health nutrition leadership faces challenges in recruiting a large enough workforce to (a) carry out the core functions of assessment, policy, and assurance; (b) update current nutritionists in new skill areas to face the demands of dynamic health care and public health climates; and (c) conduct monitoring and surveillance of Healthy People 2010 objectives. In 1996, the University of North Carolina at Chapel Hill designed and implemented this program after a market analysis to identify advanced educational need in a nine state area. PPPN was initiated as a pilot program and enrolled two cohorts of students from 1996 through 1998. This project identified four key steps: (a) conduct a detailed market analysis; (b) establish an infrastructure to deliver the program; (c) tailor the curriculum using the technology; and (d) identify, accommodate, and develop student capabilities. The findings indicate that distance education strategies are appropriate to carry out a full MPH curriculum in nutrition, but sufficient enrollment is necessary to cover the added curriculum expenditures. J Am Diet Assoc. 2003;103:602-607. [Copyright &y& Elsevier]

Presents a study that characterized the prevalence of concern about food security and its association with other sociodemographic and health characteristics at the state level in the U.S. Methodology; Results; Discussion.

Food insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls. This study examined the relationship between self-reported food insecurity and dietary intake among boys and girls. Cross-sectional survey data were used from the Children's PowerPlay! Campaign evaluation. In all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment. Individual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls. Multivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics. Girls with the highest food insecurity consumed 135 total kilocalories (P <0.005) and 60 snack kilocalories (P <0.05) more per day than girls with no food insecurity. These relationships were absent among boys. Food insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance. [ABSTRACT FROM AUTHOR]

Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE–BMI relationships. A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9–10 years) through adolescence (ages 19–20 years) to midlife (ages 36–43 years, between 2015 and 2019). In these 2020–2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19–20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15. Race only modified ACE–BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (B adjusted =3.24, 95% CI=0.92, 5.57) at ages 19–20 years and marginally associated at midlife (B adjusted =2.37, 95% CI= −0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (B adjusted =1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (B adjusted =1.45, 95% CI= −0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: B adjusted =1.23, 95% CI= −0.08, 2.54; midlife BMI: B adjusted =1.03, 95% CI= −0.71, 2.78), but not for substance abuse. Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE–BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors - or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors.Methods: Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation.Results: Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were "very useful," and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating.Conclusions: These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.Trial Registration: ClinicalTrials.gov NCT01307683 , March 8, 2011. [ABSTRACT FROM AUTHOR]

Background: Although maternal stressor exposure has been associated with shorter telomere length (TL) in offspring, this literature is based largely on White samples. Furthermore, timing of maternal stressors has rarely been examined. Here, we examined how maternal stressors occurring during adolescence, pregnancy, and across the lifespan related to child TL in Black and White mothers. Method: Mothers (112 Black; 110 White; M age = 39) and their youngest offspring (n = 222; M age = 8) were part of a larger prospective cohort study, wherein mothers reported their stressors during adolescence (assessed twice during adolescence for the past year), pregnancy (assessed in midlife for most recent pregnancy), and across their lifespan (assessed in midlife). Mother and child provided saliva for TL measurement. Multiple linear regression models examined the interaction of maternal stressor exposure and race in relation to child TL, controlling for maternal TL and child gender and age. Race-stratified analyses were also conducted. Results: Neither maternal adolescence nor lifespan stressors interacted with race in relation to child TL. In contrast, greater maternal pregnancy stressors were associated with shorter child TL, but this effect was present for children of White but not Black mothers. Moreover, this effect was significant for financial but not social pregnancy stressors. Race-stratified models revealed that greater financial pregnancy stressors predicted shorter telomeres in offspring of White, but not Black mothers. Conclusions: Race and maternal stressors interact and are related to biological aging across generations, but these effects are specific to certain races, stressors, and exposure time periods. [ABSTRACT FROM AUTHOR]

Evidence suggests that adversity experienced during fetal development may shape infant physiologic functioning and temperament. Parental sensitivity is associated with child stress regulation and may act as a buffer against risk for intergenerational health effects of pre- or postnatal adversity. Building upon prior evidence in a racially and ethnically diverse sample of infants (M infant age = 6.5 months) and women of low socioeconomic status, this study examined whether coded parenting sensitivity moderated the association between an objective measure of prenatal stress exposures (Stressful Life Events (SLE)) and infant parasympathetic (respiratory sinus arrhythmia; RSA) or sympathetic (pre-ejection period; PEP) nervous system functioning assessed during administration of the Still-Face-Paradigm (SFP) (n = 66), as well as maternal report of temperament (n = 154). Results showed that parental sensitivity moderated the associations between prenatal stress exposures and infant RSA reactivity, RSA recovery, PEP recovery, and temperamental negativity. Findings indicate that greater parental sensitivity is associated with lower infant autonomic nervous system reactivity and greater recovery from challenge. Results support the hypothesis that parental sensitivity buffers infants from the risk of prenatal stress exposure associations with offspring cross-system physiologic reactivity and regulation, potentially shaping trajectories of health and development and promoting resilience. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia, having a small for gestational age (SGA) baby or preterm delivery are associated with later maternal cardiovascular disease (CVD) risk. Therefore, we sought to examine whether peripartum CVD biomarker and risk factor trajectories differed among women with and without CVD-related pregnancy complications. Methods: In the Maternal Adiposity Metabolism and Stress (MAMAS) Study, we studied n=110 overweight and obese women in the MAMAS study of 8-week mindful eating and stress reduction intervention, we used mixed linear regression analysis to compare trajectories of CVD risk factors at three periods: 1) intrapartum at 12-20 weeks gestation, 2) 3 months postpartum, and 3) 9 months postpartum. CVD biomarkers/risk factors studied included serum glucose, insulin, HOMA-IR, leptin, ghrelin, lipids, ALT, IL-6, IL-10, tumor necrosis factor, and blood pressure (BP). Covariates for multivariable adjustment included age, maternal smoking, prepregnancy BMI, BP, age*time and prepregnancy BMI*time. Results: Women had mean age =28 y (SD 6), mean prior pregnancies=0.8 (SD 1.0), 13% were White, 36% African American and 32% Latina; n=22 women had one or more CVD-related pregnancy complications. Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values=0.008 and 0.01 respectively) (Figure). Trajectories for lipids, insulin, HOMA-IR, adipokines, ALT, IL-6 and diastolic BP were elevated in complicated versus normal pregnancies, but did not reach statistical significance. Conclusions: Glucose and systolic BP rise were significantly higher from early pregnancy to 9 months postpartum among low income women with complicated vs. uncomplicated pregnancies. Cardiometabolic risk factor modification among women with CVD-related pregnancy complications in the peripartum period may be warranted. [ABSTRACT FROM AUTHOR]

Although evidence exists for an association between income level and diet quality, a causal relationship has not been established. A number of studies found that the price of nutritious food and the time cost to prepare foods are economically driven reasons for this relationship. However, in addition to economic constraints, low-income individuals and families face a number of additional challenges linked with food choice, eating behaviors, and diet-related chronic conditions that contribute to diet quality and health. Low-income individuals have a higher burden of employment-, food-, and housing-related insecurity that threaten the livelihood of their household. Poverty and exposure to these insecurities are hypothesized to activate biobehavioral and psychological mechanisms-endocrine, immune, and neurologic systems-that influence food choice and consumption. Examples of biobehavioral and psychological factors that influence diet are stress, poor sleep, and diminished cognitive capacity. High levels of stress, poor sleep, and cognitive overload compound the challenges of economic constraints, creating a mentality of scarcity that leads to poor diet quality. [ABSTRACT FROM AUTHOR]

Consumption of sugar-sweetened beverages (SSBs) is linked to increased risks of metabolic disease, but the biological mechanisms underlying this association are still under investigation. Leukocyte telomere length maintenance underlies healthy cellular aging, and may provide a link between SSB consumption and risk of disease. Given the known effects of SSBs on oxidative stress and insulin resistance, we examined the associations between sugar-sweetened beverage, diet soda, and fruit juice consumption, and leukocyte telomere length in 5,309 healthy adults with no prior history of diabetes or cardiovascular disease, using data from the 1999- 2002 National Health and Nutrition Surveys (NHANES). We hypothesized that beverages with high sugar content would be most detrimental to cellular aging. Leukocyte telomere length was assayed from DNA specimens collected from adult NHANES participants. Diet was assessed using 24-hour dietary recalls. Because 24- hour dietary recalls may not accurately reflect long-term intake, the National Cancer Institute statistical method was used to estimate usual dietary intake. After adjustment for sociodemographic characteristics, smoking behavior, physical activity, dietary quality, and body mass index (BMI), each 8-ounce daily serving of sugar-sweetened sodas was associated with shorter telomeres (β=-0.010, 95% CI -0.019, -0.001), roughly equivalent to 1.8 additional years of aging. Twenty-one percent of study participants consumed =20 ounces of sugar-sweetened soda a day, translating into approximately 4.4 additional years of aging for heavy soda drinkers. No significant associations were observed between consumption of diet sodas, non-carbonated SSBs, or 100% fruit juice and telomere length. In conclusion, regular consumption of sugar-sweetened sodas was associated with shorter telomeres in a nationally representative sample of healthy, nonelderly adults independent of BMI and other individual characteristics. These results suggest that SSBs may influence metabolic disease development through accelerated cell aging. Although more research is needed to confirm these associations, these findings strengthen the rationale for limiting the consumption of SSBs. [ABSTRACT FROM AUTHOR]

Background: Early childhood is a pivotal period for the development of healthy eating practices. One way to promote child health is to identify early modifiable factors that affect child eating and weight. Given the intergenerational transmission of eating behaviors, this study examined how mothers' eating behaviors were associated with child feeding practices, and whether child weight-for-length (z-WFL) moderated this relation, in a community sample. Methods: Participants were 72 mother–child dyads. Maternal eating behaviors—emotional, external and restrained—were assessed 9-months postpartum, using the Dutch Eating Behavior Questionnaire. Child feeding—restrictive, pressure, and concern about overeating/overweight or undereating/underweight—was measured using the Infant Feeding Questionnaire, and child z-WFL were assessed 18-months postpartum. Linear regressions were used to test the main effect of maternal eating and the interaction effect of maternal eating and child z-WFL, on child feeding practices. Results: Maternal restrained eating was associated with child pressure feeding, and contrarily with concerns about overeating/overweight. However, a significant interaction between child z-WFL and both maternal emotional and external eating were found with regard to concern about child undereating/underweight. Paradoxically, among children who weighed more, greater maternal emotional and greater external eating were associated with greater concern about child undereating/underweight. Conclusions: In this community sample, mothers were more likely to report contradictory feeding practices and concerns, suggesting complicated relations among a mother's own eating behavior, her child's weight, and her perceptions of child eating and weight. This may indicate a need for better communication and support of infant feeding practices. Trial registration: Data was collected as part of two grants (MAMAS Grant ID: HL097973-01; SEED Grant ID: HL116511-02) conducted at the University of California, San Francisco (UCSF). All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by institutional review board at UCSF. [ABSTRACT FROM AUTHOR]

We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a geographic information system for each patient's address of longest residence. We estimated the association between change in supermarket presence (gain, loss, or no change) and change in HbA1c value, adjusting for individual- and area-level attributes and according to baseline glycemic control (near normal, <6.5%; good, 6.5%-7.9%; moderate, 8.0%- 8.9%; and poor, ≥9.0%). Supermarket loss was associated with worse HbA1c trajectories for those with good, moderate, and poor glycemic control at baseline, while supermarket gain was associated with marginally better HbA1c outcomes only among patients with near normal HbA1c values at baseline. Patients with the poorest baseline HbA1c values (≥9.0%) had the worst associated changes in glycemic control following either supermarket loss or gain. Differences were not clinically meaningful relative to no change in supermarket presence. For patients with type 2 diabetes mellitus, gaining neighborhood supermarket presence did not benefit glycemic control in a substantive way. The significance of supermarket changes on health depends on a complex interaction of resident, neighborhood, and store characteristics. [ABSTRACT FROM AUTHOR]

While stress has been linked to poor health outcomes, little is known about the impact of objective measures of neighborhood crime on stress in patients with chronic disease. Using the Kaiser Permanente Diabetes Study of Northern California (DISTANCE), we examined associations between police-recorded crime (2005-2007) and stress (Perceived Stress Scale-4) in four large Northern California cities (Oakland, Sacramento, San Francisco, and San Jose). We performed stratified analysis by gender and race/ethnicity using generalized linear regression models. In our study sample (n = 3188, mean age 59, range 30-77), 10 % reported high stress. In adjusted analyses, higher neighborhood all crimes rate was associated with modest increase in high stress for African-American (OR = 1.10; 95 % CI 1.02-1.22) and Latina women (OR = 1.36; 95 % CI 1.10-1.67) and property crime showed similar associations with stress for these groups of women. Visible crime was associated with stress only for Latina women (OR = 1.43; 95 % CI 1.14-1.78). We found no association between crime and stress among men or other racial/ethnic groups of women. High crime levels may disproportionately impact health among certain subpopulations. Studies using additional measures of stress are necessary to differentiate the health impact of crime-related stress from other forms of stressors among individuals living with diabetes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a letter by Dr. Francis Tayie and Dr. Claire Zizza concerning an article about food insecurity and hyperlipidemia, in the 2010, volume 140 of the journal.

There is extensive literature showing that psychosocial factors, income, being black, being single, and having children are the strongest predictors of household food insecurity. We examined these factors in a vulnerable sample of 201 first-time African-American mothers with 3 month old infants and mostly single (88%). Fifty-four percent of the women were food secure, 33% were marginally food secure, and 12% were food insecure. Using these categories as outcomes, we ran a multinomial logistic regression model to assess how maternal age, education, work status, living with child's grandmother, father, or other household members, and maternal depression (Center for Epidemiological Studies Depression Scale) influence household food security status. Compared to food secure households, living with the child's grandmother decreased the risk of food insecurity (Relative Risk Ratio (RRR): 0.12 [95% CI: .02, .72]) but living with the father (RRR: 3.73 [95% CI: 1.27, 10.96]) and having depressive symptoms (RRR: 4.98 [95% CI: 1.69, 14.75]) increased the risk of food insecurity. Compared to food secure households, living with an extended family (RRR: 0.73 [95% CI: .56, .96]) appeared to be protective against marginal food security. These findings suggest that living with the child's grandmother may be how a first-time mother copes with the difficulties of being single and having a young infant. These results also stress the importance of financial and emotional support for these mothers especially in the postpartum period. [ABSTRACT FROM AUTHOR]

Objective: Depression is a public health crisis, and scalable, affordable interventions are needed. Although many psychosocial interventions are effective, there is little research investigating their sustained, long-term influence on well-being. The purpose of this study was to examine whether a prenatal mindfulness intervention with demonstrated benefit for women's depressive symptoms during the early postpartum period would exert effects through 8 years. Method: The sample of 162 lower income women was racially and ethnically diverse. Women were assigned to receive an 8-week mindfulness-based intervention during pregnancy (MIND) or treatment as usual (TAU). Repeated assessments of depressive symptoms were collected using the Patient Health Questionnaire-9 at baseline, postintervention, and following childbirth (1, 2, 3–4, 5, 6, and 8 years from baseline). The most recent assessment of depressive symptoms was collected during the COVID-19 pandemic. Results: MIND and TAU women were equivalent on sociodemographic factors and depressive symptoms at baseline. Depressive symptoms at all follow-up assessments through 8 years were significantly lower among women in MIND compared to TAU. The odds of moderate or higher depressive symptoms were greater among TAU compared to MIND women at all time points except the 6-year assessment. By Year 8, 12% of women in MIND reported moderate or more severe depressive symptoms compared to 25% of women in TAU. Conclusions: Results suggest the effects of a group-based psychosocial intervention during pregnancy may endure for years, well beyond the initial perinatal period. Investing in prevention and intervention efforts for mental health during pregnancy may have sustained benefits for the well-being of women. What is the public health significance of this article?: This study highlights the potential for long-lasting benefits of a brief psychosocial, group-based intervention during pregnancy on women's depressive symptoms for 8 years. In light of the economic and social burden of maternal depression and its potential impact on offspring, our findings suggest a modest investment during pregnancy may support well-being across two generations. [ABSTRACT FROM AUTHOR]

How does diet quality (DQ) moderate associations between serious childhood stress exposures and adult depression? We analyzed a cohort of Californian women at midlife (N=382; age 36-42). Serious childhood stress was defined as high perceived stress during childhood or adverse childhood experiences (ACEs) of physical abuse, sexual abuse, and/or household substance abuse. Women were dichotomized by current depression risk (high/low). The Healthy Eating Index (HEI)-2015 and Alternate Healthy Eating Index (AHEI)-2010 measured current DQ from 3-day food records. Interactions between childhood stress exposures and DQ indices were tested one-by-one in multivariable Poisson regression models. Depression risks associated with endorsing all 3 ACEs differed by HEI and AHEI scores, as did risks associated with endorsing high perceived stress, physical abuse, and sexual abuse by AHEI. Where DQ moderated stress-depression associations, predicted prevalences of high depression risk did not vary with DQ among women endorsing the particular childhood stressors. However, among non-endorsing women, predicted high depression risk prevalences were significantly lower with higher DQ compared to in their stress-exposed counterparts – e.g. at the 90th AHEI percentile, depression prevalences were ∼20% among 'non-childhood-stressed' women versus 48.8% (high perceived stress, sexual abuse), 52.0% (physical abuse), and 73.0% (3 ACEs) in 'childhood-stressed' women. Higher current DQ, particularly as aligned with chronic disease prevention guidelines, predicts lower depression risk in women with low childhood adversity. DQ did not buffer depression risk in women with high childhood stress. Further research is warranted to examine persistent pathways of depression risk and diet's role within. [ABSTRACT FROM AUTHOR]

Household food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction. Our aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults. Secondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families. Participants in study 1 (n = 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n = 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements. The primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale. Multivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics. In study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P =.047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P =.045). These findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction. [ABSTRACT FROM AUTHOR]