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When natural hazards interact in compound events, they may reinforce each other. This is a concern today and in light of climate change. In the case of coastal flooding, sea-level variability due to tides, seasonal to inter-annual salinity and temperature variations, or larger–scale wind conditions modify the development and ramifications of extreme sea levels. Here, we explore how various prior conditions could have influenced peak water levels for the devastating coastal flooding event in the western Baltic Sea in 1872. We design numerical experiments by imposing a range of precondition circumstances as boundary conditions to numerical ocean model simulations. This allows us to quantify the changes in peak water levels that arise due to alternative preconditioning of the sea level before the storm surge. Our results show that certain preconditioning could have generated even more catastrophic impacts. As an example, a simulated increase in the water level of 36 cm compared to the 1872 event occurred in Køge just south of Copenhagen (Denmark) and surrounding areas – a region that was already severely impacted. The increased water levels caused by the alternative sea-level patterns propagate as long waves until encountering shallow and narrow straits, and after that, the effect vastly decreases. Adding artificial increases in wind speeds to each study point location reveals a near-linear relationship with peak water levels for all western Baltic locations, highlighting the need for good assessments of future wind extremes. Our research indicates that a more hybrid approach to analysing compound events and readjusting our present warning system to a more contextualised framework might provide a firmer foundation for climate adaptation and disaster risk management. In particular, accentuating the importance of compound preconditioning effects on the outcome of natural hazards may avoid under- or overestimation of the associated risks.

In the future, shifts in wind storms across the North and Baltic Seas are highly unpredictable, challenging the projection of wave conditions for managing coastal hazards. Moreover, regional sea level rise (SLR), with very large uncertainty, complicates the situation for stakeholders seeking recommendations for climate adaptation plans. The purpose of this study is to examine the change of the storm surge and wind wave components of the water level due to climate change in a low tidal range Køge Bay near the entrance of the Baltic Sea. Under a high greenhouse gas emission scenario RCP8.5, we employed a regional climate model (HIRHAM) forced wave model (WAM) and focused on the wave model results during the “storm surge conditions” (exceeding 20 years storm surge events) and “stormy conditions” (exceeding 90th percentile of wave heights). We find that the change in both wave height and period in the future is negligible under “stormy conditions”. Nevertheless, under “storm surge conditions” when considering SLR, the simulated wave height is projected to double in the near future (mid-century) under RCP 8.5, and the wave period may also increase by about 1.5 seconds. This is because some high significant wave height events in the future are associated with the storm surge events when considering SLR. The findings suggest that the combined effects of mean sea level rise, storm surge and waves are likely to increase the risk to a bay with geography and exposure comparable to Køge Bay. As a result, the future plan for climate engineering protection should place a premium on the additional wave energy protection associated with storm surges.

The Arctic region is responding heavily to climate change, and yet, the air temperature of ice-covered areas in the Arctic is heavily under-sampled when it comes to in situ measurements, resulting in large uncertainties in existing weather and reanalysis products. This paper presents a method for estimating daily mean clear-sky 2 m air temperatures (T2m) in the Arctic from satellite observations of skin temperature, using the Arctic and Antarctic ice Surface Temperatures from thermal Infrared (AASTI) satellite dataset, providing spatially detailed observations of the Arctic. The method is based on a linear regression model, which has been tuned against in situ observations to estimate daily mean T2m based on clear-sky satellite ice surface skin temperatures. The daily satellite-derived T2m product includes estimated uncertainties and covers the Arctic sea ice and the Greenland Ice Sheet during clear skies for the period 2000–2009, provided on a 0.25∘ regular latitude–longitude grid. Comparisons with independent in situ measured T2m show average biases of 0.30 and 0.35∘C and average root-mean-square errors of 3.47 and 3.20 ∘C for land ice and sea ice, respectively. The associated uncertainties are verified to be very realistic for both land ice and sea ice, using in situ observations. The reconstruction provides a much better spatial coverage than the sparse in situ observations of T2m in the Arctic and is independent of numerical weather prediction model input. Therefore, it provides an important supplement to simulated air temperatures to be used for assimilation or global surface temperature reconstructions. A comparison of T2m derived from satellite and ERA-Interim/ERA5 estimates shows that the satellite-derived T2m validates similar to or better than ERA-Interim/ERA5 against in situ measurements in the Arctic.

OBJECTIVES To estimate whether school-based body mass index (BMI) reports impacted the accuracy of children’s self-reported weight category, for children overall and within subgroups. METHODS We analyzed existing data from the Fit Study, a randomized controlled trial of a BMI screening and reporting intervention conducted in California from 2014 to 2017. The sample included 4690 children in 27 schools randomized to receive BMI reports and 4975 children in 27 controls schools that received BMI screening only. To estimate how BMI reporting affected accuracy, we fit multinomial logistic regression models to our data. We calculated average marginal effects, which capture the change in probability that children more accurately reported their weight category because of BMI reporting. RESULTS We detected no impact of BMI reporting on children’s self-reported weight accuracy. Exploratory subgroup analyses show that for Black children, exposure to 1 round of BMI reporting was associated with a 10.0 percentage point increase in the probability of accurately reporting their weight category (95% confidence interval [CI]: 2.6 to 17.4). Two rounds of reporting were associated with an increase in the probability of accuracy for Asian children (6.6 percentage points; 95% CI: 0.4 to 12.8), 5th graders (11.1 percentage points; 95% CI: 1.6 to 20.5), and those with BMI CONCLUSIONS BMI reporting has limited efficacy in increasing children’s weight perception accuracy. Although exploratory analyses show that specific subpopulations became more accurate, future prospective studies should be designed to confirm these results.

Background While a 2021 federal commission recommended that the United States government levy a sugar-sweetened beverage (SSB) tax to improve diabetes prevention and control efforts, evidence is limited regarding the longer-term impacts of SSB taxes on SSB purchases, health outcomes, costs, and cost-effectiveness. This study estimates the impact and cost-effectiveness of an SSB tax levied in Oakland, California. Methods and findings An SSB tax ($0.01/oz) was implemented on July 1, 2017, in Oakland. The main sample of sales data included 11,627 beverage products, 316 stores, and 172,985,767 product-store-month observations. The main analysis, a longitudinal quasi-experimental difference-in-differences approach, compared changes in beverage purchases at stores in Oakland versus Richmond, California (a nontaxed comparator in the same market area) before and 30 months after tax implementation (through December 31, 2019). Additional estimates used synthetic control methods with comparator stores in Los Angeles, California. Estimates were inputted into a closed-cohort microsimulation model to estimate quality-adjusted life years (QALYs) and societal costs (in Oakland) from 6 SSB-associated disease outcomes. In the main analysis, SSB purchases declined by 26.8% (95% CI −39.0 to −14.7, p < 0.001) in Oakland after tax implementation, compared with Richmond. There were no detectable changes in purchases of untaxed beverages or sweet snacks or purchases in border areas surrounding cities. In the synthetic control analysis, declines in SSB purchases were similar to the main analysis (−22.4%, 95% CI −41.7% to −3.0%, p = 0.04). The estimated changes in SSB purchases, when translated into declines in consumption, would be expected to accrue QALYs (94 per 10,000 residents) and significant societal cost savings (>$100,000 per 10,000 residents) over 10 years, with greater gains over a lifetime horizon. Study limitations include a lack of SSB consumption data and use of sales data primarily from chain stores. Conclusions An SSB tax levied in Oakland was associated with a substantial decline in volume of SSBs purchased, an association that was sustained more than 2 years after tax implementation. Our study suggests that SSB taxes are effective policy instruments for improving health and generating significant cost savings for society.

Early life exposures have been associated with obesity later in life. We aim to assess the association between early life exposure to food insecurity and change in BMI throughout childhood and adolescents. Food security status and growth variables from 243 Mother–child dyads from the Center for the Health Assessment of Mothers and Children of Salinas study were assessed 7 times over a 12-year period. Generalized log linear models with Poisson distributions and linear regression models were implemented to assess the associations between early life food insecurity and obesity and growth. Early life food insecurity was associated with a 0.43 (0.01, 0.82) kg/m2 decrease in BMI from age 2 to 3.5, and a 0.92 kg/m2 (0.38, 1.46) increase in BMI among boys from ages 3.5 to 5, after adjusting for covariates. Sex and age modify the association between early life exposure to food insecurity and BMI.

Responding to the challenges of a changing climate requires information that is relevant and actionable at the local scale where adaptation actions take place. Here we describe the development of Klimaatlas, the Danish National Climate Atlas, a tool to provide information to ministries, regional authorities, businesses and citizens about climate change in Denmark. We focus in particular on the key decisions that needed to be made during development and the lessons learnt from doing so that are relevant to the development of similar tools in other jurisdictions. We describe the user groups that we involved in the development of the atlas, how their interactions shaped the final product, and the ongoing role of the user in the project. Communication and dissemination of results was approached on three different levels simultaneously, and we describe this approach, and its benefits, in detail. We detail some of the major technical challenges faced, particularly around the choice of bias-correction methods, and how these issues were overcome. The approach to quantifying and communicating uncertainty, and its importance, also receives particular attention. We assess the impact of Klimaatlas, and the challenges around quantifying its usefulness, together with the results of a recent user survey identifying the strengths and weaknesses. We also place Klimaatlas in the context of other comparable products, and particularly the recently developed IPCC Interactive Atlas. Finally, we discuss issues around future maintenance and possible expansions of Klimaatlas, including the use of convection permitting simulations, incorporation of compound events, updates between IPCC cycles and extensions to new sectors.

Day-to-day variations in surface air temperature affect society in many ways, but daily surface air temperature measurements are not available everywhere. Therefore, a global daily picture cannot be achieved with measurements made in situ alone and needs to incorporate estimates from satellite retrievals. This article presents the science developed in the EU Horizon 2020–funded EUSTACE project (2015–19, www.eustaceproject.org) to produce global and European multidecadal ensembles of daily analyses of surface air temperature complementary to those from dynamical reanalyses, integrating different ground-based and satellite-borne data types. Relationships between surface air temperature measurements and satellite-based estimates of surface skin temperature over all surfaces of Earth (land, ocean, ice, and lakes) are quantified. Information contained in the satellite retrievals then helps to estimate air temperature and create global fields in the past, using statistical models of how surface air temperature varies in a connected way from place to place; this needs efficient statistical analysis methods to cope with the considerable data volumes. Daily fields are presented as ensembles to enable propagation of uncertainties through applications. Estimated temperatures and their uncertainties are evaluated against independent measurements and other surface temperature datasets. Achievements in the EUSTACE project have also included fundamental preparatory work useful to others, for example, gathering user requirements, identifying inhomogeneities in daily surface air temperature measurement series from weather stations, carefully quantifying uncertainties in satellite skin and air temperature estimates, exploring the interaction between air temperature and lakes, developing statistical models relevant to non-Gaussian variables, and methods for efficient computation.

Objectives. To identify lessons learned from implementation of the nation’s first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California. Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019. Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley’s SSB tax did not function as a “grocery tax,” as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021. Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley’s tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.

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

Wind patterns projected for the region, together with sea level rise and land rise, call into question our current understanding of extreme storm surges in the Danish coastal area. The Danish Meteorological Institute (DMI) will research changes in the extreme statistics of sea level in the twenty-first century through the 'Danish Climate Atlas,' a new national climate service initiative. The study will make use of multi-scenarios, multi-models and multi-parameters approach to focus on the uncertainty of the projected change in extreme statistics of sea level. Historical sea level records suggest that the relative sea level (RSL) along the Danish North Sea coast south of Skagerrak has been increasing with the global mean sea level (GMSL) rise. However, RSL has been absent in the central Skagerrak-Kattegat Seas, owing to the Fennoscandian post-glacial land-uplift offsetting the GMSL rise. According to the recent IPCC Special Report on the Ocean and Cryosphere in a Changing Climate (SROCC), due to Antarctic ice sheet dynamics, GMSL would grow more than previously estimated in the IPCC Fifth Assessment Report (AR5) by the end of the twenty-first century under RCP8.5. We regionalized the SROCC sea level forecasts for the "Danish Climate Atlas" dataset. Our findings indicate that sea level projections under RCP8.5 result in a > 40 cm RSL rise in the Skagerrak-Kattegat Seas by the end of the twenty-first century, which may necessitate a new adaptation strategy in this region. Under the RCP8.5 scenario, the rate of mean sea level rise will exceed the rate of land rise earlier than previously estimated by AR5. We emphasize, in particular, the impact of these new predictions on future severe sea levels in this region. Our findings suggest that this more current GMSL prediction should be factored into coastal risk assessments in the Skagerrak-Kattegat Seas in this century.

Public schools in the U.S. generate about 14,500 tons of municipal solid waste daily, and approximately 42% of that is food packaging generated by school foodservice, contributing significantly to the global packaging waste crisis. This literature review summarizes methods used to evaluate food packaging waste in school foodservice. This review has two objectives: first, to understand which methodologies currently exist to evaluate food packaging waste generation and disposal in school foodservice; and second, to describe the creation of and share a practical standardized instrument to evaluate food packaging waste generation and disposal in school foodservice. A systematic review was conducted using the following search terms: solid waste, school, cafeteria and food packaging, waste, and school. The final review included 24 studies conducted in school environments (kindergarten through twelfth grade or college/university), 16 of which took place in the U.S. Food packaging waste evaluations included objective methods of waste audits, models, and secondary data as well as subjective methods of qualitative observations, questionnaires, interviews, and focus groups. Large variation exists in the settings, participants, designs, and methodologies for evaluating school foodservice packaging waste. Lack of standardization was observed even within each methodology (e.g., waste audit). A new instrument is proposed to support comprehensive and replicable data collection, to further the understanding of school foodservice food packaging waste in the U.S., and to reduce environmental harms.

ObjectiveTo examine how body mass index assessments are conducted in schools and whether student comfort with assessments varies by students' perceived weight status, weight satisfaction, or privacy during measurements.MethodsIn-person cross-sectional surveys with diverse fourth- to eighth-grade students (n = 11,510) in 54 California schools in 2014-2015 about their experience being weighed in the prior school year.ResultsHalf of the students (49%) reported being weighed by a physical education teacher and 28% by a school nurse. Students were more comfortable being weighed by nurses than physical education teachers (P = 0.01). Only 30% of students reported privacy during measurements. Students who were unhappy with their weight (P

Extreme sea levels and coastal flooding can cause devastating socio-economic damages and even loss of lives. Robust and timely risk mitigation requires knowledge of recurrence frequencies, but such estimates are riddled with uncertainties, especially regarding high-impact, low-probability events. In the North Sea–Baltic Sea region, considerable inter- and intra-decadal variability mean that the risks of present-day, wind-driven extreme sea levels are not fully determined. This knowledge gap is becoming more urgent for decision-makers and stakeholders since mitigation of the impacts of current and future flooding hazards, e.g. by coastal adaptation schemes, ideally requires detailed knowledge on the current and future storm-surge regime.In the present study, we investigate the wind-driven sea-level responses across the entirety of the complex Danish coastlines. We use an idealised framework to map the ranges of critical wind directions systematically by applying an advanced oceanographic model for storm surges driven by synthetic wind fields. We find that the modelled extreme water levels increase linear-to-quadratically with increased wind speed. This increase shows no signs of levelling off even for static winds of 40ms−1, although this finding is dependent on the wind stress parameterisation, which becomes uncertain for such strong wind forcing. The magnitudes of the resulting extreme water levels are highest in the Wadden Sea region in the southeastern North Sea. Still, when taking local sea-level variability into account, the most extreme incidents are undoubtedly generated in the western Baltic Sea.Hereafter, and based on the same synthetic wind fields, we investigate a complementary methodology’s potential to generalise the synthetic modelling results. For this purpose, site-specific relations between the dynamic wind forcing (i.e. wind speed and wind direction), parameters defining the local conditions and extreme sea levels are determined based on the dynamic model simulations that are generalised using a novel empirical–statistical method. The approach is tested for the North- and Baltic Seas and performs reasonably well for the highly complex coastlines around Denmark.We propose that our method could pave the way for improved operational and physically-based impact assessments based on full, large-scale regional climate model projections as a complement to select sets of coupled ocean projections.

Highlights • 7 U.S. cities have a sugar-sweetened-beverage tax, raising $134 million annually. • Early childhood programs received the largest investment of tax revenues ($58M). • Community improvements (e.g., rec centers & libraries) were second largest ($21M). • Increasing healthy food and beverage access (e.g., produce subsidies) received $17M. • 85% of revenues supported projects and programs in impacted communities., We sought to describe how revenues from sugar-sweetened beverage (SSB) excise taxes in 7 U.S. cities are being allocated, who is benefiting from these investments, and whether allocations are consistent with the original intent of tax legislation. We collected information from public documents and key informants about allocations in the most recent fiscal year available (ranging from 2018 to 2021). Across the 7 U.S. cities with taxes, the average annual revenue from SSB taxes totaled $133.9 M. In the fiscal year studied, cities allocated a total of $133.2 M in SSB tax revenues. Human and community capital investments totaled $89.6 M (67% of all allocations) funding early childhood development, community infrastructure improvements, and youth and workforce development. Health-related investments totaled $36.9 M (28% of total allocations), funding access to healthy foods and beverages; support for physical activity opportunities; promotion of overall physical, mental or social health and wellbeing; health and nutrition education; chronic-disease prevention and management; and reducing SSB consumption. In the 3 cities that specified how tax revenues would be spent, allocations were consistent with promised uses of revenues. In addition, 85% of aggregated revenues ($112.9 M) were targeted to support work and programs in impacted communities (communities that experience health inequities, discrimination and exclusion). SSB tax revenues are supporting initiatives to improve community health, develop human and community capital, and advance equity. These investments may yield additional health benefits beyond those resulting from lower SSB consumption. Consistent tracking and public reporting on revenue allocations would increase transparency and accountability.

Advertising exerts a powerful influence over consumer decision-making, and disproportionate marketing for unhealthy products may contribute to health inequities. The objective of this study was to examine socioeconomic and racial and ethnic disparities in outdoor branded advertising for products harmful to health in San Francisco and Oakland, CA. We collected cross-sectional data on outdoor advertising from 372 blocks with≥1 residential or mixed-residential parcel in SF and Oakland in 2018-2019. Blocks were randomly sampled by city, land use, majority vs. non-majority Black and/or Hispanic composition, and upper and lower tertiles of household income. Advertisements were coded by product, healthfulness, and branding. Exposure variables were neighborhood household median income and percent of residents who were Hispanic of any race, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White. The primary outcome variable was block-level dichotomous presence of any unhealthy branded advertisement for food, beverage, alcohol, or tobacco. Analyses were unadjusted and adjusted for land use and number of total advertisements on each block. Each additional $10,000 in neighborhood household median income was associated with an 11% lower adjusted odds of having any unhealthy branded advertisements on the block (95%CI: 0.80-0.99; P=0.03). There were no significant associations between neighborhood racial and ethnic composition and presence of unhealthy branded advertisements, but with each 10% higher neighborhood composition of Hispanic residents, there was a borderline significant higher presence of unhealthy branded advertisements (OR=1.23; 95%CI: 1.00-1.51; P=0.05). Results indicate that low-income neighborhoods were disproportionately exposed to outdoor branded advertisements for unhealthy products.

BACKGROUND: Food insecurity affects 13 million children in the United States. Body dissatisfaction is also prevalent, affecting up to 46% of children. Both food insecurity and body dissatisfaction are associated with poor health outcomes, and both are associated with body weight and racial/ethnic disparities. The association between food insecurity and body dissatisfaction among children has not been examined. OBJECTIVE: The purpose of this study was twofold: to examine, in a sample of children in grades 4 through 8, the relationship of child food insecurity with body dissatisfaction and to gain an understanding of the interactive roles of body mass index (BMI), race/ethnicity, and sex in the relationship between food insecurity and body dissatisfaction. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: This study examined data obtained from 14,768 children in grades 4 through 8 from 54 public schools in California between 2014 and 2016. MAIN OUTCOME MEASURES: The primary outcome of interest was body dissatisfaction (five items converted to a binary indicator), and the exposure of interest was child-reported food insecurity (three items converted to a binary indicator). Subsets of validated questionnaires were used to assess body dissatisfaction and food insecurity. STATISTICAL ANALYSES PERFORMED: Data were analyzed using multivariable logistic regression, and effect modification was examined by BMI category (underweight, normal, overweight, obese), race/ethnicity, and sex. RESULTS: In this large and diverse sample, after adjusting for cofounders, children experiencing food insecurity, in all BMI categories and from all racial/ethnic backgrounds, had higher odds of body dissatisfaction than their food-secure counterparts. The strength of the relationship differed by BMI and race/ethnicity, with the strongest associations observed for African-American children (odds ratio=2.32; P

Sugar-sweetened beverages (SSBs) increase risk of cardiometabolic disease. Young people consume the largest amounts of SSBs and have experienced the greatest relative gains in obesity in the past several decades. There is evidence of addictive properties of both caffeine and sugar, the primary ingredients in SSBs, but little research into such properties of SSBs in naturally occurring consumption patterns. Thus, in this exploratory study, we sought to examine potentially addictive properties of SSBs during a 3-day SSB cessation intervention in overweight and obese adolescents who typically consume ≥3 SSBs daily. Participants (n = 25) were aged 13-18 years, mostly female (72%), and African American (56%) or Hispanic (16%) with a BMI≥95th percenttile (76%). Withdrawal symptoms and SSB craving were assessed approximately 1-week apart, during both regular SSB consumption and a 3-day period of SSB cessation in which participants were instructed to drink only plain milk and water. During SSB cessation, adolescents reported increased SSB cravings and headache and decreased motivation, contentment, ability to concentrate, and overall well-being (uncorrected Ps

While school meals are often the healthiest option for students, lunch participation remains relatively low. Few approaches for increasing participation have leveraged teachers’ potential social influence. We determined if a teacher intervention about the benefits of school lunch could improve teachers’ perceptions of, and participation in, school lunch, and encouragement of students to eat school lunch. This repeated cross-sectional study included teacher/student survey administration in spring of 2016 and 2018 in 19 public secondary schools (9 intervention, 10 comparison) educating students of ages ≈ 11–18. Intervention teachers received monthly newsletters; lunch taste tests; and a promotional video and website. Mixed effects models with a random effect for school showed the proportion of teachers that reported eating with students increased in intervention schools relative to control schools (difference-in-change: 7.6%; 95% CI: 3.578%, 14.861%), as did student agreement that adults at their schools encouraged them to eat school lunch (difference-in-change: 0.15 on a 5-point scale; 95% CI: 0.061, 0.244). There were no between-group differences in teachers’ perceptions of school meals or teachers’ lunch participation. These findings suggest that teachers’ perceptions of school meals do not necessarily need to improve to promote the school lunch program to students. However, to see meaningful change in teacher lunch participation, the taste of school meals likely needs improving.

Denmark has a long, complex coastline, connecting the North Sea in the west to the semi-enclosed Baltic Sea in the east, via the Skagerrak-Kattegat Seas. Historical sea level records indicate that relative sea level (RSL) has been increasing along the Danish North Sea coast, south of Skagerrak, following the global mean sea level (GMSL) rise. In the central Skagerrak-Kattegat Seas, RSL rise has been practically absent, due to the GMSL rise being off-set by the Fennoscandian post-glacial land-uplift. The new IPCC Special Report on the Ocean and Cryosphere in a Changing Climate (SROCC) reported that under RCP8.5 GMSL will increase more than the previous estimates in the IPCC Fifth Assessment Report (AR5) at the end of twenty-first century due to Antarctic ice sheet dynamics. We performed a regionalization of the SROCC sea level projections for the “Danish Climate Atlas” dataset, a nation-wide climate adaptation dataset based on IPCC and various national and international databases. In these complementary datasets, important local data have been considered, which have not been included in the IPCC SROCC GMSL rise estimates, i.e., more precise national-wide land-rise prediction and sets of sea level fingerprints. Our results indicate that sea level projections under RCP8.5 results in a > 40 cm RSL rise at the end of the twenty-first century in the Skagerrak-Kattegat Seas, which might call for a new adaptation strategy in this region. The rate of mean sea level rise will exceed the rate of the land-rise earlier than the previous estimates by AR5 under the RCP8.5 scenario. In particular, we stress how these new estimates will affect future extreme sea levels in this region. Based on our results, we suggest this more recent GMSL projection needs to be considered in coastal risk assessments in the Skagerrak-Kattegat Seas also in this century.

Despite a growing body of evidence showing that sugar-sweetened beverage (SSB) taxes nudge consumers away from SSBs, we lack an understanding of people’s awareness and perceptions of SSB taxes and whether tax awareness and perceptions differ based on sociodemographic characteristics. We used serial cross-sectional study intercept surveys (n = 2715) in demographically diverse neighborhoods of Berkeley and Oakland in 2015 and 2017, and San Francisco and Richmond in 2017. In the year following successful SSB tax ballot measures, 45% of respondents correctly recalled that an SSB tax had passed in their city. In untaxed cities, 14% of respondents incorrectly thought that a tax had passed. Perceived benefits of SSB taxes to the community and to children’s health were moderate and, like correct recall of an SSB tax, were higher among respondents with higher education levels. Awareness of SSB taxes was low overall, and perceptions about taxes’ benefits varied by educational attainment, reflecting a missed opportunity to educate citizens about how SSB taxes work and their importance. Public health efforts should invest in campaigns that explain the benefits of SSB taxes and provide information about how tax revenues will be invested, both before and after a tax proposal has passed.

Background Prior research suggests a relationship between overall diet quality and breast cancer survival, although few studies have reported on this topic. We evaluated whether 4 dietary quality indices consistent with healthy eating recommendations around the time of breast cancer diagnosis were associated with risk of recurrence, cause-specific, and all-cause mortality. Methods A total of 3660 women diagnosed with invasive breast cancer were included. Diet was assessed an average of 2.3 (range = 0.7-18.7) months after diagnosis, from which 4 dietary quality indices were derived: the American Cancer Society guidelines (ACS), the alternate Mediterranean Diet Index (aMED), the Dietary Approaches to Stop Hypertension (DASH), and the 2015 Healthy Eating Index (HEI). Over 40 888 person-years of follow-up, 461 breast cancer recurrences, and 655 deaths were ascertained. Cox models were used to estimate hazards ratios (HRs) and 95% confidence intervals (CIs). Results Adjusted comparisons between extreme quintiles showed all 4 dietary quality indices to be inversely associated with all-cause mortality, suggesting a 21%-27% lower risk (ACS HR = 0.73, 95% CI = 0.56 to 0.95; aMED HR = 0.79, 95% CI = 0.61 to 1.03; DASH HR = 0.76, 95% CI = 0.58 to 1.00; HEI HR = 0.77, 95% CI = 0.60 to 1.01). Similar patterns were noted for non-breast cancer mortality (ACS HR = 0.69, 95% CI = 0.48 to 0.98; aMED HR = 0.73, 95% CI = 0.50 to 1.05; DASH HR = 0.55, 95% CI = 0.38 to 0.79; HEI HR = 0.67, 95% CI = 0.48 to 0.94). None of the dietary quality indices were associated with recurrence or breast cancer–specific mortality. Conclusion Food intake patterns concordant with dietary quality indices consistent with recommendations for healthy eating may be beneficial for women with breast cancer.

The potential impacts of extreme sea level events are becoming more apparent to the public and policy makers alike. As the magnitude of these events are expected to increase due to climate change, and increased coastal urbanization results in ever increasing stakes in the coastal zones, the need for risk assessments is growing too.The physical conditions that generate extreme sea levels are highly dependent on site specific conditions, such as bathymetry, tidal regime, wind fetch and the shape of the coastline. For a low-lying country like Denmark, which consists of a peninsula and islands that partition off the semi-enclosed Baltic Sea from the North Sea, a better understanding of how the local sea level responds to wind forcing is urgently called for.We here present a map for Denmark that shows the most efficient wind directions for generating extreme sea levels, for a total of 70 locations distributed all over the country’s coastlines. The maps are produced by conducting simulations with a high resolution, 3D-ocean model, which is used for operational storm surge modelling at the Danish Meteorological Institute. We force the model with idealized wind fields that maintain a fixed wind speed and wind direction over the entire model domain. Simulations are conducted for one wind speed and one wind direction at a time, generating ensembles of a set of wind directions for a fixed wind speed, as well as a set of wind speeds for a fixed wind direction, respectively.For each wind direction, we find that the maximum water level at a given location increases linearly with the wind speed, and the slope values show clear spatial patterns, for example distinguishing the Danish southern North Sea coast from the central or northern North Sea Coast. The slope values are highest along the southwestern North Sea coast, where the passage of North Atlantic low pressure systems over the shallow North Sea, as well as the large tidal range, result in a much larger range of variability than in the more sheltered Inner Danish Waters. However, in our simulations the large fetch of the Baltic Sea, in combination with the funneling effect of the Danish Straits, result in almost as high water levels as along the North Sea coast.Although the wind forcing is completely synthetic with no spatial and temporal structure of a real storm, this idealized approach allows us to systematically investigate the sea level response at the boundaries of what is physically plausible. We evaluate the results from these simulations by comparison to peak water levels from a 58 year long, high resolution ocean hindcast, with promising agreement.

Objective This paper identifies implementation leadership characteristics in the school nutrition setting and places findings in the context of implementation leadership literature. Methods Fourteen interviews were conducted with school district leadership/staff in an urban school district. Modified grounded theory was employed. Results Four themes emerged: (1) understanding of technical/operational intervention details; (2) ability to proactively develop and communicate plans; (3) supervisory oversight; and (4) intervention framing. Themes were consistent with 4 of the 5 dimensions comprising the Implementation Leadership Scale: knowledgeable, proactive, perseverant, and distributed leadership. The supportive domain was not a major finding. An additional domain, how leaders message the intervention to staff, was identified. Conclusions and Implications Implementation leadership in school nutrition appears similar, but not identical, to leader behaviors present in the Implementation Leadership Scale. School nutrition leaders might consider involving staff early in implementation planning, incorporating technical expertise, and clearly communicating the intervention purpose to support successful implementation. Future research might explore the interplay between leadership and implementation outcomes.

The rise and fall of the sea surface in the coastal region is observed closely by two different sources: tide gauges measure the relative sea level anomaly at the coast at high temporal resolution (minutes or hours) and satellite altimeters measure the absolute sea surface height of the open ocean along tracks multiple times a day. However, these daily tracks are scattered across the Baltic Sea with each track being repeated at a lower temporal resolution (days). Due to the inverse relationship between spatial and temporal coverage of the satellite altimetry data, gridded satellite altimetry products often prioritize spatial coverage over temporal resolution, thus filtering out the high sea level variability. In other words, the satellite data, and especially averaged products, often miss the daily sea level variability, such as storm surges, which is most important for all societies in the coastal region. To compensate for the sparse spatial coverage from satellite altimetry, we here present an experimental product developed as part of the ESA project Baltic+SEAL: on a 3-day scale, the DMI Optimal Interpolation (DMI-OI) method is combined with error statistics from a storm surge model as well as 3-day averages from both tide gauge observations and satellite altimetry tracks to generate a gridded sea level anomaly product for the Baltic Sea for year 2017. The product captures the overall temporal evolution of the sea level changes well for most areas with an average RMSE wrt. tide gauge observations of 17.2 cm and a maximum of 34.2 cm. Thus, the 3-day mean gridded product shows potential as an alternative to monthly altimetry products, although further work is needed.

Importance Annually, US schools screen millions of students’ body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms. Objective To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population. Design, Setting, and Participants Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020. Interventions School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years. Main Outcomes and Measures Changes in BMIzscore and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up. Results A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMIzscore change (−0.003; 95% CI, −0.02 to 0.01 at 1 year and 0.01; 95% CI, −0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (−0.11; 95% CI, −0.18 to −0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (−0.06; 95% CI, −0.10 to −0.02). Conclusions and Relevance Body mass index reports alone do not improve children’s weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions. Trial Registration ClinicalTrials.gov Identifier:NCT02088086

There are a large number of geophysical processes affecting sea level dynamics and coastal erosion in the Baltic Sea region. These processes operate on a large range of spatial and temporal scales and are observed in many other coastal regions worldwide. This, along with the outstanding number of long data records, makes the Baltic Sea a unique laboratory for advancing our knowledge on interactions between processes steering sea level and erosion in a climate change context. Processes contributing to sea level dynamics and coastal erosion in the Baltic Sea include the still ongoing viscoelastic response of the Earth to the last deglaciation, contributions from global and North Atlantic mean sea level changes, or contributions from wind waves affecting erosion and sediment transport along the subsiding southern Baltic Sea coast. Other examples are storm surges, seiches, or meteotsunamis which primarily contribute to sea level extremes. Such processes have undergone considerable variation and change in the past. For example, over approximately the past 50 years, the Baltic absolute (geocentric) mean sea level has risen at a rate slightly larger than the global average. In the northern parts of the Baltic Sea, due to vertical land movements, relative mean sea level has decreased. Sea level extremes are strongly linked to variability and changes in large-scale atmospheric circulation. The patterns and mechanisms contributing to erosion and accretion strongly depend on hydrodynamic conditions and their variability. For large parts of the sedimentary shores of the Baltic Sea, the wave climate and the angle at which the waves approach the nearshore region are the dominant factors, and coastline changes are highly sensitive to even small variations in these driving forces. Consequently, processes contributing to Baltic sea level dynamics and coastline change are expected to vary and to change in the future, leaving their imprint on future Baltic sea level and coastline change and variability. Because of the large number of contributing processes, their relevance for understanding global figures, and the outstanding data availability, global sea level research and research on coastline changes may greatly benefit from research undertaken in the Baltic Sea.

Consumption of sugar-sweetened beverages (SSBs) contributes to adverse health outcomes and excess health care spending. To provide context for ongoing work assessing the impact of public health strategies, including SSB excise taxes, we used data from the California Health Interview Survey from 2011-2018 to estimate trends in beverage consumption among adults, teens, and children overall and by education, race/ethnicity, and family income. We found reductions in the annual prevalence and frequency of soda consumption across all age groups and heterogeneous increases in the consumption of fruit drinks among adults and children. Surveillance of beverage consumption trends will continue to strengthen and improve the ability of researchers and policy makers to effectively improve population health.

Background Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration. Objectives Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12. Methods We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood. Results Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households. Conclusions Changes in food security status and duration of food insecurity were associated with changes in children's growth.

The absolute sea level trend from May 1995 to May 2019 in the Baltic Sea is analyzed by means of a regional monthly gridded dataset based on a dedicated processing of satellite altimetry data. In addition, we evaluate the role of the North Atlantic Oscillation and the wind patterns in shaping differences in sea level trend and variability at a sub-basin scale. To compile the altimetry dataset, we use information collected in coastal areas and from leads within sea-ice. The dataset is validated by comparison with tide gauges and the available global gridded altimetry products. The agreement between trends computed from satellite altimetry and tide gauges improves by 9%. The rise in sea level is statistically significant in the entire region of study and higher in winter than in summer. A gradient of over 3 mm/yr in sea level rise is observed, with the north and east of the basin rising more than the south-west. Part of this gradient (about 1 mm/yr) is directly explained by a regression analysis of the wind contribution on the sea level time series. A sub-basin analysis comparing the northernmost part (Bay of Bothnia) with the south-west reveals that the differences in winter sea level anomalies are related to different phases of the North-Atlantic Oscillation (0.71 correlation coefficient). Sea level anomalies are higher in the Bay of Bothnia when winter wind forcing pushes waters through Ekman transport from the south-west toward east and north. The study also demonstrates the maturity of enhanced satellite altimetry products to support local sea level studies in areas characterized by complex coastlines or sea-ice coverage. The processing chain used in this study can be exported to other regions, in particular to test the applicability in regions affected by larger ocean tides. The absolute sea level trend from May 1995 to May 2019 in the Baltic Sea is analyzed by means of a regional monthly gridded dataset based on a dedicated processing of satellite altimetry data. In addition, we evaluate the role of the North Atlantic Oscillation and the wind patterns in shaping differences in sea level trend and variability at a sub-basin scale. To compile the altimetry dataset, we use information collected in coastal areas and from leads within sea-ice. The dataset is validated by comparison with tide gauges and the available global gridded altimetry products. The agreement between trends computed from satellite altimetry and tide gauges improves by 9%. The rise in sea level is statistically significant in the entire region of study and higher in winter than in summer. A gradient of over 3 mm/yr in sea level rise is observed, with the north and east of the basin rising more than the south-west. Part of this gradient (about 1 mm/yr) is directly explained by a regression analysis of the wind contribution on the sea level time series. A sub-basin analysis comparing the northernmost part (Bay of Bothnia) with the south-west reveals that the differences in winter sea level anomalies are related to different phases of the North-Atlantic Oscillation (0.71 correlation coefficient). Sea level anomalies are higher in the Bay of Bothnia when winter wind forcing pushes waters through Ekman transport from the south-west toward east and north. The study also demonstrates the maturity of enhanced satellite altimetry products to support local sea level studies in areas characterized by complex coastlines or sea-ice coverage. The processing chain used in this study can be exported to other regions, in particular to test the applicability in regions affected by larger ocean tides.

The sugar-sweetened beverage (SSB) industry has claimed that food and beverage retailers are opposed to SSB taxes. In 2018 and 2019, we formally evaluated retailers' perceptions of SSB taxes using semi-structured interviews (including open- and closed-ended questions) with 103 randomly selected retailers (50 corner and liquor stores; 28 chain convenience, drug, and mass-merchandise stores; 18 chain supermarkets and discount supermarkets; and 7 independent supermarkets) across 3 cities with SSB taxes (Berkeley, Oakland, and San Francisco); interviews occurred in 2018 and 2019 (approximately 3years, 1year and 6months post tax-implementation, respectively). A majority of both small and large retailers reported the tax had only a minimal effect on their business (70%). About half of retailers believed that other cities should adopt SSB taxes (53%), and were supportive of a statewide SSB tax (53%), noting it would level the playing field and better support health in their communities. Retailers' responses did not differ based on neighborhood income, and only 2 responses differed significantly between large and small retailers. Only 2 of 103 retailers reported raising the price of a non-beverage product in response to the tax, specifically raising the price of snack foods of low nutritional quality and alcoholic beverages. A majority of retailers in 3 California cities with SSB taxes have no concerns regarding the tax, endorse the health goals of SSB taxes and support statewide expansion of SSB tax policies.

Author(s): Thompson, Hannah R; Ritchie, Lorrene; Park, Esther; Madsen, Kristine A; Gosliner, Wendi | Abstract: IntroductionSchools across the United States have removed sweetened, flavored milk from cafeterias to reduce students' sugar consumption and improve their health. However, evidence on the impact of the removal is limited. We examined the effect of a policy that removed chocolate milk from secondary schools on students' milk consumption and estimated milk-related nutrient intake.MethodsWe collected data on milk selection and consumption during 1 lunch period in 24 California public secondary schools pre-policy (N = 3,158 students in 2016) and post-policy (N = 2,966 students in 2018). Schools had a student population that was 38% Asian and 29% Latino, with 63% qualifying for free or reduced-price meals. We used linear mixed effects models to assess changes in milk selection and waste, and we estimated related changes in added sugars, calcium, protein, and vitamin D consumed from milk.ResultsThe proportion of students selecting milk declined 13.6%, from 89.5% pre-policy to 75.9% post-policy (95% CI for difference, 10.8% tο 16.4%), but the proportion of milk wasted remained stable (37.1% vs 39.3%; 95% CI for difference, -0.2% to 4.6%). Although average per-student milk consumption declined by less than 1 ounce per student (from 4.8 oz to 3.8 oz; 95% CI for difference, -1.1 oz to -0.7 oz), we observed no significant reductions in average per-student intake of calcium, protein, or vitamin D from milk. Estimated added sugars from milk declined significantly, by 3.1 grams per student (95% CI, -3.2 g to -2.9 g).ConclusionRemoving chocolate milk modestly reduced student milk consumption without compromising average intake of key milk-related nutrients, and consumption of added sugars from milk declined significantly. Secondary schools should consider removing chocolate milk to support healthy beverage consumption.

OBJECTIVES: Removing chocolate milk from school cafeterias is an increasingly popular policy approach for reducing youth sugar-sweetened beverage consumption and improving health. Evidence on the impact of such policies in urban secondary schools, which is needed to inform future school-based health improvement efforts targeting our highest-need youth, is lacking. The objective of this study is to determine the impact of a school district's chocolate milk removal policy on racially/ethnically and socioeconomically diverse middle and high school students’ milk, calcium, and added sugar consumption. METHODS: Student-level lunch data were collected in the springs of 2016 (pre-chocolate milk removal policy) and 2018 (post-policy) during one lunch period each in 24 middle and high schools in a diverse urban school district. Linear mixed effects models adjusted for school-level demographic characteristics were used to assess changes in the proportion of students who purchased milk; the proportion of milk consumed; and the average grams of added sugar, ounces of milk, and grams of calcium consumed per student. RESULTS: Pre-policy, 3,158 students (mean 132 per school) participated in lunch data collection across all 24 schools; post-policy, 2,966 students (mean 124 per school) participated. There was a 13.6% (95% CI −16.4, −10.8) decrease in the proportion of students who purchased milk pre-policy (89.5%) to post-policy (75.9%). The proportion of milk consumed remained stable pre- (68.3%) and post-policy (66.3%; 95% CI for difference −4.1, 0.01). There was a statistically significant 3.8g decline in added sugar consumed post- policy (95% CI for change −3.9g, −3.6g) and no significant changes in ounces of milk or grams of calcium consumed. CONCLUSIONS: Immediately post-chocolate milk removal from school cafeterias, fewer secondary students purchased milk. However, among students who purchased milk, consumption remained stable pre- and post-policy, and added sugar consumption significantly declined. Evidence on the longer-term impact of chocolate milk removal policies is necessary. FUNDING SOURCES: This work was funded by the United States Department of Agriculture, National Institute of Food and Agriculture, (Grant ID: 2015-68001-23236); Technology and Design Innovation to Support 21st Century School Nutrition.

Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California. Methods. We collected pretax (April–May 2017) and posttax (April–May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales. Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities. Conclusions. Within 4 to 10 months of implementation, Oakland’s and San Francisco’s SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.

Extreme water levels in the micro-tidal transition zone between the North Sea and the semi-enclosed Baltic sea are predominantly determined by wind forcing associated with synoptic-scale weather systems. This connection between the two seas is partly blocked by low-lying islands, and the bathymetry comprises a complex mixture of narrow, deep channels and shallow sills. Coastlines in the Southern Kattegat and the Western Baltic Sea are therefore exposed to wind forcing from a large range of directions, and the extent of water build-up varies strongly between locations.In the present study, we aim to determine the most critical wind direction for most of the Danish coastlines by employing numerical modelling experiments. The simulations are conducted with two different regional 3D ocean models to enable model inter-comparison. The DMI-HBM model implements a structured grid with fully dynamic 2-way nesting, while the MIKE 3 FM invokes an unstructured mesh. Both models have grid resolutions of ~0.5–1 km within the Danish Straits and 4–6 km in the offshore Baltic Sea. The models are forced by synthetic wind fields, where both wind speed and wind direction are maintained at fixed levels over the entire model domains. Pairs of model simulations are then obtained by varying the angle from which the wind is blowing.From the model outputs, we describe the temporal evolution of the water level by the site-specific peak water level, and the time required for the response to reach its peak value. Our results show a steady rise of the water level up until the peak value. The peak water level significantly overshoots the final equilibrium water level, which develops further into the simulations. Our study facilitates a better understanding of the sea level's response to extreme and persistent winds in a region with highly complex geometry.

Climate change will lead to increases in the flood risk in low-lying coastal areas. Understanding the magnitude and impact of such changes is vital to design adaptive strategies and create awareness. In the context of the CoDEC project (Coastal Dataset for Evaluation of Climate impact), we developed a consistent European dataset of extreme sea levels, including climatic changes from 1979 to 2100. To simulate extreme sea levels, we apply the Global Tide and Surge Model v3.0 (GTSMv3.0), a 2D hydrodynamic model with global coverage. GTSM has a coastal resolution of 2.5 km globally and 1.25 km in Europe, and incorporates dynamic interactions between sea-level rise, tides and storm surges. Validation of the dataset shows a good performance with a mean bias of 0-.04 m for the 1 in 10-year water levels. When analyzing changes in extreme sea levels for the future climate scenarios, it is projected that by the end of the century the 1 in 10-year water levels are likely to increase up to 0.5 m. This change is largely driven by the increase in mean sea levels, although locally changes in storms surge and interaction with tides can amplify the impacts of sea-level rise with changes up to 0.2 m in the 1 in 10-year water level.The CoDEC dataset will be made accessible through a web portal on Copernicus Climate Data Store (C3S). The dataset includes a set of Climate Impact Indicators (CII’s) and new tools designed to evaluate the impacts of climate change on different sectors and industries. This data service will support European coastal sectors to adapt to changes in sea levels associated with climate change. In this presentation we will also demonstrate how the C3S coastal service can be used to enhance the understanding of local climate impacts.

The use of satellite altimetry at high latitudes and coastal regions is currently limited by the presence of seasonal sea ice coverage, and the proximity to the coast. The semi-enclosed Baltic Sea features seasonal coverage of sea-ice in the northern and coastal regions, and complex jagged coastlines with a huge number of small islands. However, as a semi-enclosed sea with a considerable extent, the Baltic Sea features a much-reduced tidal signal, both open- and coastal- waters, and an extensive multi-national network of tide-gauges. These factors maximise opportunities to drive improvements in sea-level estimations for coastal, and seasonal-ice regions.The ESA Baltic SEAL project, launched in April 2019, aims to exploit these opportunities. It is generating and validating a suite of enhanced multi-mission sea level products. Processing is developed specifically for coastal regions, with the objective of achieving a consistent description of the sea-level variability in terms of long-term trends, seasonal variations and a mean sea-surface. These will advance knowledge on adapting processing algorithms, to account for seasonal ice, and complex coastlines. Best practice approaches will be available to update current state-of-the-art datasets.In order to fulfill these goals, a novel altimeter re-tracking strategy has been developed. This enables the homogeneous determination of sea-surface heights for open-ocean, coastal and sea-ice conditions (ALES+). An unsupervised classification algorithm based on artificial intelligence routines has been developed and tailored to ingest data from all current and past satellite altimetry missions. This identifies radar echoes, reflected by narrow cracks within the sea-ice domain. Finally, the improved altimetry observations are gridded onto a triangulated surface mesh, featuring a spatial resolution greater than 1/4 degree. This is more suitable for utility for coastal areas, and use by coastal stakeholders.In addition to utilizing a wide range of altimetry data (Delay-Doppler and Pulse-Limited systems), the Baltic SEAL initiative harnesses the Baltic Seas unique characteristics to test novel geophysical corrections (e.g. wet troposphere correction), use the latest generation of regional altimetry datasets, and evaluate the benefits of the newest satellite altimetry missions. This presentation outlines the methodology and results achieved to date. These include estimations of a new regional mean sea surface, and insights into the trends of the sea level along the altimetry tracks with the longest records. The transfer of advances to other regions and sea-level initiatives are also highlighted.

Child obesity is understudied in Asian Americans, which include a growing population of recent immigrants. We examined the relationship between maternal nativity and time in the US, and obesity and obesogenic behaviors among Asian American children. We analyzed public-use data from the 2013&ndash, 2016 California Health Interview Survey for Asian American children ages 2 to 11 years. We used logistic regression to determine the odds of obesity and obesogenic behaviors associated with maternal nativity and time in the US. This study included n = 609 children. Children of US-born mothers had lower odds of obesity (adjusted odds ratio, AOR, 0.12, 95% CI 0.02 to 0.91) and lower fruit intake (AOR 0.15, 95% CI 0.03 to 0.81) than children of recent immigrants (&lt, 5 years in the US). Asian American children with recent immigrant mothers are more likely to be obese and eat less fruit than children with US-born mothers. Efforts to prevent obesity and increase fruit consumption are particularly important for this vulnerable population of children of recent immigrants.

The world’s coastal areas are increasingly at risk of coastal flooding due to sea-level rise (SLR). We present a novel global dataset of extreme sea levels, the Coastal Dataset for the Evaluation of Climate Impact (CoDEC), which can be used to accurately map the impact of climate change on coastal regions around the world. The third generation Global Tide and Surge Model (GTSM), with a coastal resolution of 2.5 km (1.25 km in Europe), was used to simulate extreme sea levels for the ERA5 climate reanalysis from 1979 to 2017, as well as for future climate scenarios from 2040 to 2100. The validation against observed sea levels demonstrated a good performance, and the annual maxima had a mean bias (MB) of -0.04 m, which is 50% lower than the MB of the previous GTSR dataset. By the end of the century (2071–2100), it is projected that the 1 in 10-year water levels will have increased 0.34 m on average for RCP4.5, while some locations may experience increases of up to 0.5 m. The change in return levels is largely driven by SLR, although at some locations changes in storms surges and interaction with tides amplify the impact of SLR with changes up to 0.2 m. By presenting an application of the CoDEC dataset to the city of Copenhagen, we demonstrate how climate impact indicators derived from simulation can contribute to an understanding of climate impact on a local scale. Moreover, the CoDEC output locations are designed to be used as boundary conditions for regional models, and we envisage that they will be used for dynamic downscaling.

Background Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. Objectives The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. Methods Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors. Results An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children. Conclusions Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.

We establish a methodology for assimilating satellite observations of ice surface temperature (IST) into a coupled ocean and sea-ice model. The method corrects the 2 meter air temperature based on the difference between the modelled and the observed IST. Thus the correction includes biases in the surface forcing and the ability of the model to convert incoming parameters at the surface to a net heat flux. A multi-sensor, daily, gap-free surface temperature analysis has been constructed over the Arctic region. This study revealed challenges estimating the ground truth based on buoys measuring IST, as the quality of the measurement varied from buoy to buoy. With these precautions we find a cold temperature bias in the remotely sensed data, and a warm bias in the modelled data relative to ice mounted buoy temperatures, prior to assimilation. As a consequence, this study weighted the modelled IST and the observed IST equally in the correction. The impact of IST was determined for experiments with and without the assimilation of IST and sea-ice concentration. We find that assimilation of remotely sensed data results in a cooling of IST, which improves the timing of the snow melt onset. The improved snow cover in spring is only based on observations from one buoy, thus additional good quality observations could strengthen the conclusions. The ice cover and the sea-ice thickness are increased, primarily in the experiment without sea-ice concentration assimilation.

Objectives. To evaluate a mass media campaign to reduce the consumption of sugar-sweetened beverages (SSBs). Methods. We disseminated messages emphasizing the health risks of SSBs through television, digital channels, and local organizations over 15 weeks in 2015–2016 in the Tri-Cities region of northeast Tennessee, southwest Virginia, and southeast Kentucky. We evaluated the campaign with pre- and post-telephone surveys of adults aged 18 to 45 years in the intervention area and by examining changes in beverage sales in the intervention and a matched comparison area in western Virginia. Results. Fifty-four percent of postcampaign respondents recalled seeing a campaign advertisement. After the campaign, 53% of respondents believed SSBs were a cause of heart disease, and respondents were more likely postcampaign to consider SSBs a “big cause of diabetes” (75% vs 60%; P

[ ]public health may be able to engage a broader coalition in fighting other preventable but deadly diseases, perhaps even obesity and diabetes [ ]sales taxes on soft drinks in Maine and Ohio, where 5 5% and 5 0% taxes, respectively, were added at the register, had no effect on sales 4 By contrast, a similarly sized excise tax in Washington State, which led to a 6% increase in shelf prices, was associated with a 5% decline in soft drink sales 5 Although Chriqui et al explain that Cook County used a sales tax because of existing restrictions, the tax size (equivalent to a 26% price increase) was five times larger than those in Maine and Ohio and led to a 21% net decline in sales while it was in place 2 FOCUS ON HEALTH Although excise taxes increase the cost of doing business for SSB manufacturers, and thereby lead to higher SSB prices and reduced consumption,1 it remains important to frame SSB taxes as a remedy to SSB-related disease and the tax revenues as a source of funding for health promotion By contrast, highlighting taxes as a means of reducing SSB consumption plays into the beverage industry's faulty but repeated claims that excise taxes restrict personal choice 3 Further, focusing on individual behaviors aligns with industry's talking points about personal responsibility;such talking points minimize the role inequitable environments across economic strata, including SSB advertising, play in shaping individual behaviors 1 NEXT STEPS Although Cook County's tax failed, it does pose an elegant natural experiment that could augment the science on SSB taxes, if the repeal's effect is consistent with evidence from Washington State and Denmark

Objectives. To examine the impact of physical education (PE) litigation on changes in cardio–respiratory fitness among racially/ethnically and socioeconomically diverse students. Methods. We used annual school-level data for all California schools with measures of fifth graders’ cardio–respiratory fitness spanning 2007–2008 through 2017–2018. A difference-in-difference design assessed changes before and after lawsuits in the proportion of students meeting fitness standards in schools in districts that were parties to PE lawsuits (n = 2715) versus in schools in districts not involved (n = 3152). We ran separate models with the proportion of students meeting fitness standards by sex, race/ethnicity, and low-income status as outcomes. Results. PE litigation led to a 1-percentage-point increase in the proportion of fifth-grade students meeting cardio–respiratory fitness standards (95% confidence interval [CI] = 0.03%, 2.0%). Effects were especially pronounced for female (1.3-percentage-point increase; 95% CI = 0.1%, 2.5%), African American (3.4-percentage-point increase; 95% CI = 0.5%, 6.2%), and low-income (2.8-percentage-point increase; 95% CI = 0.5%, 6.0%) students. Conclusions. Schools in districts subject to PE litigation showed greater improvements in student fitness, particularly among students typically at higher risk for inactivity and low fitness. Litigation may be an impactful tool for enforcing PE provision in accordance with the law.

Background: Current evidence demonstrates that, while a widely used tool for childhood obesity prevention, school-based BMI reports do not effectively reduce pediatric obesity. The purpose of this study was to examine the presumed mechanisms by which BMI reporting might impact child weight by assessing parents': (1) recall of BMI reports, (2) accuracy in recalling child overweight status, and (3) reactions to BMI reports. Methods: Mailed surveys were completed by 2205 racially/ethnically diverse parents of third- to seventh-grade students participating in the Fit Study who had either been exposed to 1 year of child BMI reporting (one report) or 2 years (two reports). Results: After 1 year of BMI reporting, parents of children with overweight were less likely [odds ratio (OR) = 0.7, 95% confidence interval (CI): 0.5-0.9] to recall receiving a BMI report and less likely (OR = 0.2, 95% CI: 0.1-0.3) to accurately recall their child's weight status from the BMI report, compared with parents of children with healthy weight. Differences in accuracy of child weight status recall persisted after 2 years of BMI reporting exposure. Only 22% of parents of children at risk for overweight and with overweight reported being surprised by the results. Conclusions: Parents' recall of receiving a school-based BMI report is low, as is the accuracy of recall of child's overweight status. Additionally, parents' surprise at, and concern for, BMI results is limited. Current BMI reports may be ineffective at reducing pediatric obesity due to their lack of salience and ability to compel meaningful behavior change among parents.

Author(s): Thompson, Hannah R; Linchey, Jennifer K; King, Benjamin; Himes, John H; Madsen, Kristine A | Abstract: BackgroundThe accuracy of students' heights and weights measured by school staff for body mass index (BMI) screening/reporting has not been established. This study examined school staffs' measurement accuracy, comparing accuracy by staff- and student-level characteristics.MethodsSchool staff and researchers measured the height and weight of 1008 4th-8th grade students, within 1 month of each other. Bland-Altman plots, mean differences, and intraclass correlation coefficients (ICCs) were calculated to examine measurement accuracy. Linear mixed effects models assessed accuracy by staff- and student-level characteristics.ResultsBland-Altman plots revealed no appreciable bias in differences between researcher and staff measurements. The mean absolute difference between researcher and school staff measurements were 1.0 ± 1.6ncm (height), 0.7 ± 1.8nkg (weight), and 0.4 ± 0.8nkg/m2 (BMI). Inter-rater ICC values were ≥0.97, demonstrating "excellent" reliability. Categorical weight status was correctly classified for 94% of students (kappa 0.90), and for 96% with a BMI ≥95th% (kappa 0.94). Physical education (PE) teachers were slightly less accurate than school nurses in measuring height (0.4ncm less accurate; pn=n.045) and weight (0.4nkg; pn=n.015).ConclusionsSchool staff conducted height/weight measurements on 4th-8th grade students with high accuracy. Resultant school-based BMI reports using similar protocols should validly reflect weight status for almost all students.

The Arctic region is responding heavily to climate change, and yet, the air temperature of Arctic, ice covered areas is heavily under-sampled when it comes to in situ measurements, and large uncertainties exist in weather- and reanalysis products. This paper presents a method for estimating daily mean 2 meter air temperatures (T2m) in the Arctic from satellite observations of skin temperature, using the Arctic and Antarctic ice Surface Temperatures from thermal Infrared (AASTI) satellite dataset, providing spatially detailed observations of the Arctic. The method is based on a linear regression model which has been developed using in situ observations and daily mean satellite ice surface skin temperatures combined with a seasonal variation to estimate daily T2m. The satellite derived T2m product including estimated uncertainties covers clear sky snow and ice surfaces in the Arctic region during the period 2000–2009. Comparison with independent in situ measured T2m gives average correlations of 95.5 % and 96.5 % and average root mean square errors of 3.47 °C and 3.19 °C for land ice and sea ice, respectively. The reconstruction provides a much better spatial coverage than the sparse in situ observations of T2m in the Arctic, is independent of numerical weather prediction model input and it therefore provides an important alternative to simulated air temperatures to be used for assimilation or global surface temperature reconstructions. A comparison between in situ T2m versus T2m from satellite and ERA-Interim shows that the T2m derived from satellite observations validate similar or better than ERA-Interim estimates in the Arctic.