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Importance: Literature suggests that well-being and health status differ by generational status among Asian American individuals., Objective: To compare young children's well-being and health behaviors and their parents' parenting practices among families of second-generation Asian American, third- or later-generation Asian American, and third- or later-generation non-Hispanic White children in the US., Design, Setting, and Participants: For this survey study, secondary data analysis was conducted from September 2, 2023, to June 19, 2024, using data from the 2018 to 2022 National Survey of Children's Health participants aged 6 months to 5 years. Parents completed a survey about their positive parenting practices and their child's psychological well-being and health behaviors via mail or online. Multivariable logistic and linear regression analyses were conducted to compare psychological well-being and health behaviors by study groups and positive parenting practices, adjusting for sociodemographic variables., Main Outcomes and Measures: Positive parenting practices (ie, reading, storytelling or singing, and family meals), psychological well-being (ie, flourishing, social-emotional development, and self-regulation), and health behaviors., Results: The analysis included 42 846 participants (5456 in 2018, 5140 in 2019, 7494 in 2020, 12 817 in 2021, and 11 939 in 2022; 46.6% female and 53.4% male). Participants were categorized into 3 groups: 2881 (6.7%) were second-generation Asian American children aged 0 to 5 years, 570 (1.3%) third- or later-generation Asian American children aged 0 to 5 years, and 39 395 (92.0%) third- or later-generation non-Hispanic White children aged 0 to 5 years. Compared with White children, Asian American children were less likely to flourish (odds ratio [OR], 0.57 [95% CI, 0.52-0.63] for second-generation Asian American; OR, 0.82 [95% CI, 0.65-1.03] for third- or later-generation Asian American), have regular bedtimes (OR, 0.80 [95% CI, 0.69-0.92] for second-generation Asian American; OR, 0.66 [95% CI, 0.49-0.88] for third- or later-generation Asian American), and have moderate screen time (OR, 0.92 [95% CI, 0.84-1.00] for second-generation Asian American; OR, 0.82 [95% CI, 0.69-0.97] for third- or later-generation Asian American). Results for regular reading and storytelling or singing were the lowest among second-generation Asian American children (1430 [49.6%] for reading and 1629 [56.5%] for storytelling or singing), followed by the third- or later-generation Asian American children (376 [66.0%] for reading and 412 [72.3%] for storytelling or singing) and than White children (28 628 [72.7%] for reading and 30 375 [77.1%] for storytelling or singing) (P < .001). Results for family meals were similar between second-generation (2356 [81.8%]) and third- or later-generation (467 [81.9%]) Asian American children; however, both were significantly lower than for White children (33 928 [86.1%]) (P < .001). All 3 positive parenting practices were positively associated with children's psychological well-being and health behaviors., Conclusions and Relevance: This survey study of young children found lower likelihoods of flourishing, regular bedtimes, and moderate screen time among Asian American children compared with non-Hispanic White children in the US. Reading and storytelling or singing parenting practices, which were associated with children's well-being and health behaviors, were particularly less frequent among parents of second-generation Asian American children than those of third- or later-generation Asian American children. Promotion of these practices among Asian immigrant parents may help improve the psychological well-being and health behaviors of their young Asian American children.

A large and growing corpus of epidemiologic studies suggests that the population-level burden of pediatric FA is not equitably distributed across major sociodemographic groups, including race, ethnicity, household income, parental educational attainment, and sex. As is the case for more extensively studied allergic disease states such as asthma and atopic dermatitis epidemiologic data suggest that FA may be more prevalent among certain populations experiencing lower socioeconomic status (SES), particularly those with specific racial and ethnic minority backgrounds living in highly urbanized regions. Emerging data also indicate that these patients may also experience more severe FA-related physical health, psychosocial, and economic outcomes relating to chronic disease management. However, many studies that have identified sociodemographic inequities in FA burden are limited by cross-sectional designs that are subject to numerous biases. Compared with cross-sectional study designs or cohorts established later in life, birth cohorts offer advantages relative to other study designs when investigators seek to understand causal relationships between exposures occurring during the prenatal or postnatal period and the atopic disease status of individuals later in life. Numerous birth cohorts have been established across recent decades, which include evaluation of food allergy-related outcomes, and a subset of these also have measured sociodemographic variables that, together, have the potential to shed light on the existence and possible etiology of sociodemographic inequities in food allergy. This manuscript reports the findings of a comprehensive survey of the current state of this birth cohort literature and draws insights into what is currently known, and what further information can potentially be gleaned from thoughtful examination and further follow-up of ongoing birth cohorts across the globe., (© 2024 The Authors. Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Introduction: Addressing the Social and Structural Determinants of Health (SSDH) is a primary strategy for attaining health equity. Teaching and learning about SSDH has increased across medical schools throughout the world; however, the published literature describing these efforts continues to be limited and many unknowns persist including what should be taught and by whom, what teaching methods and settings should be used, and how medical learners should be assessed., Materials and Methods: Based on published studies, input from experts in the field, and elements from the framework developed by the National Academy of Medicine, we created a universal Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT) to assist medical educators to assess existing SSDH curricular content, ascertain critical gaps, and categorize educational methods, delivery, and assessment techniques and tools that could help inform curricular enhancements to advance the goal of training a health care workforce focused on taking action to achieve health equity. To test the usefulness of the tool, we applied the SSDH CAT to map SSDH-related curriculum at a US-based medical school., Results: By applying the SSDH CAT to our undergraduate medical school curriculum, we recognized that our SSDH curriculum relied too heavily on lectures, emphasized knowledge without sufficient skill building, and lacked objective assessment measures. As a result of our curricular review, we added more skill-based activities such as using evidence-based tools for screening patients for social needs, and created and implemented a universal, longitudinal, experiential community health curriculum., Discussion: We created a universal SSDH CAT and applied it to assess and improve our medical school's SSDH curriculum. The SSDH CAT provides a starting point for other medical schools to assess their SSDH content as a strategy to improve teaching and learning about health equity, and to inspire students to act on the SSDH.

Background: American women tend to reduce physical activity (PA) during the transition to motherhood. Their main barrier to participation in PA is lack of time due to new/increased parenting and housework responsibilities. Because there are known racial/ethnic variations in time spent on housework among American women, their PA changes during the transition to motherhood might also differ by racial/ ethnic background. This study aimed to compare PA between American mothers of young child(ren) under age 5 years (YC) and American women without children by their racial/ethnic background., Methods: Secondary data analyses were conducted using 2011-2018 US National Health and Nutrition Survey data. The study sample included 4,892 women aged 20-45 years (Asian n = 760; Black n = 1,162; Hispanic n = 1,324; White n = 1,646). Participants completed a Physical Activity Questionnaire that asked about participation in transportation and leisure-time moderate- and vigorous-intensity PA (MVPA; minutes/week). Multivariable regression analyses were conducted to compare MVPA among women living without children and with YC (no older children) in each of the racial/ethnic groups., Results: Overall, the prevalence of physical inactivity, defined as zero minutes of MVPA in a typical week, was 43% (95% CI = 38-49%) vs. 32% (95% CI = 29-35%) among women living with YC vs. without children. The adjusted odds of physical inactivity for women living with YC, compared to women living without children, was significantly higher among Asian (OR = 2.08 [95% CI = 1.37-3.17]) and White women (OR = 1.63 [95% CI = 1.11-2.38]), while it was statistically insignificant among Hispanic and Black women. Among women who reported participating in MVPA, Asian women living with YC had 35 fewer minutes/week of MVPA than their counterparts living without children (p = 0.06), while other racial and ethnic groups showed no significant differences., Conclusions: American mothers of YC were less likely to engage in transportation or leisure-time MVPA, compared to those living without children. This association was particularly strong among Asian women. The study results suggest that a PA reduction in the transition to motherhood may be particularly large among Asian American women, calling for targeted efforts for PA promotion among Asian American mothers of YC; e.g., culturally-tailored community-based physical activity programs for Asian American mothers., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: To identify a postpartum lipidomic signature associated with gestational diabetes mellitus (GDM) and investigate the role of the identified lipids in the progression to type 2 diabetes (T2D)., Research Design and Methods: This prospective cohort study enrolled 1,409 women at 24-72 h after delivery of a singleton baby and followed them prospectively at the Boston Medical Center. The lipidome was profiled by liquid chromatography-tandem mass spectrometry. Diagnoses of GDM and incident T2D were extracted from medical records and verified using plasma glucose levels., Results: Mean (SD) age of study women at baseline was 28.5 (6.6) years. A total of 219 (16.4%) women developed incident diabetes over a median follow-up of 11.8 (interquartile range 8.2-14.8) years. We identified 33 postpartum lipid species associated with GDM, including 16 inverse associations (primarily cholesterol esters and phosphatidylcholine plasmalogens), and 17 positive associations (primarily diacyglycerols and triacyglycerols). Of these, four were associated with risk of incident T2D and mediated ∼12% of the progression from GDM to T2D. The identified lipid species modestly improved the predictive performance for incident T2D above classical risk factors when the entire follow-up period was considered., Conclusions: GDM was associated with a wide range of lipid metabolic alterations at early postpartum, among which some lipid species were also associated with incident T2D and mediated the progression from GDM to T2D. The improvements attained by including lipid species in the prediction of T2D provides new insights regarding the early detection and prevention of progression to T2D., (© 2023 by the American Diabetes Association.)

Background: Although insulin resistance is closely related to hypertension, the debate continues as to whether insulin resistance is a cause or a consequence of hypertension. This study investigated the associations of cord blood insulin concentration with blood pressure (BP) and hypertension in childhood and adolescence., Methods: This study included 951 children enrolled from 1998 to 2012 and followed from birth onwards at the Boston Medical Center, Boston, MA. Cord blood insulin concentration was measured using a sandwich immunoassay. Hypertension in childhood and adolescence was defined based on the 2017 American Academy of Pediatrics Clinical Practice Guidelines., Results: The median (interquartile range) for cord blood insulin concentration was 12.1 (7.2-19.0) µIU/mL. The age range of BP measurements was 3 to 18 years (median, 10.6 years). Cord blood insulin concentration was positively associated with systolic and diastolic BP as well as the risk of hypertension at age 3 to 18 years. Compared with the lowest tertile of cord blood insulin concentration, the top tertile insulin concentration was associated with a 5.18 (95% CI, 1.97-8.39) percentile increase in systolic BP, 4.29 (95% CI, 1.74-6.84) percentile increase in diastolic BP, and 1.62-fold (95% CI, 1.27-2.08) higher risk of hypertension. The association between insulin and hypertension was stronger among children born preterm ( P for interaction=0.048). Furthermore, preterm birth and childhood overweight or obesity enhanced the associations., Conclusions: Our results suggest that elevated insulin concentration at birth plays a critical role in the early life origins of hypertension and support the hypothesis implicating insulin resistance in the etiology of hypertension.

Background: Immunoglobulin E (IgE)-mediated food allergies (FAs) are increasingly common among US children and adults. Not only can living with FA impose considerable physical health impacts, but it also imposes economic burden and can negatively affect quality of life. Limited data indicate that allergy to multiple foods (multi-FA) also may be common, but much remains unknown about its distribution and determinants., Objective: To characterize the prevalence, characteristics, determinants, psychosocial burden, and distribution of multi-FA among a large, nationally representative sample of US children and adults., Methods: A US population-based survey was administered. Estimates of multi-FA prevalence, conditional frequencies of multi-FA combinations, and associated factors were derived. Latent class analyses were conducted using 9 dichotomized indicators of specific FA prevalence, which were used to determine factors associated with latent class membership and characterize FA-related psychosocial burden within each class., Results: Surveys were completed for 38,408 children and 40,443 adults. Among children and adults meeting established symptom-report criteria for FA, an estimated 40% and 48% had multi-FA, respectively. Among pediatric and adult populations with convincing FAs, the lifetime reported prevalence of physician-diagnosed atopic comorbidities increased significantly as the number of reported current convincing FAs increased, as did the proportion reporting multi-FA-related health care utilization and higher perceived psychosocial burden. Latent class analyses suggested the existence of the following 4 key latent phenotypes of multi-FA: milk and egg-dominant, seafood-dominant, peanut and tree nut-dominant, and broadly multi-food allergic., Conclusion: The US population-level burden of multi-FA is high among both children and adults, and data indicate the presence of 4 major phenotypes of multi-FA in both populations., (Copyright © 2022 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: In utero exposure to diabetes has been shown to contribute to preterm birth, though the underlying biological mechanisms are yet to be fully elucidated. Fetal epigenetic variations established in utero may be a possible pathway. This study aimed to investigate whether in utero exposure to diabetes was associated with a change in newborn DNA methylation, and whether the identified CpG sites mediate the association between diabetes and preterm birth in a racially diverse birth cohort population., Methods: This study included 954 mother-newborn pairs. Methylation levels in the cord blood were determined using the Illumina Infinium MethylationEPIC BeadChip 850 K array platform. In utero exposure to diabetes was defined by the presence of maternal pregestational or gestational diabetes. Preterm birth was defined as gestational age at birth less than 37 weeks. Linear regression analysis was employed to identify differentially methylated CpG sites. Differentially methylated regions were identified using the DMRcate Package., Results: 126 (13%) newborns were born to mothers with diabetes in pregnancy and 173 (18%) newborns were born preterm, while 41 newborns were born both preterm and to mothers with diabetes in pregnancy. Genomic-wide CpG analysis found that eighteen CpG sites in cord blood were differentially methylated by maternal diabetes status at an FDR threshold of 5%. These significant CpG sites were mapped to 12 known genes, one of which was annotated to gene Major Histocompatibility Complex, Class II, DM Beta (HLA-DMB). Consistently, one of the two identified significant methylated regions overlapped with HLA-DMB. The identified differentially methylated CpG sites mediated the association between diabetes in pregnancy and preterm birth by 61%., Conclusions: In this US birth cohort, we found that maternal diabetes was associated with altered fetal DNA methylation patterns, which substantially explained the link between diabetes and preterm birth., (© 2023. The Author(s).)