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Although it has been demonstrated that (a) body dissatisfaction and internalization of societal appearance standards contribute to disordered eating and (b) that internalization of societal appearance standards leads to decreased skin color satisfaction among Black women, it has not been established whether skin color dissatisfaction contributes to disordered eating among Black women or girls. The objective of the present study is to determine the influence of skin color satisfaction as a potential predictor for binge eating, and its effect through body image in Black girls during the vulnerable developmental period of adolescence. Using data from ten annual measurements in 1213 Black girls across ages 10–19, we sought to determine whether skin color satisfaction predicts Binge Eating Disorder (BED) risk and symptoms using pre-registered logistic and multilevel models. We found that lower skin color satisfaction at ages 13 and 14 significantly predicted greater odds of BED and lower skin color satisfaction at all ages predicted greater BED symptoms. Body satisfaction mediated the relationship between skin color satisfaction and BED symptoms. Our results suggest that skin color dissatisfaction is a novel component of body image for Black girls that is also related to binge eating. • Body image in Black women is underexplored despite potential health consequences. • Skin color dissatisfaction was related to increased odds of Binge Eating Disorder. • Body dissatisfaction mediated this longitudinal link. • Sociocultural value placed on whiteness may have adverse effects on Black girls. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the associations between 3 prenatal stress exposures and rapid infant weight gain.Study Design: Participants were 162 maternal-child dyads drawn from a nonrandomized controlled trial evaluating a prenatal intervention for reducing women's stress and excessive gestational weight gain and subsequent longitudinal observational study of offspring outcomes. Participants were predominantly low-income and racial or ethnic minorities, and mothers were overweight or obese prepregnancy. Primary exposures were objective stress exposures (number of stressful life events) and subjective distress (maternal perceived stress and depressive symptoms) during pregnancy. The primary outcome was rapid infant weight gain from birth to 6 months, assessed via birth records and in-person anthropometry measurements.Results: In total, 28% of the sample (N = 40) met criteria for rapid infant weight gain. In adjusted models, exposure to prenatal stressful life events was associated with increased odds of rapid infant weight gain (OR 1.40, 95% CI 1.07-1.83, P = .014). Neither prenatal perceived stress (OR 0.47, 95% CI 0.16-1.37, P = .17) nor depressive symptoms (OR 0.89, 95% CI 0.76-1.03, P = .13) were significantly associated with rapid infant weight gain.Conclusions: Each additional stressful life event a woman experienced during pregnancy was associated with 40% greater odds of rapid infant weight gain. Future research should evaluate whether prenatal interventions that focus on reducing exposure to stressful events prevent rapid infant weight gain. [ABSTRACT FROM AUTHOR]

Background: Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.Objective: The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.Methods: Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity.Results: Children from food-insecure households had higher BMI-z (β: 0.14; 95% CI: 0.06, 0.21), waist circumference (β: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (β: 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (β: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (β: -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity.Conclusions: Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old. [ABSTRACT FROM AUTHOR]

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

Summary Background While there is information in the literature describing the poor nutritional intake of food-insecure youth, eating behaviours among food-insecure children – particularly, obese children are less well-described. We conducted focus groups with family members of low-income children who were initiating care in a paediatric obesity clinic. Food hiding emerged as a theme, and generated the motivation for this analysis. Methods Between April 2012 and December 2013, a total of 7 focus groups were conducted (4 food-insecure groups and 3 food-secure). Based on recruitment from 37 index patients, the focus groups were attended by a total of 47 participants. Participant responses about eating behaviours were evaluated using a combination of inductive codes derived from the data and deductive codes informed by criteria for diagnosis of disordered eating. Results While participants from food-secure and food-insecure households all had anecdotes about their children overeating, respondents in two of the food-insecure groups described episodes that resemble binge eating. The topic of hiding food emerged in the food-insecure groups, though was not endorsed in the food-secure groups despite probing. Night-time eating arose spontaneously in two of the food-insecure groups, but not in the food-secure groups. Conclusion This study highlights the presence of food hiding, binge eating, and night-time eating in food-insecure children with obesity. These factors would further compound their health burden, and the relationship between disordered eating and food insecurity in children with obesity warrants further study. [ABSTRACT FROM AUTHOR]

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

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

Background: Food insecurity is associated with adverse mental health outcomes. Given that federal food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), aim to alleviate food insecurity, there may be heterogeneity in the association between food insecurity and depression by SNAP participation status. Objective: With the use of data from the 2005-2010 NHANES, we examined the associations between household food security and depression and whether these differed by SNAP participation. Methods: The study population was restricted to 3518 adults with household incomes ≥130% of the federal poverty level. Food insecurity was assessed with the 18-item US Household Food Security Survey Module; a score of $3 was considered food insecure. Depression was assessed with the 9-item Patient Health Questionnaire and was defined as a score of ≥10. Multivariate logistic regression models examined the associations between food insecurity and depression, adjusting for sociodemographic and health characteristics. Results: The overall prevalence of depression was 9.3%, ranging from 6.7% among SNAP nonparticipants to 12.8% among SNAP participants. For every depressive symptom, there was a dose-response relation, such that a higher prevalence was observed with worsening food insecurity. After multivariate adjustment, food insecurity was positively associated with depression (P-trend < 0.0001), but SNAP participation modified this relation (P-interaction = 0.03). Among low-income, eligible nonparticipants, very low food security was significantly associated with higher odds of depression (OR: 5.10; 95% CI: 3.09, 8.41 ). Among SNAP participants, very low food security was also associated with higher odds of depression but at a lower magnitude (OR: 2.21; 95% CI: 1.54,3.17). Conclusion: The complex relation between food insecurity and mental health may vary on the basis of SNAP participation status. Programmatic efforts to address the risk of depression among their beneficiaries may positively affect the mental health of low-income adults. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

Objectives: To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness.Study Design: Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life.Results: The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness.Conclusions: In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

We examined three generations (grandparents, mothers, and grandchildren) to assess the association between grandparents' educational attainment and their grandchildren's epigenetic-based age acceleration and whether the association was mediated by parental educational attainment and mothers' life course health-related factors. Mothers were recruited to the NHLBI Growth and Health Study at 9–10 years and followed for 10 years (1987–1998). Mothers were then re-contacted three decades later (ages 37–42) to participate in the National Growth and Health Study (NGHS), and health information from their youngest child (i.e., grandchildren; N = 241, ages 2–17) was collected, including their saliva samples to calculate epigenetic age. Five epigenetic-based age acceleration measures were included in this analysis, including four epigenetic clock age accelerations (Horvath, Hannum, GrimAge, and PhenoAge) and DunedinPACE. Grandparents reported their highest education during the initial enrollment interviews. Parental educational attainment and mothers' life course health-related factors (childhood BMI trajectories, adult cardiovascular health behavioral risk score, and adult c-reactive protein) are included as mediators. Grandparents' education was significantly associated with Horvath age acceleration (b = −0.32, SE = 0.14, p = 0.021). Grandchildren with college-degree grandparents showed significantly slower Horvath age accelerations than those without college degrees. This association was partially mediated by parental education and mothers' health-related factors, especially adult cardiovascular health behavioral risk score and CRP, but not mothers' childhood BMI trajectory. This ability to conserve the speed of biological aging may have considerable consequences in shaping health trajectories across the lifespan. • We examined epigenetic intergenerational transmission of socioeconomic status. • Grandparents' education was linked to grandchildren's epigenetic age acceleration. • Parental education and health partially mediated the association. • Intergenerational SES is linked to the ability to conserve biological aging. [ABSTRACT FROM AUTHOR]

Subjective social status (SSS), an individual's assessment of their own social status in relation to others, is associated with health and mortality independently of objective SES; however, no studies have tested whether SSS influences epigenetic aging. The current study examines if SSS is associated with epigenetic age acceleration in both Black and White women, independently of objective SES measured during both childhood and adulthood. For 9- and 10-year-old Black and White girls, parental education and annual household income was obtained. At ages 39–42, 361 participants (175 Black, 186 White) reported their current education, household income, and SSS, and provided saliva to assess age acceleration using the GrimAge epigenetic clock. Linear regression estimated the association of SSS with epigenetic age acceleration, controlling for objective SES (current education, current income, parents' education, income during childhood), smoking, and counts of cell types. When all objective SES variables were included in the model, SSS remained significantly associated with epigenetic age acceleration, b = − 0.31, p =.003, ß = − 0.15. Black women had significantly greater age acceleration than White women, (t (359) = 5.20, p >.001, d = 0.55) but race did not moderate the association between SSS and epigenetic age acceleration. Women who rated themselves lower in SSS had greater epigenetic age acceleration, regardless of income and education. There was no difference by race for this association. • Women lower in subjective social status had greater epigenetic age acceleration. • Accelerated epigenetic aging may link subjective social status and health. • Race did not moderate the relationship between social status and epigenetic age. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this research was to assess the consistency of associations between neighborhood characteristics and pregnancy-related behaviors and outcomes across four nested neighborhood boundaries using race-stratified fixed-slope random-intercept multilevel logistic models. High incivilities was associated with increased smoking, inadequate weight gain and pregnancy-induced hypertension (PIH), while walkability was associated with decreased smoking and PIH for white women across all neighborhood definitions. For African American women, high incivilities was associated with increased smoking and inadequate gestational weight gain, while more walkable neighborhoods appeared protective against smoking and inadequate weight gain in all but the smallest neighborhoods. Associations with neighborhood attributes were similar in effect size across geographies, but less precise as neighborhoods became smaller. [Copyright &y& Elsevier]

Background: Low-income and minority children have higher rates of obesity and overweight. Greater understanding of their food access is important. Because of higher rates of walking to school in these populations, these children likely have greater exposure to the food environment immediately around their schools. Mobile food vendors are an understudied aspect of the food environment in U.S. urban areas. Purpose: This study aims to observe the after-school food environment in an urban area where mobile vending is known to occur in order to study the range of vendors encountered near schools and the items sold in the after-school period. Methods: In the spring of 2008, the presence of mobile food vendors after school within ¼ mile of nine public schools was assessed in a predominantly Latino district of Oakland CA. At six schools with regular presence of vendors, observations were made at mobile vendors documenting characteristics of transactions, consumers, and items. Results: During 37 observation-hours across 23 days, there were 1355 items sold to 1195 individuals. Fifty-six percent of the transactions involved children with no adults present. There was a wide range in foods sold, and although there were vendors selling low-nutrient, energy-dense foods, there were also vendors selling whole and processed (precut and bagged) fresh fruits and vegetables. Roughly 40% of these whole fruits and processed fruits and vegetables were consumed by children. On average, children each consumed $1.54 of foods per transaction. Conclusions: Mobile food vendors in urban areas contribute to after-school snacking among children, and should be considered as a component of the school food environment. [Copyright &y& Elsevier]

Abstract: Epidemiologic research suggests that racial segregation is associated with poor health among blacks in the United States (US). We used geocoded birth records and US census data to investigate whether neighborhood-level percent black is associated with preterm birth (PTB) for black and white women in two counties in the southern US, whether area-level deprivation modifies this association, and whether the association is influenced by the choice of geographic unit used to approximate a neighborhood. A 20%-point increase in tract-level percent black was found to be associated with increased PTB odds in white (OR=1.09, 95% CI: 1.01, 1.18) and black (OR=1.05, 95% CI: 0.99, 1.11) women. These small associations were similar to those observed in other US regions. Effects were robust to choice of neighborhood proxy and were not modified by area-level deprivation. [Copyright &y& Elsevier]

Neighborhood socioeconomic effects on health have been estimated using multiple variables and indices. This inconsistent estimation approach makes comparison across geographic areas challenging. In this paper, we developed indices representing specific socioeconomic domains that can be reproduced in other areas to estimate elements of the neighborhood socioeconomic environment on health outcomes, specifically preterm birth. Using year 2000 U.S. census data and principal components analysis, socioeconomic indices were developed representing a priori – defined domains of education, employment, housing, occupation, poverty and residential stability. These socioeconomic indices were subsequently used in race-stratified multilevel logistic regression models of preterm birth in eight socioeconomically distinct study areas in the U.S. Maternal residence was obtained from birth records and was geocoded to census tracts. In maternal age and education adjusted models, living in tracts with high unemployment, low education, poor housing, low proportion of managerial or professional occupation and high poverty was associated with increased odds of preterm birth for non-Hispanic white women at most sites. Among non-Hispanic black women, similar associations were noted for tract-level low education, high unemployment, low occupation, and high poverty, but the effect estimates were generally smaller than those seen for white women. Increasing amounts of residential stability were not associated with preterm birth in these analyses. We combined the domain estimates across the eight study sites to produce pooled effect estimates for the socioeconomic domains on preterm birth. The research reported here suggests that specific neighborhood-level socioeconomic features may be especially influential to health outcomes. These socioeconomic domains represent potential targets for intervention or policy efforts designed to improve maternal and child health and reduce health disparities. [Copyright &y& Elsevier]

Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress. To critically explore the psychological distress associated with children's food insecurity using children's own reports of their experiences. In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity. Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year. Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents' well-being, anger and frustration about not having enough food, embarrassment about their family's food situation, strain on the family's dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family's food situation, and appreciating their parents for providing food and resources. Food insecurity contributes to children's psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children's growth and development and deserves investigation in future studies. [ABSTRACT FROM AUTHOR]

Background Endocrine-disrupting chemicals (EDCs) can target immune and metabolic pathways. However, few epidemiologic studies have examined the influence of EDCs on measures of inflammation and cellular aging during pregnancy and postpartum. Objective We investigated associations between prenatal exposures to polybrominated diphenyl ethers (PBDEs), hydroxylated PBDE metabolites (OH-PBDEs), polychlorinated biphenyls (PCBs), and per- and polyfluorochemicals (PFASs) with repeated biomarker measurements of inflammation and cellular aging in women during pregnancy and the postpartum period. Methodology Overweight or obese pregnant women were recruited from the San Francisco Bay area (n = 103) during their first or second trimester of pregnancy. Blood samples were collected from participants at baseline (median 16 weeks gestation) and at three and nine months postpartum. Serum concentrations of PBDEs, OH-PBDEs, PCBs, and PFASs were measured at baseline. Inflammation biomarkers (interleukin 6 [IL-6], interleukin 10 [IL-10], and tumor necrosis factor [TNF-α]) and leukocyte telomere length (LTL), a biomarker of cellular aging, were measured at all three time points. Associations between serum chemical concentrations and repeated measures of IL-6, IL-10, TNF-α, and LTL were examined using linear mixed models. We also examined the potential for effect modification by time (visit) and obesity. Results In adjusted models, we observed positive relationships between PBDEs and pro-inflammatory cytokines (IL-6 and TNF-α). A doubling in ∑PBDEs was associated with a 15.26% (95% CI 1.24, 31.22) and 3.74% (95% CI −0.19, 7.82) increase in IL-6 and TNF-α, respectively. Positive associations were also observed for PFASs and IL-6. A two-fold increase in ∑PFASs was associated with a 20.87% (95% CI 3.46, 41.22) increase in IL-6. 5-OHBDE-47 was inversely associated with anti-inflammatory cytokine IL-10. Some EDC-outcome associations, including those of PBDEs with TNF-α, were stronger during pregnancy (compared to three or nine months postpartum) and among obese (compared to overweight) women (p-interaction <0.05). Conclusions These findings suggest that exposure to specific EDCs is associated with increased inflammation among women during pregnancy and the postpartum period. Future studies should replicate these findings in additional study populations and examine the implications of these associations for maternal and child health. [ABSTRACT FROM AUTHOR]

Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a sample (n=721) of adults (mean age:63) with diabetes. Self-reported neighborhood safety, violent crime, physical activity, and stress were collected and linked to clinical measures of BMI and HbA1c. Approximately 54% and 15% of patients reported neighborhood safety concerns and violent crimes, respectively. Any neighborhood safety concerns (β=1.14, 95% C.I. 0.04-2.24) and violent crime (β=2.04, 95% C.I. 0.34-3.73) were associated with BMI in adjusted analysis. Any violent crime was associated with class II-III obesity (BMI≥35) (OR=1.34, 95% C.I.: 1.02, 1.75). There were no significant associations between neighborhood safety concerns or violent crime with stress, physical activity, or HbA1c. Neighborhood safety is associated with BMI and obesity. Further studies, including longitudinal designs, are needed to study how people with diabetes may be influenced by a sense of poor personal safety in their neighborhoods. [ABSTRACT FROM AUTHOR]

Purpose: The racial disparity in preterm birth (PTB) is a persistent feature of perinatal epidemiology. Its consistency is not only an outcome of reproductive interest but may function as a persistent inequality to which women are exposed over time. Herein we sought to analyze exposure to area-level PTB disparity and its association with individual-level PTB risk. Methods: Using geocoded birth records (1999–2001) and year 2000 census data for Wake County, North Carolina, we created a tract-level PTB disparity variable for each woman in our study area, comprising all births in her tract excluding her birth. Multilevel random intercept models for exposure to neighborhood PTB disparity and odds of PTB were fit. Results: Exposure to area-level PTB disparity was associated with increased odds of PTB for all women. After adjustment for maternal and neighborhood covariates, odds of delivering preterm increased by 25%, 26%, and 36% for the second, third, and fourth quartiles of exposure to PTB disparity (odds ratio [OR]=1.25, 95% confidence interval [CI]: 1.00–1.57; OR=1.26, 95% CI: 1.01–1.58; and OR=1.36, 95% CI: 1.06–1.75, respectively). Conclusions: Exposure to persistent inequality, in the form of PTB disparity, appears associated with individual-level PTB risk. Knowing where PTB disparity is greatest has implications for PTB prevention policy efforts to buffer adverse conditions. [Copyright &y& Elsevier]

Abstract: A previous publication in this journal documented a decreased risk of adverse birth outcomes when African-American women have a positive income incongruity (defined as mothers living in a census tract with a higher household income than would be expected based on their individual education and marital status) and live in a census tract with “predominately African-American” residents [Pickett, K. E., Collins, J. W. Jr., Masi, C. M., & Wilkinson, R. G. (2005). The effects of racial density and income incongruity on pregnancy outcomes. Social Science & Medicine, 60(10), 2229–2238.]. The communities included in that study were from Chicago and were highly segregated by race. Our objective was to repeat this analysis in a less severely segregated environment: two urban counties (Wake and Durham) in central North Carolina. Rather than assuming an absence of knowledge about the effects of interest, we used the previously published results to inform our prior distributions in a Bayesian logistic regression analysis. This approach, which is analogous to a meta-analysis of the two studies, revealed a protective effect of positive income incongruity for African-American women living in census tracts with high relative African-American density across a much wider range of residential segregation patterns. Positive income incongruity was not associated with a decreased risk of low birth weight or preterm delivery for women living in tracts with a low relative density of African-Americans. These estimates are comparable to those that might have been observed had the original authors included a much more diverse set of communities with respect to degree of segregation, and so these new results provide important information about the generality of this intriguing finding. [Copyright &y& Elsevier]

Purpose: Significant racial disparity in preterm birth (PTB; birth at <37 weeks'' gestation) exists, poorly explained by Individual-level factors. This research explores whether neighborhood crime contributes to the racial disparity in PTB. Methods: Geocoded Wake County, NC, birth records and crime-report data for 1999 to 2001 were merged with US Census data (2000). Race-stratified logistic and multilevel logistic models produced odds ratios (ORs) and 95% confidence intervals (CIs) for block-group violent, theft, property, and vice crime rates and singleton PTB. Results: A total of 13,960 women resided in a 114-block-group crime area. Non-Hispanic black women were more likely than non-Hispanic white women to deliver preterm (12.8% versus 6.7%), live in economically deprived block groups (42.2% versus 19.3% in the highest deprivation quartile), and experience more crime (32.0% versus 3.8% in the highest violent-crime-rate quartile). Quartiles of violent, theft, property, and vice crimes were associated with PTB in unadjusted models. Living in very high violent-crime-rate block-group quartiles was suggestive of increased odds of PTB for white and black non-Hispanic women (OR = 1.5; 95% CI, 0.9–2.6; and OR = 1.4; 95% CI, 1.0–2.1, respectively) in adjusted models. Other crime effects were attenuated after adjustment. Conclusions: Differential neighborhood exposures may contribute to racial disparity in PTB. [Copyright &y& Elsevier]

Abstract: Background: Prepregnancy body mass index and excessive gestational weight gain (GWG) are associated with adverse maternal and infant outcomes. Because stress contributes to obesity and eating behaviors, stress reduction interventions during pregnancy may be a novel way to influence GWG, positively affect maternal and infant outcomes, and address the obesity epidemic intergenerationally. Methods: Our research team is developing a mindfulness-based stress reduction and nutrition intervention for low-income, overweight and obese pregnant women, with healthy GWG as the primary outcome measure. To inform development of the intervention, we conducted focus groups with our target population. Focus group transcripts were analyzed for themes related to sources and importance of stress, relationship between stress and eating, and motivation for a stress reduction pregnancy intervention. Findings: Fifty-nine low-income pregnant women from the San Francisco Bay Area participated in focus groups and completed a questionnaire. The vast majority of women (80%) reported experiencing significant stress from a variety of sources and most recognized a relationship between stress and eating in their lives. Conclusions: This at-risk population seems to be extremely interested in a stress reduction intervention to support healthy GWG during pregnancy. The women in our groups described high levels of stress and a desire for programs beyond basic dietary recommendations. These findings inform practitioners and policymakers interested in pregnancy as a “window of opportunity” for behavior change that can affect the metabolic and weight trajectory both for women and their offspring. [Copyright &y& Elsevier]