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Data from observational studies demonstrate that variants of SARS-CoV-2, the virus that causes COVID-19, have evolved rapidly across many countries (1,2). The SARS-CoV-2 B.1.617.2 (Delta) variant of concern is more transmissible than previously identified variants,* and as of September 2021, is the predominant variant in the United States. † Studies characterizing the distribution and severity of illness caused by SARS-CoV-2 variants, particularly the Delta variant, are limited in the United States (3), and are subject to limitations related to study setting, specimen collection, study population, or study period (4-7). This study used whole genome sequencing (WGS) data on SARS-CoV-2-positive specimens collected across Kaiser Permanente Southern California (KPSC), a large integrated health care system, to describe the distribution and risk of hospitalization associated with SARS-CoV-2 variants during March 4-July 21, 2021, by patient vaccination status. Among 13,039 SARS-CoV-2-positive specimens identified from KPSC patients during this period, 6,798 (52%) were sequenced and included in this report. Of these, 5,994 (88%) were collected from unvaccinated persons, 648 (10%) from fully vaccinated persons, and 156 (2%) from partially vaccinated persons. Among all sequenced specimens, the weekly percentage of B.1.1.7 (Alpha) variant infections increased from 20% to 67% during March 4-May 19, 2021. During April 15-July 21, 2021, the weekly percentage of Delta variant infections increased from 0% to 95%. During March 4-July 21, 2021, the weekly percentage of variants was similar among fully vaccinated and unvaccinated persons, but the Delta variant was more commonly identified among vaccinated persons then unvaccinated persons overall, relative to other variants. The Delta variant was more prevalent among younger persons, with the highest percentage (55%) identified among persons aged 18-44 years. Infections attributed to the Delta variant were also more commonly identified among non-Hispanic Black persons, relative to other variants. These findings reinforce the importance of continued monitoring of SARS-CoV-2 variants and implementing multiple COVID-19 prevention strategies, particularly during the current period in which Delta is the predominant variant circulating in the United States., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. The following authors received funding for work unrelated to this study: Katia J. Bruxvoort (Dynavax Technologies, Gilead Sciences Inc., GlaxoSmithKline plc., Moderna, Inc., Pfizer Inc., and Seqirus); Bradley Ackerson (Dynavax Technologies, GlaxoSmithKline plc., Moderna, Inc., Pfizer Inc., and Seqirus); Ana Florea (GlaxoSmithKline plc., Moderna, Inc., Pfizer Inc., and Gilead Sciences Inc.); Julia Tubert (Moderna, Inc.); Harpreet Takhar (ALK, GlaxoSmithKline plc., Moderna, Inc., Pfizer Inc., and Wellcome); Sara Y. Tartof (Genentech, Gilead Sciences Inc., GlaxoSmithKline plc., Pfizer Inc., Spero Therapeutics, and Wellcome); and Lei Qian (Dynavax Technologies, Genentech, GlaxoSmithKline plc., and Moderna, Inc.). Hung Fu Tseng received funding for work unrelated to this study from GlaxoSmithKline plc. and Moderna, Inc. and served on advisory boards for Janssen (Johnson & Johnson) and Pfizer Inc. John M. McLaughlin holds stock and stock options in Pfizer Inc. Carla A. Talarico is a shareholder in Moderna, Inc. No other potential conflicts of interest were disclosed.

Background and Objectives: We examined the health disparities of older adults (age 50 and older) in California at the intersection of sexual identity and Latinx ethnicity, by comparing the prevalence of health outcomes of 4 groups: LGB (lesbian, gay, and bisexual) Latinx, straight Latinx, LGB non-Latinx, and straight non-Latinx older adults., Research Design and Methods: Data were from the 2015-2016 California Health Interview Survey. Multivariable logistic regressions tested differences among the 4 groups and the effect of covariates on prevalence of mental and physical health outcomes. We compared LGB and straight people within the same ethnic groups and Latinx and non-Latinx people within the same sexual identity groups to understand the intersectional effect of Latinx ethnicity and LGB identity., Results: Tests by sexual identity showed that among Latinx older adults, more LGB than non-LGB people experienced serious psychological distress. Among non-Latinx older adults, there were no health disparities due to sexual identity. Tests by Latinx ethnicity showed that among LGB older adults, more Latinx than non-Latinx people were obese. Among straight people, more Latinx than non-Latinx older people had poor health, diabetes, and obesity., Discussion and Implications: The compounded effect of Latinx and LGB identity on psychological distress is notable. However, most health disparities were among straight older adults, between Latinx and non-Latinx people, indicating that Latinx, not sexual identity, nor their intersection, was most influential. Given the importance of sociodemographic factors on health outcomes, programs targeting LGB older adults should take a comprehensive approach to understand their experiences as ethnic minorities., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Farmers' markets have the potential to improve the health of underserved communities, shape people's perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers' market located at a federally qualified health center. Although provider communication about diet decreased over time, communication strategies included: providing patients with "prescriptions" and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed that the market had potential to improve the health of staff and patients of the federally qualified health center. Provider modeling of healthy behaviors may influence patients' food-related perceptions and dietary behaviors.

Purpose: An association between hospital volume and postoperative mortality has been identified for several oncologic surgical procedures. Our objective was to analyze differences in surgical outcomes for patients with rectal cancer according to hospital volume in the state of California., Methods: A cross-sectional study from 2000 to 2005 was performed using the state of California Office of Statewide Health Planning and Development database. Hospitals were categorized into low (≤30)-, medium (31-60)-, and high (>60)-volume groups based on the total number of rectal cancer operations performed during the study period., Results: Overall, 7,187 rectal cancer operations were performed. Of the 321 hospitals in the study cohort, 72 % (n = 232), 20 % (n = 65), and 8 % (n = 24) were low-, medium-, and high-volume hospitals, respectively. Postoperative mortality was significantly lower- in high-volume hospitals (0.9 %) when compared to medium- (1.1 %) and low-volume hospitals (2.1 %; p < 0.001). High-volume hospitals also performed more sphincter-preserving procedures (64 %) when compared to medium- (55 %) and low-volume hospitals (51 %; p < 0.001)., Conclusions: These data indicate that hospital volume correlates with improved outcomes in rectal cancer surgery. Rectal cancer patients may benefit from lower mortality and increased sphincter preservation in higher-volume centers.