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Purpose: Ankle arthrodesis is a mainstay of surgical management for ankle arthritis. Accurately risk-stratifying patients who undergo ankle arthrodesis would be of great utility. There is a paucity of accurate prediction models that can be used to pre-operatively risk-stratify patients for ankle arthrodesis. We aim to develop a predictive model for major perioperative complication or readmission after ankle arthrodesis. Methods: This is a retrospective cohort study of adult patients who underwent ankle arthrodesis at any non-federal California hospital between 2015 and 2017. The primary outcome is readmission within 30 days or major perioperative complication. We build logistic regression and ML models spanning different classes of modeling approaches, assessing discrimination and calibration. We also rank the contribution of the included variables to model performance for prediction of adverse outcomes. Results: A total of 1084 patients met inclusion criteria for this study. There were 131 patients with major complication or readmission (12.1%). The XGBoost algorithm demonstrates the highest discrimination with an area under the receiver operating characteristic curve of 0.707 and is well-calibrated. The features most important for prediction of adverse outcomes for the XGBoost model include: diabetes, peripheral vascular disease, teaching hospital status, morbid obesity, history of musculoskeletal infection, history of hip fracture, renal failure, implant complication, history of major fracture. Conclusion: We report a well-calibrated algorithm for prediction of major perioperative complications and 30-day readmission after ankle arthrodesis. This tool may help accurately risk-stratify patients and decrease likelihood of major complications. [ABSTRACT FROM AUTHOR]

With increasing rates of overweight and obesity and disparities by ethnicity, it is important to understand the role of diet in ameliorating this health problem. This study examined the relation of diet quality as measured by the Healthy Eating Index 2015 with body mass index (BMI; calculated as kg/m2) and obesity among participants of the Multiethnic Cohort (MEC) in cross-sectional analyses at 3 time points (T-1, T-2, and T-3) over 20 years. In a subset of 1,860 MEC participants, 3 cross-sectional analyses at cohort entry (1993 to 1996, T-1) and follow-ups in 2003 to 2008 (T-2) and 2013 to 2016 (T-3) were performed. The cohort consists of African American, Native Hawaiian, Japanese American, Latino, and White adults in Hawaii and California; mean age was 48 years at T-1. BMI and weight status in relation to diet quality were measured. Linear and multinomial logistic regressions were applied to analyze the relation of diet quality with BMI and obesity, while adjusting for known confounders. Healthy Eating Index 2015 increased by 6.1 and 5.1 units for men and women, respectively, from T-1 to T-3; the respective values for BMI were 1.5 and 2.4. Diet quality was inversely associated with BMI across time: BMI was lower by –0.47, –0.72, and –0.92 units for every 10-point increase in Healthy Eating Index 2015 scores at T-1, T-2, and T-3, respectively (P <.0001 for all). During the 20 years, the association was consistently high among Japanese American participants (–0.79, –0.87, and –1.02) and weakest in African American cohort members (–0.34, –0.37, and –0.40). Higher diet quality was related to lower odds of having obesity at all 3 time points; prevalence odds ratios were 0.72, 0.57, and 0.60. These findings suggest that consuming a high-quality diet is related to lower BMI and rates of overweight and obesity but with the strongest association at an older age. To understand the ethnic differences, investigations of dietary habits and behaviors and/or fat distribution patterns will be needed in the future. [ABSTRACT FROM AUTHOR]

To prevent diabetes and increase equitable access to health care screenings, Touro University California has created and implemented a community outreach program called the Mobile Diabetes Education Center (MOBEC). This program is a joint effort that also involves Sutter Health, the California Department of Public Health, Kaiser Permanente, the Solano County Department of Public Health, and community-based organizations, focusing on advancing health equity in Solano County's at-risk populations. This article reports on the services and initial successes of MOBEC. With its strong community collaboration, MOBEC has helped to raise awareness of diabetes and ensure access to much-needed health screenings and education. This model can potentially be used as a blueprint for similar efforts nationwide to address the health care needs of medically underserved communities. [ABSTRACT FROM AUTHOR]

Kidney transplantation in pediatric patients can lead to partial improvement of some of the cardiometabolic parameters that increase the risk for cardiovascular disease (CVD) in patients with chronic kidney disease. However, even after restoration of kidney function, transplant recipients remain at risk for CVD due to the continual presence of traditional and non-traditional risk factors, including the side effects of immunosuppression and chronic inflammation. This educational review describes the prevalence of CVD risk factors in pediatric kidney transplant recipients and presents available evidence for therapeutic lifestyle changes and other non-pharmacologic strategies that can be used to improve traditional and modifiable CVD risk factors. Although trial-grade evidence for interventions that improve CVD in pediatric kidney transplant recipients is limited, potential strategies include lowering dietary sodium and saturated fat intake and increasing physical activity levels. Intensive follow-up may help patients achieve guideline-recommended goals for reducing their overall CVD risk. [ABSTRACT FROM AUTHOR]

Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods. [ABSTRACT FROM AUTHOR]

Objective: There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan. Methods: We used electronic health record data to examine smoking, overweight/obesity (body mass index ≥23.0 kg/m2), obesity (body mass index ≥27.5 kg/m2), prediabetes, diabetes, and hypertension among middle-aged (n = 12 757; aged 45-64 years) and older (n = 3418; aged 65-84 years) Vietnamese adults, including 37.8% whose preferred language was Vietnamese. Findings were compared with East Asian adults. Results: Current smoking prevalence was 20.3% for middle-aged men, 7.0% for older men, and <1% for women in both age groups. Obesity prevalence was 12.0% for older men, 17.9% for middle-aged men, and 10% for women in both age groups. Among middle-aged men and women, 20.9% and 17.0% had hypertension and 13.5% and 8.5% had diabetes, respectively. Among older men and women, 64.0% and 60.0% had hypertension and 32.8% and 29.3% had diabetes, respectively. In both age groups, Vietnamese language preference was associated with higher risk of smoking (men only) and of diabetes and hypertension (women only). Compared with East Asian adults, Vietnamese adults had lower obesity prevalence but similar prevalence of diabetes, prediabetes, and hypertension. Vietnamese men were more likely and Vietnamese women less likely than East Asian adults to be current smokers. Conclusions: Study results suggest that more research on health conditions, lifestyle, and social factors among Vietnamese American adults is needed to develop culturally competent interventions to reduce CVD risk in this growing ethnic group. [ABSTRACT FROM AUTHOR]

To evaluate the association between serum folate levels during pregnancy and prenatal depression and the extent to which obesity may modify this relationship. This secondary data analysis leveraged data from a previous study of pregnant Kaiser Permanente Northern California participants who completed a survey and provided a serum sample between 2011 and 2013. Serum folate was assessed using the Center for Disease Control's Total Folate Serum/Whole Blood Microbiological Assay Method. A score of 15 or greater on the Center for Epidemiologic Studies Depression Scale was defined as prenatal depression. We used Poisson regression to estimate risk of prenatal depression given prenatal serum folate status (low/medium tertiles vs. high tertile) in the full sample and in subsamples of women with pre-pregnancy body mass index in the (a) normal range and (b) overweight/obese range. Of the sample, 13% had prenatal depression. Combined low/medium folate tertiles was associated with prenatal depression (adjusted relative risk [aRR] = 1.97, 95% confidence interval [CI]: 0.93–4.18), although results did not reach statistical significance. This relationship was stronger among women with overweight/obesity than women with normal weight (aRR: 2.61, 95% CI: 1.01–6.71 and aRR: 1.50, 95% CI: 0.34–6.66, respectively). Results suggest an association between lower pregnancy folate levels and prenatal depression that may be stronger among women with overweight or obesity. Future studies need to clarify the temporal sequence of these associations. [ABSTRACT FROM AUTHOR]

Earlier puberty has been associated with numerous adverse mental, emotional, and physical health outcomes. Obesity is a known risk factor for earlier puberty in girls, but research with boys has yielded inconsistent findings. We examined sex- and race/ethnicity-specific associations between childhood obesity and puberty in a multiethnic cohort of 129,824 adolescents born at a Kaiser Permanente Northern California medical facility between 2003 and 2011. We used Weibull regression models to explore associations between childhood obesity and breast development onset (thelarche) in girls, testicular enlargement onset (gonadarche) in boys, and pubic hair development onset (pubarche) in both sexes, adjusting for important confounders. Clear dose-response relationships were observed. Boys with severe obesity had the greatest risk for earlier gonadarche (hazard ratio = 1.23, 95% confidence limit: 1.15, 1.32) and pubarche (hazard ratio = 1.44, 95% confidence limit: 1.34, 1.55), while underweight boys had delayed puberty compared with peers with normal body mass index. A similar dose-response relationship was observed in girls. There were significant interactions between childhood body mass index and race/ethnicity. Childhood obesity is associated with earlier puberty in both boys and girls, and the magnitude of the associations may vary by race/ethnicity. Prevention of childhood obesity may delay pubertal timing and mitigate health risks associated with both conditions. [ABSTRACT FROM AUTHOR]

Background: Asian adults develop Type 2 diabetes at a lower body mass index (BMI) compared to other racial/ethnic groups. We examined the variation in prevalence of prediabetes and diabetes among Asian ethnic groups within weight strata by comparing middle-aged Chinese, Filipino, South Asian, and White adults receiving care in the same integrated healthcare delivery system.Methods: Our retrospective cross-sectional U.S. study examined data from 283,110 (non-Hispanic) White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45-64 years who were members of a Northern California health plan in 2016 and had measured height and weight. Prediabetes and diabetes were classified based on laboratory data, clinical diagnoses, or diabetes pharmacotherapy. Age-standardized prevalence of prediabetes and diabetes were compared by race/ethnicity within healthy weight, overweight, and obesity categories, using standard BMI thresholds for White adults (18.5 to < 25, 25 to < 30, ≥ 30 kg/m2) and lower BMI thresholds for Asian adults (18.5 to < 23, 23 to < 27.5, ≥ 27.5 kg/m2). Prevalence ratios (PRs) were used to compare the prevalence of diabetes and prediabetes for Asian groups to White adults in each weight category, adjusted for age and BMI.Results: Across all weight categories, diabetes prevalence was higher for Asian than White adults, and among Asian groups it was highest for Filipino and South Asian adults. Compared to White, PRs for South Asian men/women at healthy BMI were 1.8/2.8 for prediabetes and 5.9/8.0 for diabetes, respectively. The PRs for Filipino men/women at healthy BMI were 1.8/2.6 for prediabetes and 5.0/7.5 for diabetes, respectively. For Chinese men/women at healthy BMI, the PRs for prediabetes (2.1/2.9) were similar to Filipino and South Asian, but the PRs for diabetes were lower (2.1/3.4).Conclusion: Chinese, Filipino, and South Asian adults have higher prevalence of prediabetes and diabetes than White adults in all weight categories, despite using lower BMI thresholds for weight classification in Asian groups. Within Asian ethnic groups, Filipino and South Asian adults had considerably higher diabetes prevalence than Chinese adults. Our data emphasize the disproportionate metabolic risk among middle-aged Asian adults and underscore the need for diabetes screening among high-risk Asian groups at healthy BMI levels. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite.Design: This study was a two-arm parallel group, cluster randomised controlled trial, where participants received either a twelve-session lifestyle intervention (intervention) or six-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected socio-demographic and outcome data (i.e. BMI as primary outcome and waist circumference, glycated Hb (HbA1c), cholesterol and blood pressure as secondary outcomes) at baseline and follow-up assessments (i.e. 3 months, 6 months, 1 year and 1·5 years).Setting: Recruitment and intervention delivery occurred at twelve study ranches in Oxnard, California.Participants: We enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening.Results: A total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (β = -0·01 for slope difference, P = 0·29). No significantly different trend by group was observed in secondary outcomes (P > 0·27).Conclusions: The worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions. [ABSTRACT FROM AUTHOR]

Anemia affects physical work capacity and may therefore have health and economic impacts for farmworkers, possibly exacerbating the effects of other occupational hazards such as risk of injury. This study contributes new information on the prevalence of anemia and associated factors in this population. Objective: This study aimed to determine the prevalence of anemia and overweight/obesity and assess the relationships between hematocrit (Hct) and body mass index (BMI), and between fatigue and Hct, among a sample of farmworkers in California. Methods: We estimated the prevalence of anemia (using Hct), overweight/obesity (BMI ≥25 kg/m2), and self-reported fatigue in 587 farmworkers. Multivariable linear and logistic regression models were used to examine the associations between Hct and BMI, and between fatigue and Hct. Results: Anemia prevalence was 3.1%, overweight/obesity prevalence was 80.7%, and 78% of workers reported fatigue at work. There was no association between Hct and BMI or between Hct and reported fatigue. Women were more likely than men to have lower Hct and higher BMI. Conclusions: A majority of farmworkers in this sample were overweight/obese, but anemia was uncommon. Anemia among more vulnerable subgroups of farmworkers should be explored. [ABSTRACT FROM AUTHOR]

Objective: The growing prevalence of obesity among college students is a major public health issue, as over one-third are overweight or obese. This study used gender-stratified multivariate analyses to examine psychological distress and social contextual factors as key determinants of obesity. Participants: Students of a large public university in Southern California (N = 2392). Methods: In-class survey administered across various departments and general education courses. Results: Among females, distress (OR = 1.02) and sophomores (OR = 1.87) were associated with increased odds of obesity; Greek life (OR = 0.53) was associated with decreased odds of obesity. Among males, distress was not associated with obesity (OR = 1.00); financial strain (OR = 1.16) was associated with increased odds of obesity. Conclusions: There are gendered patterns in obesity risk with social context having potentially protective effects among women. Enhancing psychological wellbeing as well as creating gender- and context-specific interventions may be an effective strategy to address the rising rates of obesity among the college population. [ABSTRACT FROM AUTHOR]

This study evaluated the association between children's daily negative affect (NA) trajectories and unhealthy food consumption during weekends using ecological momentary assessment (EMA). Children answered mobile phone-based EMA surveys 7 times a day for 2 weekend days per wave, with each survey assessing current NA and past 2-hour consumption of fried foods (chips or fries), sweets (pastries or sweets), and sugary beverages (drank soda or energy drinks). Los Angeles, California. The sample consisted of 195 children (51% female; mean age, 9.65 years; SD, 0.93) from the Mothers and Their Children's Health cohort study. Negative affect trajectory (independent variable), unhealthy food consumption (dependent variable). Latent growth mixture modeling classified NA trajectories across days and examined their association with unhealthy food consumption. The latent growth mixture modeling identified 3 classes of daily NA trajectories: (1) stable low, (2) early increasing and late decreasing and (3) early decreasing and late increasing. Fried food consumption was higher on early increasing and late decreasing and early decreasing and late increasing NA trajectories than days with stable low NA. By better understanding day-to-day variability in children's affect and eating, we can individually tailor obesity interventions to account for the emotional contexts in which unhealthy eating occurs. [ABSTRACT FROM AUTHOR]

Background: Excessive gestational weight gain (GWG) is consistently linked with maternal risk of obesity. However, the literature on its long-term cardiovascular risk is minimal and conflicting. We evaluated whether excessive GWG is associated with a high-risk cardiovascular profile among parous women in midlife. Materials and Methods: Participants were women in the multiethnic cohort Study of Women's Health Across the Nation with a history of live birth(s). Excessive GWG was defined according to Institute of Medicine guidelines and collected by self-recall. Outcomes were the atherosclerotic cardiovascular disease (ASCVD) risk score and C-reactive protein (CRP), measured at the study baseline when mean age was 47 years, and at 10 follow-up visits (1996–2017). We estimated the association of excessive GWG with outcomes through linear mixed model regression. Results: The analytic sample included 1318 women with 3049 singleton births. Over 40% (536) reported one or more pregnancies with excessive GWG. Longitudinal models estimated that at a mean age of 67, women with a history of excessive GWG had a 9.8% (9.2, 10.5) 10-year ASCVD risk, compared to 9.5% (8.9, 10.1) for those without, and mean CRP of 2.20 mg/L (1.89, 2.57) versus 1.85 mg/L (1.61, 2.14), respectively, adjusted for participant characteristics. Conclusions: In this multiethnic cohort of parous women, a history of excessive GWG was associated with a small, but statistically significant difference in ASCVD risk, and a moderate, statistically significant difference in CRP across midlife. More research is necessary to understand the mechanistic pathway between excessive GWG and long-term maternal cardiovascular health. [ABSTRACT FROM AUTHOR]

Schools are a critical setting for improving child nutrition and food security and preventing obesity in the United States. The U.S. Department of Agriculture mandates that the Supplemental Nutrition Assistance Program–Education, known as CalFresh Healthy Living (CFHL) in California, implements obesity prevention efforts that utilize multicomponent policy, systems, and environmental change interventions supplemented with direct and indirect education. However, evaluation of these complex interventions has proven challenging due to a lack of established evaluation methods, particularly for comprehensively measuring the dose of multicomponent interventions. This article proposes and demonstrates a method to score the dose of multicomponent California Department of Public Health–funded CFHL school interventions received by children attending public schools, using administrative data collected by CFHL in California. [ABSTRACT FROM AUTHOR]

To 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. In-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. Half 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 <0.001) and those who perceived themselves as overweight (P <0.001) were less comfortable being weighed than their peers. Student weight dissatisfaction, higher perceived weight status, and being female were associated with discomfort with school-based weight measurements. Prioritizing school nurses to conduct weight measurements could mitigate student discomfort, and particular attention should be paid to students who are unhappy with their weight to avoid weight stigmatization. [ABSTRACT FROM AUTHOR]

We examine whether exposure to the US, experienced under certain conditions of disadvantage, namely immigrant legal status, is associated with body weight. Using the pooled, cross-sectional 2001 and 2008 Los Angeles Family and Neighborhood Survey (LAFANS) (n = 2063), we examine whether body mass index (BMI) and obesity vary by Hispanic immigrants' legal status and time exposure to the US. The increased risk of obesity associated with greater US exposure is more pronounced among unauthorized Hispanic immigrants compared to their legally resident coethnic peers, after adjusting for age and age-at-arrival. It is not only residing in the US that is associated with increases in body weight, but residing in the US as an unauthorized immigrant. Improved data and methods are needed to facilitate research of greater policy significance and a refined understanding of how health integration processes vary by legal status. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exposure to per- and polyfluoroalkyl substances (PFAS), a prevalent class of persistent pollutants, may increase the risk of type 2 diabetes. OBJECTIVE: We examined associations between PFAS exposure and glucose metabolism in youth. METHODS: Overweight/obese adolescents from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR; 푛=310) participated in annual visits for an average of 3.3±2.9 y. Generalizability of findings were tested in young adults from the Southern California Children's Health Study (CHS; 푛=135) who participated in a clinical visit with a similar protocol. At each visit, oral glucose tolerance tests were performed to estimate glucose metabolism and b-cell function via the insulinogenic index. Four PFAS were measured at baseline using liquid chromatography–high-resolution mass spectrometry; high levels were defined as concentrations >66th percentile. RESULTS: In females from the SOLAR, high perfluorohexane sulfonate (PFHxS) levels (=2.0 ng/mL) were associated with the development of dysregulated glucose metabolism beginning in late puberty. The magnitude of these associations increased postpuberty and persisted through 18 years of age. For example, postpuberty, females with high PFHxS levels had 25-mg/dL higher 60-min glucose (95% CI: 12, 39 mg/dL; 푝<0.0001), 15-mg/dL higher 2-h glucose (95% CI: 1, 28 mg/dL; 푝=0:04), and 25% lower b-cell function (푝=0.02) compared with females with low levels. Results were largely consistent in the CHS, where females with elevated PFHxS levels had 26-mg/dL higher 60-min glucose (95% CI: 6.0, 46 mg/dL; 푝=0.01) and 19-mg/dL higher 2-h glucose, which did not meet statistical significance (95% CI: –1, 39 mg/dL; 푝=0.08). In males, no consistent associations between PFHxS and glucose metabolism were observed. No consistent associations were observed for other PFAS and glucose metabolism. DISCUSSION: Youth exposure to PFHxS was associated with dysregulated glucose metabolism in females, which may be due to changes in b-cell function. These associations appeared during puberty and were most pronounced postpuberty. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a previously reported association between the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package change and reduced child obesity risk among WIC-participating children in Los Angeles County holds across levels of family income and neighbourhood poverty.Design: Analysis of prospectively collected WIC administrative data. The outcome was obesity at age 4 years (BMI-for-age ≥ 95th percentile). Poisson regression was applied to a matched sample (n 79 502) to determine if the association between the WIC food package change and child obesity was modified by family income (<50 % federal poverty level (FPL), 50-100 % FPL, >100 % but <185 % FPL) and neighbourhood poverty.Setting: Los Angeles County, California.Participants: Children who participated in WIC in Los Angeles County between 2003 and 2016; children were grouped as receiving the old WIC food package (2003-2009) or the new WIC food package (2010-2016).Results: Receiving the new WIC food package (i.e., post-2009) was associated with 7-18 % lower obesity risk across all family income categories. Neither family income nor neighbourhood poverty significantly modified the association between the WIC food package and child obesity. However, certain sub-groups seemed to benefit more from the food package change than others. In particular, boys from families with income above poverty but residing in the poorest neighbourhoods experienced the greatest reductions in obesity risk (relative risk = 0·77; 95 % CI 0·66, 0·88).Conclusions: The WIC food package revisions were associated with reduced childhood obesity risk among all WIC-participating families in Los Angeles County, across levels of income eligibility and neighbourhood poverty. [ABSTRACT FROM AUTHOR]

Background: Obesity has been generally understudied in Asian Americans. It is important to identify subgroups of Asian Americans at high risk of obesity to help develop targeted interventions for those subgroups. This study aimed to examine the disparities in obesity among Asians (i.e., Chinese, Filipino, Japanese, Korean, and Vietnamese) living in California.Methods: A sample of Adult Americans in California (n = 47,970) including Asian American adults (n = 3810) aged 18 years or older were obtained from the 2013-2014 California Health Interview Survey (the U.S. nation's largest state cross-sectional health survey). Body mass index was calculated using self-reported height and weight. Weight status was determined using the WHO Asian BMI cut points in 4 categories: < 18.5 kg/m2 (underweight), 18.5-22.9 kg/m2 (normal weight), 23-27.5 kg/m2 (overweight), and ≥ 27.5 kg/m2 (obese). Multiple logistic regression analyses were used to estimate odds ratio (OR) and 95% confidence interval (CI) after adjustment for covariates.Results: Overall, the prevalence of Asians was 23.3% for obesity and 40.0% for overweight. The obesity prevalence was higher in Asians who were males, aged 45-64 years old, had higher family income, were current smokers, never got married, had lower education level, had an insufficient level of physical activity, and had more frequent consumption of fast foods. After adjusting for other factors, compared to Whites, being Hispanics and Blacks were associated with higher odds of obesity (OR = 1.47, 95%CI = 1.31-1.65; OR = 2.04, 95%CI = 1.65-2.53, respectively); being Chinese, Korean, and Vietnamese were associated with lower odds of obesity (OR = 0.28, 95%CI = 0.18-0.45; OR = 0.14, 95%CI = 0.04-0.46; OR = 0.28, 95%CI = 0.14-0.58, respectively). Compared to Chinese, being Japanese and Filipino were associated with higher odds of obesity (OR = 2.75, 95%CI = 1.52-4.95; OR = 2.90, 95%CI = 1.87-4.49, respectively).Conclusions: The prevalence of adult obesity was high among Asian Americans in California. Ethnic/racial disparities in obesity among Asian Americans in California were observed in 2013-2014. Compared to Whites, being Chinese, Korean, Vietnamese were associated with lower odds of obesity. Among Asians, compared to Chinese, being Japanese and being Filipino were associated with higher odds of obesity. These findings can help design better interventions to reduce racial and ethnic disparities in obesity, especially for Asian Americans. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a sugar-sweetened beverage (SSB) tax implemented in Oakland, California, in July 2017, on prices of beverages sold in fast-food restaurants 2-year post-tax.Design: Using a difference-in-differences (DID) approach, we analysed beverage price data collected from fast-food restaurants 1-month pre-tax and 2-year post-tax in Oakland (intervention site) and Sacramento, California (comparison site). Separate linear regression models were used to estimate the impact of the tax on prices of bottled regular soda, bottled diet soda, bottled unsweetened beverages and fountain drinks.Setting: Oakland and Sacramento, California, USA.Participants: Chain and non-chain fast-food restaurants (n 85).Results: DID estimates indicate that in fast-food restaurants, on average, the price of bottled regular soda increased by 1·44 cents/oz (95 % CI 0·50, 2·73) (tax pass-through rate of 144 %) and the price of bottled diet soda increased by 1·17 cents/oz (95 % CI 0·07, 2·13). No statistically significant differences were found between bottled regular and diet soda price increases. Price effects for unsweetened beverages and fountain drinks were not statistically significant. Further, the estimated price change for fountain drinks was nearly zero.Conclusions: Findings suggest that the effectiveness of SSB taxes in discouraging SSB consumption may be limited in fast-food restaurants in Oakland, California, because there were similar price increases in taxed and untaxed bottled soda and no changes in fountain drink prices. [ABSTRACT FROM AUTHOR]

Background: Children's consumption of sugar-sweetened beverages is associated with obesity, diabetes, and dental decay. California's Healthy Beverages in Child Care Act (AB 2084) requires all licensed child care centers and family child care homes to comply with healthy beverages standards, however many licensed providers in California are unaware of the law and few are fully compliant with the law's requirements. The aim of the current project is to describe the development of a self-paced online training on best practices and implementation of AB 2084 in English and Spanish for family child care home and child care center providers; and to evaluate the feasibility, defined as being accessible, acceptable, and satisfactory to providers, of this new online course.Methods: The project was broken into two main stages: (1) development of the online course; and (2) evaluation of the final online course. The first stage was completed in five phases: (1) identify relevant course content and develop narration script; (2) conduct in-person focus groups with child care providers to review and edit the content; (3) adapt course content and translate for Spanish-speaking providers; (4) build the online course and resources; and (5) pilot online course and evaluate accessibility. The second stage, evaluation of the acceptability and satisfaction of the final course was rated on a Likert scale from 1 to 4; the evaluation was completed as part of a larger randomized control trial with 43 child care providers. The course features four key requirements of AB 2084 as the main sections of the course (milk, sweetened beverages, juice, and water), plus background information about beverages and children's health, special topics including caring for children with special needs, family engagement, written policies, and child engagement.Results: The child care providers who completed the evaluation found the online training was easily understandable (median(Q1,Q3,IQR) = 4 (4,4,0)), included new information (3 (1, 3, 4)), provided useful resources (4(4,4,0)), and was rated with high overall satisfaction (3 (1, 3, 4)).Conclusion: Online training in English and Spanish designed for child care providers is a feasible medium to deliver important health messages to child care providers in an accessible, acceptable, and satisfactory manner. [ABSTRACT FROM AUTHOR]

Higher frequency of eating outside the home can be an unhealthy behavior that may contribute to higher rates of obesity among Latinas, a disproportionately affected group. There is a growing need to understand potentially modifiable factors (eg, dispositional mindfulness, self-efficacy, nutrition knowledge) associated with higher frequency of eating outside the home in this population. This study assessed associations of cognitive factors (ie, dispositional mindfulness, self-efficacy of eating and purchasing healthy foods, nutrition knowledge) with frequency of eating out among Latinas. A secondary analysis was performed of data from a cross-sectional study of Latinas between February and May 2015. The study comprised a convenience sample of 218 Spanish- or English-literate Latinas, between the ages of 18 and 55 years, who lived in South or East Los Angeles and self-identified as the primary person responsible for grocery shopping in the household. Most participants identified as foreign-born Mexican Americans. Frequency of eating out was assessed as the outcome variable, and three cognitive variables (mindfulness disposition, self-efficacy, nutrition knowledge) served as independent variables. Multinomial models assessed the association between cognitive factors and frequency of eating out. Models were adjusted for age, English-speaking ability, income, having an obesity-related disease (ie, overweight or obesity, diabetes, high blood pressure, cardiovascular disease), household size, and education level. For every 1-unit increase in mindfulness disposition, the risk of a participant eating out every week compared with every month decreased by a factor of 0.42 (relative risk ratio [RRR] = 0.58, P < 0.01). For every 1-unit increase in self-efficacy, the risk of a participant eating out every week compared with every month decreased by a factor of 0.32 (RRR = 0.68, P < 0.05), and the risk of a participant eating out every 2 weeks compared with every month decreased by a factor of 0.44 (RRR = 0.56, P < 0.05). For every 1-unit increase in nutrition knowledge, the risk of a participant eating out every week compared with every month increased by a factor of 1.42 (RRR = 1.42, P < 0.01). Lower dispositional mindfulness was associated with higher frequency of eating out when comparing individuals who ate out at least every week with those who ate out once a month or less or every 2 weeks. Lower self-efficacy was associated with eating out more when comparing those who ate out once a month or less with those who ate out at least every week or every 2 weeks. Lower nutrition knowledge was associated with lower frequency of eating out for participants who ate out once a month or less compared with those who ate out at least every week. [ABSTRACT FROM AUTHOR]

Objective: To identify maternal characteristics associated with 24-month postpartum weight retention. Methods: Data were collected from the 2016 Los Angeles Mommy and Baby (LAMB) Follow-Up Survey, a population-based prospective cohort study that assesses maternal and infant health in Los Angeles County. In 2014, LAMB initially surveyed 6035 women 6 months following a live birth. The 2016 LAMB Follow-Up reevaluated this same cohort after the index child's second birthday. 2679 women completed 2016 LAMB Follow-Up (52% adjusted response rate). The final sample size was 1524 after excluding subjects with subsequent pregnancies after the index child and missing information for postpartum weight. Eight predictors were included in this analysis: gestational weight gain, pre-pregnancy BMI, exercise, depressed mood since having child, age, race, education, and job loss during pregnancy. Chi-square tests and logistic regression analyses were performed using SAS 9.3. Results: Two years after delivery, women with postpartum weight retention weighed on average of 15.3 lb. more than before the index pregnancy. Women were more likely to retain postpartum weight when they exceeded gestational weight gain guidelines (AOR = 2.03, 95% CI = 1.40–2.93), did not exercise (AOR = 3.32, CI = 1.85–5.98), were between ages 20–29 (AOR = 1.54, CI = 1.01–2.36), were Hispanic (AOR = 1.51, CI = 1.02–2.24), completed high school only (AOR = 1.77, CI = 1.15–2.73), or lost a job during pregnancy (AOR = 2.62, CI = 1.39–4.93). Conclusions: Modifiable risk factors and sociodemographic characteristics can impact maternal weight retention 24 months after pregnancy. Understanding postpartum weight retention is essential for guiding future public health research, programming, and policy. Tailoring appropriate public health interventions may help women sustain healthy weight during their reproductive years and beyond. [ABSTRACT FROM AUTHOR]

Background: Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)-associated outcomes, yet studies have not adequately disentangled their effects.Objective: To determine the adjusted effect of body mass index (BMI), associated comorbidities, time, neighborhood-level sociodemographic factors, and other factors on risk for death due to COVID-19.Design: Retrospective cohort study.Setting: Kaiser Permanente Southern California, a large integrated health care organization.Patients: Kaiser Permanente Southern California members diagnosed with COVID-19 from 13 February to 2 May 2020.Measurements: Multivariable Poisson regression estimated the adjusted effect of BMI and other factors on risk for death at 21 days; models were also stratified by age and sex.Results: Among 6916 patients with COVID-19, there was a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively. This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.Limitation: Deaths occurring outside a health care setting and not captured in membership files may have been missed.Conclusion: Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.Primary Funding Source: Roche-Genentech. [ABSTRACT FROM AUTHOR]

• California regulates the provision of sugar-sweetened beverages and juice by child care facilities. • California working households with preschool-age children increased their juice purchases right after the regulation became effective. • However, such offsetting increase disappears after 1 year. • We find no increases in the purchases of sugary substitutes. • Regulating the consumption of sugary drinks in child care facilities may be an effective policy to lower children's preferences for sugary drinks. Excessive sugar intake is associated with higher risk for a range of diseases in children, including childhood obesity. To reduce sugar intake in children, California regulates the provision of sugar-sweetened beverages and juice by child care facilities. The regulation may reduce the consumption of beverages high in sugar in the short run and weaken their preferences for sugary drinks in the long run. Whether these objectives are achieved depends on how parents respond to the regulation by providing sugary drinks at home. Using detailed scanner data on grocery purchases, we find that affected California households increased their juice purchases right after the regulation became effective. However, this increase disappears after 1 year. Moreover, we do not find an increase in the purchases of sugary substitutes. Our findings suggest that parents provide more juice for their children after child care facilities limit their provision of sugary beverage, but such offsetting behavior disappears after 1 year. Regulating the consumption of sugary drinks in child care facilities may be an effective policy to lower children's preferences for sugary drinks. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and efficacy of in-restaurant interventions aiming to promote healthy choices via fundraising incentives benefiting school wellness programmes and point-of-purchase nutrition promotion.Design: Twelve schools were randomly assigned to one of the two intervention periods: Fundraising Incentive (FI) donated funds for visiting the study restaurant and Fundraising-Healthy Eating Incentive (F-HEI) included FI with additional funds given when selecting a healthier item. Both conditions included point-of-purchase nutrition promotions. Families were recruited to attend their designated intervention and complete a survey. Feasibility was assessed based on recruitment and participation, implementation fidelity and intervention acceptability. Efficacy was assessed by comparing participant receipts between intervention periods and by comparing overall restaurant sales during intervention v. two no-intervention time frames.Setting: Fast-casual restaurant in Southern California.Participants: Parents with children attending participating schools.Results: Eighty-one families visited the restaurant during the intervention, with sixty-six completing surveys. All study activities were implemented successfully, but school family participation in the intervention was low (0·95 %). Among participants completing surveys, all indicated satisfaction with the programme. The percentage of healthier items ordered was significantly greater during both FI (χ2 = 5·97, P = 0·01) and F-HEI (χ2 = 8·84, P = 0·003) v. Comparison 2. Results were similar but did not reach statistical significance when comparing the interventions to Comparison 1.Conclusions: Results support potential efficacy of this programme, but more research is needed to inform feasibility. Fidelity and acceptability data supported feasibility, but participation rates were low in this initial study. Methods evaluating this intervention with a greater proportion of parents should be considered. [ABSTRACT FROM AUTHOR]

Asthma and obesity are among the most prevalent chronic health conditions in children. Although there has been compelling evidence of co-occurrence of asthma and obesity, it is uncertain whether asthma contributes to the development of obesity or obesity contributes to the onset of asthma or both. In this study, we used a joint transition modeling approach with cross-lagged structure to understand how asthma and obesity influence each other dynamically over time. Subjects for this study included 5,193 kindergarten and first-grade students enrolled from 13 communities in 2002–2003 in the Southern California Children's Health Study, with up to 10 years of follow-up. We found that nonobese children with diagnosed asthma at a study visit were at 37% higher odds of becoming obese by the next annual visit compared with children without asthma (odds ratio = 1.38; 95% credible interval: 1.12, 1.71). However, the presence of obesity at the current visit was not statistically significantly associated with asthma onset in the next visit (odds ratio = 1.25; 95% credible interval: 0.94, 1.62). In conclusion, childhood asthma appears to drive an increase in the onset of obesity among schoolchildren, while the onset of obesity does not necessarily imply the future onset of asthma, at least in the short term. [ABSTRACT FROM AUTHOR]

Background: Food packages provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were revised in 2009 to better align them with the Dietary Guidelines for Americans. This study was conducted to evaluate whether the effect of the food package change on childhood obesity varied by the food environment in the neighborhoods where WIC-participating children live.Methods: Administrative data from participating children in Los Angeles County, California (2003-2016) were merged with geocoded food vendor information by neighborhood of residence. Obesity risk at age 4 was compared between children receiving old (2003-2009) and new (2010-2016) WIC food packages using sex-stratified Poisson regression models, with interaction terms between WIC package and neighborhood density (number per square mile) of healthy and unhealthy food outlets.Results: The new food package was associated with a significant decrease in obesity risk. Among boys, the new food package was associated with 8 to 18% lower obesity risk at all healthy and unhealthy food outlet densities, and the association was not modified by neighborhood food outlet density. Among girls, the association of the new food package with obesity risk was protective in neighborhoods with high healthy and low unhealthy food outlet densities, and adverse in neighborhoods with high unhealthy and low healthy food outlet densities. The effect of the new food package among girls was modified by unhealthy food outlet density, with significantly smaller (p-value = 0.004) decreases in obesity risk observed in neighborhoods with higher unhealthy food outlet density.Conclusions: The impact of the food package change was modified by the neighborhood food environment among girls only. Future policy changes should incorporate consideration of ways to mitigate potentially inequitable geographic distribution of the health benefits of policy changes. [ABSTRACT FROM AUTHOR]

Background: Studies exploring the effect of body mass index (BMI) on outcomes in the intensive care unit (ICU) have yielded mixed results, with few studies assessing patients at the extremes of obesity. We sought to understand the clinical characteristics and outcomes of patients with super obesity (BMI > 50 kg/m2) as compared to morbid obesity (BMI > 40 kg/m2) and obesity (BMI > 30 kg/m2). Methods: A retrospective review of patients admitted to the Los Angeles County + University of Southern California medical intensive care unit (MICU) service between 2008 and 2013 was performed. The first 150 patients with BMI 30 to 40, 40 to 50, and 50+ were separated into groups. Demographic data, comorbid conditions, reason for admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, serum bicarbonate, and arterial carbon dioxide pressure (P co 2) at admission were collected. Hospital and ICU length of stay (LOS), discharge disposition, mortality, use of mechanical ventilation (invasive and noninvasive), use of radiography, and other clinical outcomes were also recorded. Results: There was no difference in age, sex, and APACHE II score among the 3 groups. A pulmonary etiology was the most common reason for admission in the higher BMI categories (P <.001). There was no difference in mortality among the groups. Intensive care unit and hospital LOS rose with increasing BMI (P <.001). Patients admitted for pulmonary etiologies and higher BMIs had an increased ICU and hospital LOS (P <.001). Super obese patients used significantly more noninvasive mechanical ventilation (NIMV, P <.001). There were no differences in the use of invasive mechanical ventilation across the groups. Conclusion: Super obese patients are most commonly admitted to the MICU with pulmonary diagnoses and have an increased use of noninvasive ventilation. Super obesity was not associated with increased ICU mortality. Clinicians should be prepared to offer NIMV to super obese patients and anticipate a longer LOS in this group. [ABSTRACT FROM AUTHOR]

Introduction: An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms.Study Design: This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018.Setting/participants: Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California.Intervention: The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression.Main Outcome Measures: A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months.Results: Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (β=0.01, 95% CI=0.01, 0.02) and sleep disturbance (β= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (β= -0.01, 95% CI= -0.01, 0) and mental health components (β= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (β=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (β=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms.Conclusions: An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months.Trial Registration: This study is registered at clinicaltrials.gov NCT02246413. [ABSTRACT FROM AUTHOR]

Obesity affects American adolescents and has also been associated with poor family functioning. Improved family functioning may be associated with lower familial stress, which may improve lifestyle habits and reduce obesity, as well as its risk factors. Forty-seven, predominantly Hispanic, adolescents aged 10-16 years participated in the eight-week SHAPEDOWN program, a family-based intervention that sought to improve nutrition, physical activity, and family functioning. The intervention successfully reduced participants BMI (p= 0.012) and waist-hip ratio (p= 0.001). Additionally, several participants (> 70%) perceived poor family cohesion, high family conflict, and poor moral-religious emphasis and these did not significantly improve post-intervention. The lack of improvement to family functioning may have thwarted more significant weight reductions among adolescents. However, our study demonstrated that a successful weight loss intervention is possible despite poor perceived family functioning. While the effort to improve overall family functioning should not be ignored, our study provides hope that weight-loss interventions can be successful for overweight, minority, lower SES adolescents even when reductions in stressors cannot be found over such a short timeframe. [ABSTRACT FROM AUTHOR]

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were updated. WIC-participating children in Los Angeles County receiving the new food package, compared with the old, had lower obesity risk at age 4. To determine if the association between the new WIC food package and obesity varies by type of infant WIC food package received. Longitudinal study using administrative data on children participating in WIC in Los Angeles County continuously from birth until age 4. Children were compared across periods: Before (period 1: born 2003-2004), straddling (period 2: born 2005-2008), and after (period 3: born 2009-2011) the food package change. Children were further grouped as Fully Breastfed, Mostly Breastfed, Mostly Formula Fed, and Fully Formula Fed based on the type of food packages received during the first year of life. WIC-participating children in Los Angeles County between 2003 and 2016 (N=116,991). Weight-for-height z-score growth trajectories from 0 to 4 years and obesity (body mass index-for-age≥95th percentile) at age 4. Children were matched across periods on infant feeding group; age, sex, race or ethnicity, and initial weight status; maternal education and language; and family poverty. Sex-stratified piecewise linear spline mixed models and Poisson regression models were fit to the data. No differences across periods were observed for children in the Fully Breastfed group. Boys in the Mostly Breastfed (relative risk [RR]=1.27, 95% CI=1.17 to 1.38), Mostly Formula Fed (RR=1.07, 95% CI=1.02 to 1.13), and Fully Formula Fed (RR=1.13, 95% CI=1.06 to 1.20) groups in period 1 had higher obesity risk than their counterparts in period 3; girls in the Mostly Breastfed group in period 1 had a higher obesity risk than those in period 3 (RR=1.17, 95% CI=1.07 to 1.28). The association between the WIC food package change and obesity varied by type of infant food package received, with the strongest associations observed for those who were mostly breastfed. [ABSTRACT FROM AUTHOR]

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the food packages provided to its participants in 2009, to better align them with the Dietary Guidelines for Americans. Previous research found that the 2009 WIC food package change was associated with reduced obesity risk, particularly among breastfed infants but also among those who were never breastfed. The objective of this study was to determine if the new child food package introduced in 2009, including more produce and whole grains for 1–4-year old children, was associated with healthier growth trajectories and reduced obesity risk at age 4 years among children who were exclusively formula fed during infancy. Methods: Administrative data on WIC-participating children in Los Angeles County, 2003–2016, were used (N = 74,871), including repeated measures of weight and length (or height); child's age, gender, and race/ethnicity; maternal education and language; and family poverty. Gender-stratified spline mixed models were used to examine weight-for-height z-score (WHZ) growth trajectories from 0 to 4 years and Poisson regression models were used to assess obesity (BMI-for-age > 95th percentile) at age 4. The main independent variable was duration of receipt (dose) of the new child package, categorized as 0, > 0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and 4 years. Results: WHZ growth trajectories were similar for children across new child package dose groups. Boys and girls who were fully formula fed during infancy but received the new child food package for 4 years had a 7% (RR = 0.93; 95%CI = 0.89–0.98) and a 6% (RR = 0.94; 95%CI = 0.89–0.99) lower obesity risk, respectively, compared to children who received the new child food package for 0 years. There were no differences in obesity risk for children receiving < 4 years of the new child package vs. 0 years. Conclusions: Providing healthy foods during childhood to children who were exclusively formula fed as infants was associated with modest improvements in obesity outcomes. While breastfeeding promotion should still be prioritized among WIC participants, providing healthy foods during childhood may provide health benefits to formula fed children, who comprise a sizeable proportion of children served by WIC. [ABSTRACT FROM AUTHOR]

Introduction. South Asians in the United States have a high prevalence of obesity and an elevated risk for cardiometabolic diseases. Yet, little is known about how aspects of neighborhood environment influence cardiometabolic risk factors such as body mass index (BMI) in this rapidly growing population. We aimed to investigate the association between perceived neighborhood social cohesion and BMI among South Asians. Methods. We utilized cross-sectional data from the MASALA study, a prospective community-based cohort of 906 South Asian men and women from the San Francisco Bay area and the greater Chicago area. Multivariable linear regression models, stratified by sex, were used to examine the association between perceived level of neighborhood social cohesion and individual BMI after adjusting for sociodemographics. Results. Participants were 54% male, with an average age of 55 years, 88% had at least a bachelor's degree, and the average BMI was 26.0 kg/m2. South Asian women living in neighborhoods with the lowest social cohesion had a significantly higher BMI than women living in neighborhoods with the highest cohesion (β coefficient = 1.48, 95% CI 0.46–2.51, p = 0.02); however, the association was not statistically significant after adjusting for sociodemographic factors (β coefficient = 1.06, 95% CI −0.01–2.13, p = 0.05). There was no association between level of neighborhood social cohesion and BMI in South Asian men. Conclusion. Perceived neighborhood social cohesion was not significantly associated with BMI among South Asians in our study sample. Further research is recommended to explore whether other neighborhood characteristics may be associated with BMI and other health outcomes in South Asians and the mechanisms through which neighborhood may influence health. [ABSTRACT FROM AUTHOR]

Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2–20.7°], external rotation at 0° = 23.4° [95% CI = 31.1–12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9–26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer. [ABSTRACT FROM AUTHOR]

Objective  To describe the characteristics and risk factors for preterm birth in Hawaiian and Pacific Islander women. Study Design  Retrospective cohort study of 10,470 women of Hawaiian or Pacific Islander descent drawn from a population-based birth cohort dataset in California. Variables were examined across preterm birth subtype (spontaneous, provider initiated) and by gestational age grouping (early preterm birth and late preterm birth) and all preterm births. Results  Hawaiian/Pacific Islander women were at higher risk for preterm birth when they had fewer than three prenatal visits; were underweight, reported tobacco, alcohol, or illicit drugs use in pregnancy; had a diagnosis of anemia, gestational diabetes, preexisting diabetes, or hypertension with or without pre-eclampsia; or had a history of previous preterm birth. Obesity was found to be protective for preterm birth. Conclusion  Women of Hawaiian and Pacific Islander descent demonstrate a similar yet unique constellation of risk and protective factors for preterm birth as compared with other groups at high risk for preterm birth. Interventions aimed to prevent preterm birth need to support the specific needs of this population. [ABSTRACT FROM AUTHOR]

Objectives: Latinos have a disproportionately high risk for obesity and hypertension. The current study analyzes survey data from Latin American women to detect differences in rates of obesity and hypertension based on their number of health-related social ties. Additionally, it proposes individuals' health-related media preference (ethnic/ mainstream) as a potential moderator. Design: The dataset includes 364 Latinas (21–50 years old) from the greater Los Angeles metropolitan area, who responded to a series of sociodemographic, physiological, health-related, and media-related questions. Results: Controlling for various sociodemographic and health variables, each additional health-related tie in a Latina's social network significantly decreased her likelihood of being obese OR =.79, p =.041, 95% CI [.66,.95], but did not affect hypertension. Further, the analysis revealed a significant interaction between media preference and health-related social ties, such that exposure to ethnic media tended to compensate for the absence of social ties for the likelihood of obesity OR =.75, p =.041, 95% CI [.52,.97], as well as hypertension OR =.79, p =.045, 95% CI [.55,.98]. Conclusion: In concurrence with the literature, increases in health-related ties reduced the likelihood of obesity in this population. Moreover, ethnic media preference may play an important role in mitigating the likelihood of obesity and hypertension among Latinas. [ABSTRACT FROM AUTHOR]

Objective: To determine recent trends in maternal prepregnancy body mass index (BMI) and to quantify its association with birth and maternal outcomes. Methods: A population-based retrospective cohort study included resident women with singleton births in the California Birth Statistical Master Files (BSMF) database from 2007 to 2016. There were 4,621,082 women included out of 5,054,968 women registered in the database. 433,886 (8.6%) women were excluded due to invalid or missing information for BMI. Exposures were underweight (BMI < 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30 kg/m2) at the onset of pregnancy. Obesity was subcategorized into class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥ 40 kg/m2), while adverse outcomes examined were low birth weight (LBW), very low birth weight (VLBW), macrosomic births, preterm birth (PTB), very preterm birth (VPTB), small-for-gestational-age birth (SGA), large-for-gestational-age birth (LGA), and cesarean delivery (CD). Descriptive analysis, simple linear regression, and multivariate logistic regression were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations were estimated. Results: Over the ten-year study period, the prevalence of underweight and normal weight women at time of birth declined by 10.6% and 9.7%, respectively, while the prevalence of overweight and obese increased by 4.3% and 22.9%, respectively. VLBW increased significantly with increasing BMI, by 24% in overweight women and by 76% in women with class III obesity from 2007 to 2016. Women with class III obesity also had a significant increase in macrosomic birth (170%) and were more likely to deliver PTB (33%), VPTB (66%), LGA (231%), and CD (208%) than women with a normal BMI. However, obese women were less likely to have SGA infants; underweight women were 51% more likely to have SGA infants than women with a normal BMI. Conclusions: In California from 2007 to 2016, there was a declining trend in women with prepregnancy normal weight, and a rising trend in overweight and obese women, particularly obesity class III. Both extremes of prepregnancy BMI were associated with an increased incidence of adverse neonatal outcomes; however, the worse outcomes were prominent in those women classified as obese. [ABSTRACT FROM AUTHOR]

Early puberty is associated with adverse health outcomes, but little is known regarding early-life determinants influencing pubertal timing. We examined the associations between maternal gestational weight gain (GWG) and the timing of the onset of breast development (thelarche) and pubic hair development (pubarche) in a cohort of 2,070 girls born in a Kaiser Permanente Northern California facility between 2005 and 2006. Using Weibull regression models accommodating interval censoring and adjusting for important confounders, we found that excess GWG was associated with increased risk of early thelarche (hazard ratio (HR) = 1.50, 95% confidence interval (CI): 1.26, 1.78) and early pubarche (HR = 1.35, 95% CI: 1.10, 1.66). Inadequate GWG was associated with early thelarche (HR = 1.36, 95% CI: 1.08, 1.71). The associations between excess or inadequate GWG and risk of earlier thelarche were stronger if mothers were obese before or at the beginning of pregnancy (body mass index ≥30 kg body weight per m height squared) (HR = 2.01, 95% CI: 1.53, 2.63; HR = 2.08, 95% CI: 1.45, 2.98, respectively). Similar associations were found for pubarche outcome. Inclusion of girls' prepubertal body mass index slightly attenuated these associations, but they remained significant. Monitoring of maternal weight before and throughout pregnancy might help prevent early pubertal onset and subsequent negative health outcomes. [ABSTRACT FROM AUTHOR]

The intent of this research was to determine if disability, body mass index (BMI), and serious psychological distress are associated withfood insecurity among residents of California. We conducted a secondary analysis of 61,274 Californians who responded to the California Health Interview Survey (CHIS) for 2013-2015. Disability was measured as having a physical, mental, or emotional condition. Serious psychological distress (SPD) was measured using the Kessler-6 Scale. Food security was measured as either beingfood secure, food insecure without hunger, or food insecure with hunger. The relationship between food insecurity status, disability, BMI, and SPD was assessed by means of multivariate logistic regression analyses using STATA/SE 14.2 for Windows. Of the 61,274 participants, 15.4 percent reported food insecurity. Among the food insecure, we found that individuals born outside of the US accounted for 54.8 percent, Latinos accounted for 60.1 percent, individuals on food stamps accounted for 24.7 percent, individuals with serious psychological distress accounted for 11.7 percent, disabled individuals accounted for 45.1 percent, and obese individuals accounted for 34.5 percent. From our multivariate logistic regression results, food insecurity was associated with being on food stamps (Odds Ratio [OR] 3.50), having serious psychological distress (OR 2.42), beingforeign born (OR 2.38), and being disabled (OR 1.92). The data showed food insecurity was prevalent among immigrants in California and it was significantly associated with Supplemental Nutrition Assistance Program (SNAP), SPD, disability, and being overweight or obese. These results show a need for culturally appropriate interventions targeting immigrants in California dealing withpsychological distress and other mental, physical, and emotional disabilities. [ABSTRACT FROM AUTHOR]

Objective: To estimate the risk of childhood obesity associated with the various criteria proposed for diagnosis of gestational diabetes (GDM), and the joint effects with maternal BMI. Methods: Cohort study of 46,396 women delivering at the Kaiser Permanente Northern California health care delivery system in 1995–2004 and their offspring, followed through 5–7 years of age. Pregnancy hyperglycemia was categorized according to the screening and oral glucose tolerance test values proposed for the diagnosis of GDM by the International Association of the Diabetes and Pregnancy Study Group (IADPSG), Carpenter Coustan (CC), and the National Diabetes Data Group (NDDG). Childhood obesity was defined by the International Obesity Task Force’s age and sex-specific BMI cut-offs. Poisson regression models estimated the risks of childhood obesity associated with each category of pregnancy glycemia compared to normal screening, and the joint effects of maternal BMI category and GDM by the CC and the IADPSG criteria. Results: Compared with normal screening, increased risks of childhood obesity were observed for abnormal screening [RR (95% CI): 1.30 (1.22, 1.38)], 1+ abnormal values by the IADPSG or CC [1.47 (1.36, 1.59) and 1.48 (1.37, 1.59), respectively], and 2+ values by CC or NDDG [1.52 (1.39, 1.67) and 1.60 (1.43, 1.78), respectively]. Compared to obese women without GDM, obese women with GDM defined by the CC criteria had significantly increased risk of childhood obesity [1.20 (1.07, 1.34)], which was also observed for GDM by the IADSPG [1.18 (1.07, 1.30)], though GDM did not significantly increase the risk of childhood obesity among normal weight or overweight women. Conclusions: The risk of childhood obesity starts to increase at levels of pregnancy glycemia below those used to diagnose GDM and the effect of GDM on childhood obesity risk appears more pronounced in women with obesity. Interventions to reduce obesity and pregnancy hyperglycemia are warranted. [ABSTRACT FROM AUTHOR]

Introduction Obesity rates among US Hispanic women and children are high. Childhood obesity prevention beginning prenatally is desirable, but studies show mixed results. Methods We tested a pilot intervention to promote optimal gestational and infant weight with primigravid Hispanic women at a Federally Qualified Health Center (FQHC) on the U.S.-Mexico border. The intervention included promotora-led exercise, nutrition, breastfeeding activities (n = 23), supported by text/social media messaging (text messaging prenatally, private Facebook page postnatally). Measures included demographics, BMI, weight gain/retention, infant feeding, and attendance. Results Most women were U.S. born (73%), Spanish-language dominant (83%), with ≤ high school education (65%), and overweight/obese (56%). Retention rates were modest for the prenatal component (50%), supported by an SMS text-messaging program. Retention of the remaining postnatal sample, supported by a private Facebook® page, was 100%. Of women who regularly attended group sessions pre and postpartum, over 70% were within 5 lbs of pre-pregnancy weight at 6 months postpartum. A private Facebook® group was feasible for out-of-class support, including among women with regular cross-border mobility. Discussion While the intervention was well-received, almost 2/3 of the original participants did not follow up postpartum. Importantly, the findings indicate the use of social media (private Facebook® page) was more feasible than the SMS text-messaging program and may be a successful approach to reach and engage women living in mobile and transnational settings. Future studies should examine social media as an intervention tool to influence optimal weight and encourage healthy behaviors in primigravidas living near the U.S.-Mexico border. [ABSTRACT FROM AUTHOR]

Objective  To test the hypothesis that maternal height is associated with adverse perinatal outcomes, controlling for and stratified by maternal body mass index (BMI). Study Design  This was a retrospective cohort study of all births in California between 2007 and 2010 (n  = 1,775,984). Maternal height was categorized into quintiles, with lowest quintile (≤20%) representing shorter stature and the uppermost quintile (≥80%) representing taller stature. Outcomes included gestational diabetes mellitus (GDM), preeclampsia, cesarean, preterm birth (PTB), macrosomia, and low birth weight (LBW). We calculated height/outcome associations among BMI categories, and BMI/outcome associations among height categories, using various multivariable logistic regression models. Results  Taller women were less likely to have GDM, nulliparous cesarean, PTB, and LBW; these associations were similar across maternal BMI categories and persisted after multivariable adjustment. In contrast, when stratified by maternal height, the associations between maternal BMI and birth outcomes varied by specific outcomes, for example, the association between morbid obesity (compared with normal or overweight) and the risk of GDM was weaker among shorter women (adjusted odds ratio [aOR], 95% confidence interval [CI]: 3.48, 3.28–3.69) than taller women (aOR, 95% CI: 4.42, 4.19–4.66). Conclusion  Maternal height is strongly associated with altered perinatal risk even after accounting for variations in complications by BMI. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine the influence of obesity and sociodemographic factors on the health hardships among women veterans, using a sample from California. This study evaluates the following research questions: 1) What health hardships do women veterans experience? 2) What are the differences among women veterans with normal weight, overweight, and obesity and their experience with health hardships? 3) What is the impact of obesity combined with other factors (sociodemographic and health-care variables) in predicting the presence of one or more health hardships? Health hardships encompass the presence of several diseases including (heart disease, asthma, diabetes, or high blood pressure) among women veterans? The study sample included 197 female veterans retrieved from a community sample of women in California. Nearly a third (29.5%) of female veterans served in the armed forces for 2 years or less, 32.5% served in the armed forces for 2 to 4 years, 28.9% served in the armed forces 4 to 20 years, and the reminder (12.7%) served in the armed forces over 20 years. Statistically significant differences were noted among the BMI categories in having diabetes (χ2 = 9.671; df = 2; p <.008) and having high blood pressure (χ2 = 11.323; df = 2; p <.003) (Table 3). Female veterans who were obese (58.3% vs. 43.0%) and overweight (29.2% vs. 33.7%) suffered from diabetes and high blood pressure more than female veterans who had normal weight (12.5% vs. 23.3%). Being obese or overweight (Wald χ2 (1) = 8.346, p <.004), being White (Wald χ2 (1) = 4.893, p <.027), being employed (Wald χ2 (1) = 3.951, p <.047), and being poor (Wald χ2 (1) = 9.269, p <.002) predicted health hardships (χ2 = 43.114; p <.0005).  [ABSTRACT FROM AUTHOR]

Purpose: To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes.Design: Cluster randomized controlled trial (pilot).Setting: Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California.Participants: Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church).Intervention: Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals.Measures: Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race-ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status.Analysis: Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes.Results: Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (-0.05 effect sizes; 95% confidence interval [CI] = -0.06 to -0.04), lower BMI (-0.08; 95% CI = -0.11 to -0.05), and healthier diet (-0.09; 95% CI = -0.17 to -0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week.Conclusion: Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention. [ABSTRACT FROM AUTHOR]

Objective  We compared the prevalence of and risk factors for stillbirth and live birth at periviable gestational age (20–25 weeks). Study Design  This is a cohort study of 2.5 million singleton births in California from 2007 to 2011. We estimated racial–ethnic prevalence ratios and used multivariable logistic regression for risk factor comparisons. Results  In this study, 42% of deliveries at 20 to 25 weeks' gestation were stillbirths, and 22% were live births who died within 24 hours. The prevalence of delivery at periviable gestation was 3.4 per 1,000 deliveries among whites, 10.9 for blacks, 3.5 for Asians, and 4.4 for Hispanics. Nonwhite race–ethnicity, lower education, uninsured status, being U.S. born, older age, obesity, smoking, pre-pregnancy hypertension, nulliparity, interpregnancy interval, and prior preterm birth or stillbirth were all associated with increased risk of both stillbirth and live birth at 20 to 25 weeks' gestation, compared with delivery of a live birth at 37 to 41 weeks. Conclusion  Inclusion of stillbirths and live births in studies of deliveries at periviable gestations is important. [ABSTRACT FROM AUTHOR]