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Background: In spite of aromatase inhibitors reducing risk of recurrence and mortality, painful side effects often cause women to discontinue use of the drug. Side effects of aromatase inhibitors include joint and muscle pain, loss of bone mineral density, and impairment of heart functioning. Discontinuation of aromatase inhibitors due to these side effects occur in up to 40% of breast cancer survivors, and consequently risks of recurrence and mortality increase. Objective: We developed two interventions designed to reduce inflammation, alleviate pain and stabilize bone mineral density. Methods: We are currently conducting a pilot parallel intervention trial that is targeted toward alleviating side effects from aromatase inhibitors through dietary and exercise controlled interventions lasting for three months. The dietary intervention is an anti-inflammatory Mediterranean diet designed to decrease inflammation and lessen joint and muscle pain. Participants randomized to the Mediterranean dietary intervention are exclusively consuming food provided by Territory Foods®, an outside food preparation and delivery service, local to Los Angeles. Our exercise intervention is designed to mobilize the joints, and strengthen and reduce bone loss. Participants are visiting the UCLA Kinross gym for three days per week and are undergoing tailored exercise sessions delivered from personal trainers following our bone strengthening intervention protocol. Anthropometric measures, muscle strength, DXA scanning of bone mineral density, peripheral arterial tonometry, pulse wave velocity and biomarkers of inflammation, bone turnover and heart functioning are conducted at baseline, mid- and end of intervention. Results: Our trial is targeted to accrue 20 participants. Thus far we enrolled six participants, with three participants completing the trial. Analysis is ongoing and preliminary results will be presented at the San Antonio Breast Cancer Symposium in December, 2022. Post intervention reports from participants have noted a reduction in pain symptoms, moderate weight loss and increase in muscle strength. Citation Format: Catherine L. Carpenter, Aashini K. Master, Olivia Julian, Dina Ben-Nissan, Michele Rakoff, Gail Thames, Zhaoping Li. Improving the health of women on Aromatase Inhibitors: A pilot controlled dietary and exercise intervention trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-06-01.

Workplace wellness programs can reduce cardiovascular risk and improve worker productivity; however, recruitment and adherence remain a challenge. Tailoring programs based on employee exercise preferences may address these concerns.A total of 458 UCLA adult employees who responded to UCLA Bruin marketing e-mail completed a battery of questions regarding their exercise preferences (eg, preferred duration, intensity, type). Recruitment took place in June 2021.Participants prefer workplace wellness programs that (1) focus on improving multiple different aspects of physical health; (2) take place in a variety of locations; (3) were administered by a coach who is physically present; (4) occur 2-3 times per week for roughly 60 minutes each time; (5) include a range of intensities; and (6) consist of aerobic and weight training.Future studies should use these results to design future workplace wellness programs.

BackgroundHead trauma has been associated with increased brain tumor risk in adults. Instrument assisted delivery can be a cause of head trauma in newborns. The goal of this study was to determine if instrument-assisted deliveries influenced the odds of childhood brain tumors in Denmark.MethodsWe conducted a matched case-control study of childhood (

An increasing proportion of people ever diagnosed with invasive cancer will live 5 years or more after their cancer diagnosis. For them, the clinical focus has been shifting from a focus on extending recurrence-free survival to a focus on improving the survivor’s quality of life. Fortunately, increasingly sophisticated behavior change research is equipping healthcare providers with patient behavior change strategies and providing cancer survivors with practical steps that can optimize cancer survivors’ physical well-being and quality of life. Although different cancer diagnoses require somewhat different lifestyle prescriptions to optimize the survivor’s quality of life, a variety of cancer diagnoses respond well to lifestyle interventions that promote greater adherence to federal nutrition and physical activity guidelines for all Americans. More specifically, cancer survivors experience higher quality of life by eating a more Mediterranean-style diet and by engaging in a 30-minute brisk walk at least 5 days a week for reasons that probably involve salubrious impacts on their gut microbiota composition. Behavior change approaches to promoting healthier lifestyle behaviors in cancer survivors can be cancer-specific or originally designed for the general population. Either way, research in which behavior theory-specific components are exhaustively embedded yield greater impact than research that is merely theory-informed. Selected theories are discussed with illustrations taken from recent scientific literature. Which behavioral approaches are most appropriate depends on the progress with which the cancer survivor has embedded the desired behaviors into their everyday routines as well as on supports for the recommended behaviors by family and community members. The most appropriate behavioral approaches are also, of course, conditioned on the survivor’s demographic, physical, and emotional health status characteristics. Finally, we present several recommendations for accelerating progress in the use of behavior change interventions to optimize cancer survivors’ recurrence-free survival and quality of life.

BackgroundRecent studies have shown that circulating branched-chain amino acids (BCAAs) are elevated in obese, insulin-resistant individuals. However, it is not known if supplementation of additional BCAAs will further impair glucose metabolism.ObjectivesThe aim of this pilot study was to determine the effects of BCAA supplementation on glucose metabolism in obese, prediabetic individuals.MethodsThis is a randomized crossover study involving 12 obese individuals with prediabetes. Participants were randomly assigned to receive a daily supplement containing either 20 g BCAA or protein low in BCAAs for 4 wk with a 2-wk washout in between. At each visit, an oral-glucose-tolerance test (OGTT) was performed. Collected blood samples were used to measure glucose, insulin, and insulin resistance-associated biomarkers.ResultsBCAA supplementation tended to decrease the plasma glucose area under the curve (AUC) measured by the OGTT (AUC percentage change from supplementation baseline, BCAA: -3.3%±3%; low-BCAA: 10.0%±6%; P=0.08). However, BCAA supplementation did not affect plasma insulin during OGTT challenge (BCAA: -3.9%±8%; low-BCAA: 14.8%±10%; P=0.28). The plasma concentrations of nerve growth factor (BCAA: 4.0±1 pg/mL; low-BCAA: 5.7±1 pg/mL; P=0.01) and monocyte chemoattractant protein-1 (BCAA: -0.4%±9%; low-BCAA: 29.0%±18%; P=0.02) were significantly lowered by BCAA supplementation compared to low-BCAA control. Plasma interleukin 1β was significantly elevated by BCAA supplementation (BCAA: 231.4%±187%; low-BCAA: 20.6%±33%; P=0.05). BCAA supplementation did not affect the circulating concentrations of the BCAAs leucine (BCAA: 9.0%±12%; low-BCAA: 9.2%±11%), valine (BCAA: 9.1%±11%; low-BCAA: 12.0%±13%), or isoleucine (BCAA: 2.5%±11%; low-BCAA: 7.3%±11%).ConclusionsOur data suggest that BCAA supplementation did not impair glucose metabolism in obese, prediabetic subjects. Further studies are needed to confirm the results seen in the present study. This study was registered at clinicaltrials.gov as NCT03715010.

Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.

Background The elderly population of Jordan is growing, due to the low mortality rate, high total fertility rate, and the high rate of forced migration from neighboring countries to Jordan in recent years. However, the prevalence of chronic illnesses associated with other comorbidities among the elderly population in Jordan is high. Maintaining a good nutritional status is essential for maintaining general health and well-being among older people. Aim The aim of this study is to identify the nutritional status of community-dwelling older adults in Jordan and determine its possible associated factors. Methodology A cross-sectional, descriptive design was utilized. Proportional multistage nonprobability sampling was employed to obtain a convenient sample of 225 Jordanian community-dwelling older adults. The participants were asked to complete a set of questionnaires related to nutritional status, which included a demographic information sheet, and the Mini Nutritional Assessment (MNA). Results Among the sample, only 60 participants (26.7%) showed normal nutritional status. Most of the participants (n = 156; 68.3%) were found to be at risk of malnutrition, and nine participants (4%) were found to suffer from malnutrition. Advanced age (r = -0.631; p = 0.001), body mass index (BMI) (r = 0.546; p = 0.001), being single (mean (M) = 20.43, SD = 3.55), being male (M = 21.10, SD = 3.73), being unemployed (M = 21.71, SD = 3.51), being dependent in activities of daily living (ADLs) (M = 21.35; SD = 3.62), eating only two meals per day (M = 19.60; SD = 3.39), having suffered from illness or anxiety in the preceding 3 months (M = 21.11; SD = 2.39), having a mid-arm circumference of less than 31 cm (M = 19.51; SD = 3.47), low consumption of fruit and vegetables (M = 20.79; SD = 2.53), and polypharmacy (M = 20.62, SD = 4.09) were found to predict susceptibility to malnutrition among the participating older adults. Amongst the variables, age was identified as the most significant predictor of nutritional status and explained approximately 40% of the variance in nutritional status. Conclusion Malnutrition in older adults is a multifaceted phenomenon that needs to be integrated into the comprehensive assessment of older adults. It is essential that health-care professionals, particularly nurses, are fully aware of the associated risks of malnutrition among the elderly population. The high prevalence of the risk factors for malnutrition warrants conducting a controlled national-based assessment, using probability sampling, of the nutritional status among older adults in Jordan. Specifically, there is a real need to assess nutritional status among older adults who are at high risk of malnutrition, including senior, unmarried, male, unemployed, ADL dependent, and/or poly-medicated older adults.

OBJECTIVES: People living with HIV/AIDS are at increased risk of nutritional deficiencies. Loss of lean muscle mass has been associated with a more rapid decline of immune function and increased risk of mortality among individuals suffering from HIV. Our objectives were to evaluate the relative contributions of nutrition supplementation and nutrition education on body composition outcomes using a cluster randomized factorial trial among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. METHODS: We conducted a prospective cluster randomized controlled 2 × 2 factorial design to assess impacts of nutritional education and nutritional supplementation over a six-month period, with follow up at six, twelve and eighteen months post enrollment. Study protocols were approved by Human Subjects Committees at the Universities of California at Los Angeles, Irvine, and San Francisco and the Ministry of Health in India. Interventions were delivered in the Nellore and Prakasam regions of Andhra Pradesh by trained lay village women, Ashas (Accredited Social Health Activists). Interventions included: usual supportive care provided by Ashas; 2) Asha Support plus Nutrition education; 3) Asha support plus Nutrition supplementation; and, 4) Asha support plus Nutrition education plus Nutrition supplementation. We measured body composition using a Bioimpedance Analyzer Model 310e. All data was analyzed using SAS 9.4. RESULTS: Mixed models evaluated change in lean muscle mass from baseline as the primary outcome, and fat weight, overall weight and BMI changes as secondary outcomes. Change in muscle mass from baseline was significantly associated with nutrition supplementation (P = 0.001), nutrition education (P = 0.01), with a significant interaction (P = 0.03) for the combined nutrition supplementation and education term. Using the same factorial structure, nutrition supplementation and education were independently associated with changes in BMI and fat mass. CONCLUSIONS: Interventions that target nutrition may be an important approach to improving the physiologic response to HIV. We observed significant increases in muscle mass resulting from independent contributions of nutrition education and nutrition supplementation, as well as their combined contribution. FUNDING SOURCES: NIMH R01MH098728.

HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.

We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6months (p=0.016) and adherence, with adherence decreasing with each additional OI for 0-5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence.

BackgroundMalnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India.MethodsWe assigned women living with HIV and their child (oldest 3–8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1–3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4+ T-cell counts (children with HIV only).ResultsOverall, 600 mother–child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P < .001). We found a higher increase in CD4+ T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P < .001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4+ T cells.ConclusionsA combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells, and such interventions can be integrated into HIV-care programs in low-income settings.

Spices were used as food preservatives prior to the advent of refrigeration, suggesting the possibility of effects on microbiota. Previous studies have shown prebiotic activities in animals and in vitro, but there has not been a demonstration of prebiotic or postbiotic effects at culinary doses in humans. In this randomized placebo-controlled study, we determined in twenty-nine healthy adults the effects on the gut microbiota of the consumption daily of capsules containing 5 g of mixed spices at culinary doses by comparison to a matched control group consuming a maltodextrin placebo capsule. The 16S ribosomal RNA sequencing data were used for microbial characterization. Spice consumption resulted in a significant reduction in Firmicutes abundance (p &lt, 0.033) and a trend of enrichment in Bacteroidetes (p &lt, 0.097) compared to placebo group. Twenty-six operational taxonomic units (OTUs) were different between the spice and placebo groups after intervention. Furthermore, there was a significant negative correlation between fecal short-chain fatty acid propionate concentration and Firmicutes abundance in spice intervention group (p &lt, 0.04). The production of individual fecal short-chain fatty acid was not significantly changed by spice consumption in this study. Mixed spices consumption significantly modified gut microbiota, suggesting a prebiotic effect of spice consumption at culinary doses.

Quality of life (QOL) is associated with better outcomes in HIV/AIDS populations, yet few studies have examined variables that predict improvements in QOL over time. We explored these issues in a sample (N=600) of Women Living with HIV/AIDS (WLH/A) in India, enrolled in a nurse-led Asha (Accredited Social Health Activist) intervention. Trained local interviewers ascertained self-report data using metrics previously validated in Indian populations at baseline and again 6 months later. Prior to enrollment, on average women were 34.31 (SD=6.96) years old and had received their diagnosis 48.16 months (SD=34.56) ago. Latent Class Analysis (LCA) was utilized to identify constellations of responses on key psychosocial indicators (depression, social support, internalized stigma and stigma fears) and their relationship with QOL over time. At baseline, mean depression, social support, internalized stigma, and stigma fears was M=9.18 (SD=3.08), M=1.08 (SD=0.22), M=2.30 (SD=0.35), and M=2.81 (SD=0.26), respectively. We identified three classes: Class 1) Highest Social Resources/ Lowest Depression; Class 2) Some Social Resources/ Highest Depression; and Class 3) Lowest Social Resources/ Higher Depression. At baseline, Class 3 reported the lowest QOL (M=0.25, SD=0.26); Class 1 reported the highest (M=0.37, SD=0.33). QOL in Class 2 did not differ from QOL in Class 3, likely due to the potent effects of high depression. After participation in the Asha intervention, at six-month follow-up, all groups reported improved QOL; class membership no longer predicted variability (contrast between Class 2 and 1=−0.05, 95% CI=−0.14, 0.04; contrast between Class 3 and 1=0.01, 95% CI=−0.03, 0.05; contrast between Class 3 and 2=0.07, 95% CI, −0.02, 0.15). Psychosocial indicators are important predictors of QOL; an Asha-supported approach to addressing HIV/AIDS-related factors may have broad applicability to improve QOL in WLH/A in India.

BACKGROUND: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression. SETTING: WLH were recruited from primary-health centers in rural India. METHOD: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (ASHA)-supported intervention compared four distinct ASHA-based programs [1) standard education alone (SE); 2) nutrition education (+NE); 3) nutrition supplements (+NS); or 4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately post-intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time. FINDINGS: Among 600 WLH enrolled (n=150 per arm), mean age, CD4 count and BMI (kg/m(2)) were 34.31, 447.42, and 20.09, and 30.4 respectively, at baseline. At 18-month follow-up, Program 4 (+NENS) experienced greatest improvements in CD4 counts compared to Program 1 (+SE) (adjusted difference=223.81, 95% CI=170.29, 277.32). For BMI, Programs 3 (+NS; adjusted difference=2.33, 95% CI, 1.39, 3.26) and 4 (+NENS; adjusted difference=2.14, 95% CI, 1.17, 3.12) exhibited greater gains compared to Program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference=−0.18, 95% CI, −1.12, 0.76). Hemoglobin and serum albumin also improved over time; Program 4 (+NENS) exhibited the greatest gains. CONCLUSIONS: A low-cost ASHA-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02136082

BACKGROUND: Leptin is derived in adipose tissue and circulates in the body to play a key role in metabolism and energy regulation. In non-psychiatric populations, there is evidence that leptin levels are associated with neurocognitive performance. The production of its circulating soluble binding receptor increases during exercise, which has been associated with neuroplasticity and memory enhancement. The soluble leptin receptor (SLR) is the main leptin binding protein in blood in humans, which serves as an antagonist of the transport of leptin to the brain. Cognitive deficits are well established in schizophrenia, even early in the course of the disorder. However, the question as to whether leptin plays a role in the well-observed cognitive deficits in schizophrenia is unanswered. We examined the relationship between soluble leptin receptor levels and cognitive deficits assessed with the MATRICS Consensus Cognitive Battery (MCCB) prior to participation in a longitudinal study of a combined cognitive training and aerobic exercise program intended to improve cognition and functional outcomes in these young-adult schizophrenia patients. METHODS: The participants were 48 first-episode adult-onset schizophrenia patients treated at the UCLA Aftercare Research Program. Plasma soluble leptin R levels were measured by solid phase sandwich ELISA (D0BR00, R&D Systems) using a Molecular Devices SpectraMax M2 plate reader, and concentrations calculated using a 5-Parameter Logistic Nonlinear Regression Model (SoftMax Pro software). The MATRICS Consensus Cognitive Battery (MCCB) was administered contemporaneously with the plasma blood draw during study baseline, prior to the randomized treatment conditions. RESULTS: Higher plasma soluble leptin receptor levels were significantly correlated in cross-sectional analyses with lower MCCB overall composite cognitive index scores (r= -.33, P=.03). Post-hoc analyses of the individual MCCB domains found 4 of the 7 to be significantly correlated with leptin levels (Speed of Processing (r = -34, P=.02), Attention/Vigilance (r = -34, P=.02), Verbal Learning and Memory (r = -30, P=.04), and Social Cognition (r = -30, P=.04). Soluble leptin receptor levels were not, however, significantly associated Working Memory (r = -19, P=.20), Visual Learning and Memory (r = -.21, P=.15), or Reasoning and Problem Solving (r = -07, P=.63). DISCUSSION: These results indicate certain cognitive deficits after onset of schizophrenia are moderately associated with soluble leptin receptor levels, even early in the course of the disorder. The higher incidence of the leptin receptor levels is thought to have an impact on lower rates of bioavailability of leptin to cross the blood-brain barrier and thus lend to improved neuroplasticity. Weight very commonly increases over time on antipsychotic medication. These findings are consistent with the known association between weight, and in particular, adipose tissue, and leptin. The negative impact of weight increase on cognitive functioning is rarely considered in the treatment of schizophrenia. However, these findings suggest that they should be an area of concern. Future reports will examine the effects of an exercise intervention on both leptin and cognition.

Background Avocados contain fiber, lutein, and vitamin E, and they are a rich source of MUFAs. The effect of including an avocado daily as part of a hypocaloric weight-loss diet on weight loss is not known. Objective The aim of this study was to determine the effect of daily avocado consumption as part of a hypocaloric diet on weight loss, body composition, satiety, biomarkers of inflammation, and intestinal microbiota composition. Methods In this randomized, parallel-controlled, open-label, 2-arm intervention study, 51 healthy overweight/obese women and men were assigned to a hypocaloric diet with 1 Hass avocado daily (AVO; n = 24) or a hypocaloric diet (CTRL; n = 27) without daily avocado for 12 wk. Serum markers and intestinal microbiota were analyzed at baseline and week 12. Results Both groups experienced significant weight loss, decrease in BMI (in kg/m2), total body fat, and visceral adipose tissue, respectively (AVO: -2.3 ± 2 kg, -0.8 ± 0.8, -1.1% ± 2%, and -81.2 ± 118 g; CTRL: -2.6 ± 3.6 kg, -0.9 ± 1, -1.5% ± 2%, and -87.4 ± 216 g). We observed a significant decrease in serum glucose over time in the control group compared with the AVO group. There was no change between the groups in serum triglyceride, but a significant decrease from baseline to 12 wk was observed in the AVO group. Serum hepatic growth factor (HGF) and relative proportion of bacterial phyla (Firmicutes and Bacteroidetes), family (Bacteroidaceae and Erysipelotrichaceae), and genus (Bacteroides, Clostridium, Methanosphaera, and Candidatus Soleaferrea) were significantly altered in the AVO group compared with the CTRL group. A trend to decrease in serum inflammatory factors IL-1β (P = 0.07) and C-reactive protein (P = 0.074) was observed in the AVO group compared with CTRL. Conclusions Daily Hass avocado consumption as part of a hypocaloric diet supported weight loss, a decrease in serum HGF, and an increase in the abundance of bacteria involved in plant polysaccharide fermentation. This trial was registered at clinicaltrials.gov as NCT02953158.

To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India.Cluster randomized controlled trial.Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering.At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D) = 343.97, standard deviation (SD) = 106.94], nutrition education (D = 356.15, SD = 0.69), nutrition supplement (D = 469.66, SD = 116.0), and nutrition supplement and education (D = 530.82, SD = 128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimate = 529.9; 95% confidence interval (CI) 512.0, 547.8; P = 0.006]. BMI also increased for all groups: Asha only (D = 0.95, SD = 0.82), Asha and nutrition education (D = 1.28, SD = 0.53), Asha and nutrition supplement (D = 2.38, SD = 0.60), nutrition supplement, and nutrition supplement and education (D = 2.72, SD = 0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimate = 0.27; 95% CI = 2.5, 2.7; P = 0.80).Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.

Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections.

Obesity-related conditions including heart disease, stroke, and type 2 diabetes are leading causes of preventable death. Recent evidence suggests that altered myocellular lipid metabolism in obesity may lead to increased insulin resistance (IR) that predisposes to these disorders. To test the hypothesis that muscles rich in type I vs. type II muscle fibers would exhibit similar changes in intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) content in obesity, we utilized a new four-dimensional multi echo echo-planar correlated spectroscopic imaging technique that allows separate determination of IMCL and EMCL content in individual calf muscles in obese vs. normal healthy human subjects. Calf muscles were scanned in 32 obese and 11 healthy subjects using a 3T MRI/MRS scanner, and IR in the obese subjects was documented by glucose tolerance testing. In obese subjects, elevation of both IMCL and EMCL content was observed in the gastrocnemius and tibialis anterior muscles (with mixed type I and II fiber content), while a significant increase in only IMCL content (+48%, p

Background. Preclinical and epidemiologic studies suggest chemopreventive effects of green tea (GT) and black tea (BT) in prostate cancer. In the current study we determined the effect of GT and BT consumption on biomarkers related to prostate cancer development and progression. Methods. In this exploratory, open label, phase II trial 113 men diagnosed with prostate cancer were randomized to consume six cups daily of brewed GT, BT or water (control) prior to radical prostatectomy (RP). The primary endpoint was prostate tumor markers of cancer development and progression determined by tissue immunostaining of proliferation (Ki67), apoptosis (Bcl-2, Bax, Tunel), inflammation (nuclear and cytoplasmic nuclear factor kappa B [NFkB]) and oxidation (8-hydroxydeoxy-guanosine [8OHdG]). Secondary endpoints of urinary oxidation, tea polyphenol uptake in prostate tissue, and serum prostate specific antigen (PSA) were evaluated by high performance liquid chromatography and ELISA analysis. Results. Ninety three patients completed the intervention. There was no significant difference in markers of proliferation, apoptosis and oxidation in RP tissue comparing GT and BT to water control. Nuclear staining of NFkB was significantly decreased in RP tissue of men consuming GT (P ¼0.013) but not BT (P ¼0.931) compared to water control. Tea polyphenols were detected in prostate tissue from 32 of 34 men consuming GT but not in the other groups. Evidence of a systemic antioxidant effect was observed (reduced urinary 8OHdG) only with GT consumption (P ¼0.03). GT, but not BT or water, also led to a small but statistically significant decrease in serum prostate-specific antigen (PSA) levels (P ¼0.04). Conclusion. Given the GT-induced changes in NFkB and systemic oxidation, and uptake of GT polyphenols in prostate tissue, future longer-term studies are warranted to further examine the role of GT for prostate cancer prevention and treatment, and possibly for other prostate conditions such as prostatitis. Prostate # 2014 Wiley Periodicals, Inc.

In this study, focus groups were conducted with 16 rural Women Living with AIDS (WLA) from Andhra Pradesh, India who had previously participated in a clinical trial wherein 68 WLA were randomized into either an Accredited Social Health Activists (ASHA) - Life (AL) intervention or a Usual Care program. Findings are discussed in terms of: a) mental health issues, b) perceived stressors, c) individual resources for coping with mental health issues, and d) role of Asha support in coping with mental health issues. These findings highlight the salience of mental health issues in the lives of WLA and the role played by Asha in addressing some of these issues. The discussion section makes a case for increased emphasis on mental health care in future community-based interventions for this population.

A cross-sectional examination was conducted on quality of life (QOL) among women living with HIV (WLWH) in rural Andhra Pradesh, India. Baseline data were collected from 400 WLWH and their children. QOL was measured with 10 items from the Quality of Life Enjoyment and Satisfaction Questionnaire. Findings revealed low QOL scores; on a scale from 0 to 3, the mean QOL score was 0.38 (SD = 0.30). Depression symptoms were reported by 25.5%, internalized stigma was high, and most reported little to no social support. Multivariable analysis revealed positive associations between QOL and CD4+ T cells (b = .0011, p = .021) and social support (b = .260, p

Epigenetics describes heritable alterations of gene expression and chromatin organization without changes in DNA sequence. Both hypermethylation and hypomethylation of DNA can affect gene expression and the multistep process of carcinogenesis. Epigenetic changes are reversible and may be targeted by dietary interventions. Bioactive compounds from green tea (GT) such as (–)-epigallocatechin gallate have been shown to alter DNA methyltransferase activity in studies of esophageal, oral, skin, Tregs, lung, breast and prostate cancer cells, which may contribute to the chemopreventive effect of GT. Three out of four mouse model studies have confirmed the inhibitory effect of (–)-epigallocatechin gallate on DNA methylation. A human study demonstrated that decreased methylation of CDX2 and BMP-2 in gastric carcinoma was associated with higher GT consumption. It is the goal of this review to summarize our current knowledge of the potential of GT to alter epigenetic processes, which may be useful in chemoprevention.

Objective The brain reward circuits that promote drug abuse may also be involved in pleasure seeking behavior and food cravings observed in severely obese subjects. Drug addiction polymorphisms such as the TaqI A1 allele of the dopamine D2 receptor (DRD2) are associated with cocaine, alcohol, and opioid use, but few studies have linked DRD2 to food craving. Other genes such as the leptin receptor gene (LEPR) and mu-opioid receptor gene (OPRM1) that affect appetite and pleasure centers in the brain may also influence food addiction and obesity. The three genes together may function synergistically. Design and Methods To evaluate associations between candidate genes, food craving, overeating, and BMI, we administered questionnaires including Power of Food Scale and Food Craving Inventory, conducted anthropometric measures, and collected blood from patients undergoing weight-loss treatment. Questionnaires and DNA specimens were collected for 80 participants. Results Participants were mostly female (74%) and Caucasian (79%), with an average age of 53 years old. Mean BMI for all participants was 43 kg/m2 and was significantly associated in a linear fashion with Food Craving Inventory scores (P=0.0001) and Power of Food (P=0.02). The DRD2 TaqI A1 allele was significantly associated with BMI (P=0.04), while LEPR Lys109Arg and OPRM1 A118G variants were not. We stratified DRD2 by LEPR and OPRM1, and observed a significant interaction (P = 0.04) between DRD2 and LEPR, and a marginally significant interaction (P=0.06) between DRD2 and OPRM1. Conclusion Genes associated with addictive behavior and appetite control may therefore, in combination, markedly influence development of clinically severe obesity.

There is increasing evidence that the same brain reward circuits involved in perpetuating drug abuse are involved in the hedonic urges and food cravings observed clinically in overweight and obese subjects. A polymorphism of the D2 dopamine receptor which renders it less sensitive to dopamine stimulation has been proposed to promote self-stimulatory behavior such as consuming alcohol, abusing drugs, or binging on foods. It is important to determine how this polymorphism may interact with other well-known candidate genes for obesity including polymorphisms of the leptin receptor gene and the opiomelanocortin gene. Leptin is a proinflammatory cytokine as well as a long-term signal maintaining body fat. Upper-body obesity stimulates systemic inflammation through the action of multiple cytokines including leptin throughout many organs including the brain. The association of numerous diseases including diabetes mellitus, heart disease, as well as depression with chronic low-grade inflammation due to abdominal obesity has raised the possibility that obesity-associated inflammation affecting the brain may promote addictive behaviors leading to a self-perpetuating cycle that may affect not only foods but addictions to drugs, alcohol, and gambling. This new area of interdisciplinary research holds the promise of developing new approaches to treating drug abuse and obesity.

The purposes of this study were to determine the role of bone mineral density (BMD) and mood in influencing health-related behaviors of serious leisure male athletes (cyclists and triathletes) at risk for osteoporosis. A cross-sectional design evaluated BMD in 18-60-yr-old serious leisure male cyclists by dual-energy X-ray adsorptiometry (DXA). Activity was measured using the International Physical Activity Questionnaire; personality was assessed using the NEO-60; and quality of life using Short-Form Health 12 (SF-12). Participants completed an online survey questionnaire after completing their DXA testing a minimum of 3 mo before assessing health-related behaviors and general attitudes toward general health and well-being. Forty-two (61.9%) participants responded to the follow-up questionnaire. Serious leisure male athletes are more likely to initiate significant health-related behavioral changes after learning of their bone density results including calcium supplementation and weight-bearing exercise. Men with low BMD (LBMD) had higher openness subscales on NEO-60 compared with men with normal BMD. SF-12 mental and physical health scores were significantly lower in men with LBMD. Perhaps, the interaction and interplay of genetics, activity and behaviors, and aspects of mental and psychological functions contribute to their reduction in BMD and heightened risk for fracture. Findings from this study suggest that early BMD testing in "serious athletes" has important clinical relevance for their potential risk for osteoporosis in the future.

Background : Previous experimental and laboratory studies have implicated antibodies against Hu proteins (anti-Hu) as a potential marker for small cell lung cancer (SCLC); there are no estimates of the association between anti-Hu and SCLC using a population-based design. Methods : We used stored plasma specimens to evaluate anti-Hu reactivity in relationship to small cell lung cancer in a population-based case–control study. Using Western Blot analysis, we measured anti-Hu reactivity against recombinant Hu family member, HuD, in plasma samples from 41 SCLC cases and 79 controls individually matched for age, race, sex, and smoking status (never, past, current). We analyzed the association between anti-Hu reactivity and SCLC using conditional logistic regression. Results : Anti-Hu reactivity was associated with SCLC, both before and after adjustment for amount of smoking. We observed a smoking-adjusted odds ratio of 3.2 (95% confidence interval from 0.98 to 13.4) comparing subjects above 1800 units (the lower limit of the second tertile of the distribution among antibody positive controls) to subjects with lower reactivity. We also found suggestive evidence in follow-up of our cases that anti-Hu above 1800 units was related to longer-term survival from SCLC. The present research is the first report of anti-Hu reactivity and SCLC in a population-based study. Conclusions : Given the suggestive evidence in this study, prospective analyses to examine whether anti-Hu reactivity might predict risk of developing SCLC, or whether anti-Hu reactivity could serve as an early marker for SCLC, may be warranted.

To evaluate the effects of body adiposity on bone mineral density in the presence and absence of ovarian hormones in female mice and postmenopausal women.We assessed percentage body fat, serum leptin levels, and bone mineral density in ovariectomized and non-ovariectomized C57BL/6 female mice that had been fed various calorically dense diets to induce body weight profiles ranging from lean to very obese. Additionally, we assessed percentage body fat and whole body bone mineral density in 37 overweight and extremely obese postmenopausal women from the Women's Contraceptive and Reproductive Experiences study.In mice, higher levels of body adiposity (40% body fat) were associated with lower bone mineral density in ovariectomized C57BL/6 female mice. A similar trend was observed in a small sample of postmenopausal women.The complementary studies in mice and women suggest that extreme obesity in postmenopausal women may be associated with reduced bone mineral density. Thus, extreme obesity (BMI40 kg/m2) may increase the risk for osteopenia and osteoporosis. Given the obesity epidemic in the U.S. and in many other countries, and, in particular, the rising number of extremely obese adult women, increased attention should be drawn to the significant and interrelated public health issues of obesity and osteoporosis.

© 2016, Copyright © Taylor & Francis Group, LLC. In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial, and cultural impact of the AL on their lives. Four themes emerged among AL participants: (a) the importance of tangible support, (b) need for social support, (c) ongoing challenges to accessing antiretroviral therapy (ART), and (d) perspectives on future programs. Our research findings support the development of future programs targeting mother–child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support.

Truth be told, we are afraid for our children and we are afraid of our children. The intersection of these disparate thoughts has produced a perfect storm. We have created increasingly harsh sex offender registration schemes to protect our children from sexual abuse. At the same time, fear of our children ensnares and punishes them under the very same laws that were designed to protect them. Yet, what compels action is premised on a false narrative that includes flawed studies on recidivism rates and misguided case decisions that embraced these findings. In this article, I explore the inherently unfair and deeply flawed practice of mandatory lifetime registration for children who commit sex offenses. Examination reveals two fallacies in a system that condemns children to lifetime monitoring: the breadth of its ensnarement, and the presumption of a child’s continued sexual predatory behavior. Fueled by emotional rhetoric, both are tightly bound in a fundamentally false narrative that is unnecessary and wholly damaging for the child registrant. The utility of an overly-simplified registration scheme comes with a hefty price tag: the acknowledgement that mandatory lifetime registration captures and shatters the lives of many non-dangerous children. It is a price tag we should no longer be willing to bear. In the face of overwhelming statistical evidence to the contrary, we must commit to changing the false narrative that children who commit sex offenses are presumed to become sexually dangerous adults. We must commit to replacing it with a narrative that acknowledges that recidivism rates are low and that mandatory lifetime registration is both unnecessary and devastating.

There have been case reports suggesting that cranberry beverages may interact with warfarin. To date, no research study has been conducted to examine the potential interaction of cranberry and warfarin. The current study is a randomized, placebo-controlled, double-blind, crossover study to investigate the effect of cranberry juice on prothrombin time as assessed by the international normalized ratio (INR). Seven subjects with atrial fibrillation on a stable dose of warfarin for 3 months were randomized to consume 250 mL of cranberry juice for 7 days, then placebo for 7 days, or vice versa. The washout period was 7 days. The prothrombin time/INR was measured at baseline, and on days 2, 4, 7, 10, 14, 16, 18, 21, and 24. Data were analyzed by the Student t test for paired values. The baseline INR was 2.28±0.54 for the cranberry group and 2.13±0.50 for the placebo group. For all test points, the INR did not change significantly from baseline. At day 7 on cranberry juice, the INR was 2.23±0.53 for cranberry first group and 2.16±0.40 for placebo first group. The mean differences between the cranberry and placebo groups were not statistically significant. Our results suggest no significant interaction between the daily consumption of 250 mL cranberry juice and warfarin. When counseling patients on dietary changes necessary during warfarin treatment, it does not seem necessary to eliminate daily cranberry juice consumption at amounts of 250 mL, but the INR should be followed up closely.

Tea polyphenols have strong in vitro antioxidant activity. Due to their limited bioavailability, however, their contribution to in vivo antioxidant activity may depend on the form of administration. A human intervention study was performed to evaluate the bioavailability and antioxidant capacity of (-)-epigallocatechin-3-gallate (EGCG) administered as a single large dose in the form of either purified EGCG or as green tea extract (Polyphenon E). Plasma concentrations of tea polyphenols were determined by high-performance liquid chromatography (HPLC) analysis combined with coulometric array electrochemical detection (ECD). We found no differences in plasma EGCG concentrations and trolox equivalents determined by the trolox equivalent antioxidant capacity assay after administration of either form of EGCG. However, we found that the plasma antioxidant activity was significantly affected by changes in the plasma urate concentration, which may have interfered with the effect of tea polyphenols on the antioxidant activity. In addition, lymphocyte 8-hydroxydeoxyguanosine to deoxyguanosine (8-OHdG/10(6)dG) ratios were determined by HPLC with ECD. The 8-OHdG/10(6)dG ratios did not change significantly during the 24 h following both EGCG interventions but correlated significantly within individuals determined during the two interventions separated by 1 week. In summary, changes in plasma uric acid due to dietary intake were significantly correlated to the plasma antioxidant activity and exerted a stronger influence on the plasma antioxidant activity compared with the EGCG intervention. In future studies of dietary effects on the plasma antioxidant capacity, changes in plasma uric acid will need to be closely monitored.

Preclinical and epidemiologic studies suggest chemopreventive effects of green tea (GT) and black tea (BT) in prostate cancer. In the current study we determined the effect of GT and BT consumption on biomarkers related to prostate cancer development and progression.In this exploratory, open label, phase II trial 113 men diagnosed with prostate cancer were randomized to consume six cups daily of brewed GT, BT or water (control) prior to radical prostatectomy (RP). The primary endpoint was prostate tumor markers of cancer development and progression determined by tissue immunostaining of proliferation (Ki67), apoptosis (Bcl-2, Bax, Tunel), inflammation (nuclear and cytoplasmic nuclear factor kappa B [NFκB]) and oxidation (8-hydroxydeoxy-guanosine [8OHdG]). Secondary endpoints of urinary oxidation, tea polyphenol uptake in prostate tissue, and serum prostate specific antigen (PSA) were evaluated by high performance liquid chromatography and ELISA analysis.Ninety three patients completed the intervention. There was no significant difference in markers of proliferation, apoptosis and oxidation in RP tissue comparing GT and BT to water control. Nuclear staining of NFκB was significantly decreased in RP tissue of men consuming GT (P = 0.013) but not BT (P = 0.931) compared to water control. Tea polyphenols were detected in prostate tissue from 32 of 34 men consuming GT but not in the other groups. Evidence of a systemic antioxidant effect was observed (reduced urinary 8OHdG) only with GT consumption (P = 0.03). GT, but not BT or water, also led to a small but statistically significant decrease in serum prostate-specific antigen (PSA) levels (P = 0.04).Given the GT-induced changes in NFκB and systemic oxidation, and uptake of GT polyphenols in prostate tissue, future longer-term studies are warranted to further examine the role of GT for prostate cancer prevention and treatment, and possibly for other prostate conditions such as prostatitis.

Although studies generally support a positive association between alcohol consumption and lung-cancer risk, the relationship between specific alcoholic beverages and lung-cancer risk has been inconsistent. We examined recent and past alcoholic beverage intake among 261 incident cases and 615 population controls enrolled in a lung-cancer case-control study of African Americans and Caucasians in Los Angeles County between 1991 and 1994. An in-person interview elicited information about past alcohol intake from ages 30 to 40 y, smoking, other lung-cancer risk factors, as well as recent intake of alcohol, and recent dietary intake. An association was observed between recent hard-liquor consumption and lung-cancer risk. The odds ratio (OR) for 1 or more drinks (1.5 oz or 0.051 mL) per day of hard liquor compared with infrequent liquor drinking (0-3 drinks per month), adjusted for smoking, the matching factors, saturated fat and other alcoholic beverages was 1.87 [95% confidence interval (CI) = 1.02-3.42]. No appreciable association was observed for total alcohol, whereas small inverse associations were observed for beer and wine, although confidence intervals were wide. An elevated lung-cancer risk was also observed for past liquor consumption (between ages 30 and 40 y). The adjusted OR for 1 or more drinks per day of liquor compared with infrequent drinkers was 1.83 (95% CI = 1. 06-3.15). Confounding of the association between alcohol and lung cancer by smoking was apparent. Although we devoted considerable efforts to adjusting for smoking in our analyses, residual confounding is still possible because smoking and alcohol are closely associated. In addition, case-control studies including this study should be viewed with caution because of possible selection bias. An increased risk of lung cancer might occur with moderate drinking of hard liquor but confirmation is required in larger studies.

W. James Gauderman,* John L. Morrison, Catherine L. Carpenter, andDuncan C. ThomasDepartment of Preventive Medicine, University of Southern California,Los AngelesThe Louisiana Lung Cancer Dataset, consisting of 337 extended pedigrees, isanalyzed to determine whether a major Mendelian gene interacts with cumula-tive tobacco smoking (pack-years). The proportional hazards model is utilized,as it is a natural framework for estimating relative risks while adjusting for vari-ability in age of disease onset. Segregation analyses show evidence that a Men-delian gene is segregating in these families, with the most parsimonious model,including sex, pack-years, pack-years squared, and a dominant major gene. Theestimated frequency of the high-risk allele is 2% and carriers are estimated tohave relative risk of 17.3 for developing lung cancer, compared to noncarriers.The addition of a gene × pack-years interaction does not significantly improvethe fit of the model, indicating that on a multiplicative scale, these two factorsindependently influence lung cancer risk. Smoking history is missing for 23% ofthe study subjects and degree of “missingness” depends on disease status,age, and birth-year. To account for the nonrandomness of the missing data, aMarkov chain Monte Carlo method for covariate imputation is proposed andimplemented. Results from this analysis also support a nonsignificant gene-smoking interaction and an allele frequency of 2%, but a lower genetic rela-tive risk (9.0) compared to the “complete case” analysis. Genet. Epidemiol.14:199–214, 1997.

Our goal was to determine the degree to which joint segregation and linkage analysis leads to increased efficiency for estimating the recombination fraction and to greater power for detecting linkage, compared to separate analyses. We concentrated on the quantitative phenotype Q2 and analyzed linkage with a tightly linked marker, a loosely linked marker, and eight unlinked markers, the latter chosen to evaluate false positive rates. We considered both nuclear-family and extended-pedigree data, using the 200 replicates of each provided to GAW participants. We found joint analysis to be consistently more efficient, with relative efficiencies for the tightly linked marker of 1.16 and 1.06 in extended pedigrees and nuclear families, respectively. These relative efficiencies translated into modest but consistent gains in power to detect linkage. Both methods appear to produce unbiased parameter estimates and similar false positive rates.

The purpose of this descriptive study is to highlight the physical and mental health symptoms of 68 rural women living with AIDS (WLA) in India, their compliance to antiretroviral therapy (ART) medication, and barriers to accessing health care within the past 6 months. Physical and mental health status was obtained by self-report, administered by questionnaire and physician-determined clinical assessment, as well as selected objective parameters. Findings revealed that while rural WLA had been on antiretroviral therapy for just under 2 years, they self-reported a high prevalence of physical symptoms, and more than half reported high levels of depressive symptoms and major barriers to accessing health care. CD4 levels, body weight, and basal metabolic rate were also low. While the rural and urban WLA faced similar health care challenges, the demographic characteristics of the rural women may make them more vulnerable, as they are less adherent to ART and slimmer than their urban counterparts.

Imagine if you were held accountable the rest of your life for something you did as a child? This is the Child Scarlet Letter in force: kids who commit criminal sexual acts and who pay the price with the burdens and stigma of sex offender registration. And in a game of “how low can you go?,” states have forced children as young as nine and ten years old onto sex offender registries, some with registration requirements that extend the rest of their lives. No matter the constitutionality of adult sex offender registration – and on that point, there is debate – this article argues that child sex offender registration violates the Eighth Amendment’s prohibition against cruel and unusual punishment. Once a sex offender, always a sex offender is not an apt adage when dealing with children who commit sexual offenses. Low recidivism rates and varied reasons for their misconduct demonstrate that a child’s criminal sexual act does not necessarily portend future predatory behavior. And with a net cast so wide it ensnares equally the child who rapes and the child who engages in sex with an underage partner, juvenile sex offender registration schemes are not moored to their civil regulatory intent. Compounding the problem is mandatory lifetime registration for child offenders. This paper analogizes this practice to juvenile sentences of life imprisonment without the possibility of parole, which the Supreme Court declared unconstitutional in Miller v. Alabama and Graham v. Florida. This article argues that mandatory lifetime registration applied to children in the same manner as adult offenders is cruel and unusual punishment because it violates fundamental principles that require sentencing practices to distinguish between adult and child offenders. Scrutiny of child sex offender registration laws places front and center the issue of what it means to judge our children. And on that issue, we are failing. The public’s desire to punish children appears fixed despite our understanding that child offenders pose little danger of recidivism, possess diminished culpability, and have the capacity for rehabilitation. In a debate clouded by emotion, it is increasingly clear that juvenile sex offender registration is cruel and unusual punishment.

Obesity prevalence and average body composition vary by US race and gender. Asian Americans have the lowest prevalence of obesity. Relying on body-mass index (BMI) to estimate obesity prevalence may misclassify subgroups that appear normally weighted but have excess body fat. We evaluated percentage body fat (PBF) and BMI to determine whether BMI reflects PBF consistently across different races. 940 college students were recruited from a local public university over four consecutive years. We measured PBF by bioelectrical impedance analysis (BIA), weight by physicians' scales, and height with stadiometers. Our sample comprised Asians (49%), Caucasians (23%), Hispanics (7%), and Other (21%). Participants averaged 21.4 years old; BMI was 22.9 kg/m(2); PBF was 24.8%. BMI and PBF varied significantly by race and gender (P value = 0.002 and 0.005 for men; 0.0009 and 0.0008 for women). Asian-American women had the lowest BMI (21.5 kg/m(2)) but the second highest PBF (27.8%). Linear association between BMI and PBF was the weakest (r (2) = 0.09) among Asian-American women and BMI had the poorest sensitivity (37%) to detect PBF. The high PBF with low BMI pattern exhibited by Asian-American women suggests that they could escape detection for obesity-related disease if BMI is the sole measure that estimates body composition.