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Purpose: The Black Women's Health Study (BWHS) was designed to investigate determinants of health and disease in US black women. More than 64,000 women are enrolled in the BWHS cohort. This study assessed the relative validity of the 68-item food frequency questionnaire (FFQ) used in the BWHS baseline questionnaire.Methods: Four hundred and eight BWHS enrollees were asked to provide three telephone, 24-hour recalls and one written 3-day food diary over a one-year period. Means and Pearson correlations were computed to compare estimates for energy, total fat, saturated fat, protein, carbohydrate, dietary fiber, calcium, iron, vitamin C, folate, beta-carotene, and vitamin E from the FFQ, recalls, and diaries.Results: Mean energy intake (kcal) was higher for the diary (1716) than the FFQ (1601) or recalls (1510). Other nutrient estimates (% kcal or per 1000 kcal) were similar across methods, except beta-carotene (FFQ higher). Correlations (energy-adjusted, except for energy, and corrected for intraperson variation) between the FFQ and the recalls were higher than for the diary data and were between 0.5 and 0.8, except for energy and vitamin E (both <0.3).Conclusion: The BWHS FFQ will support meaningful analyses of diet-health associations for 10 of the 11 energy-adjusted nutrient intake variables analyzed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study compared responses of US and Geneva residents to items on analogous questionnaires concerning knowledge and attitudes about diet and health. METHODS: Comparable data were available from 2 population-based sample surveys: the Cancer Control Supplement of the 1987 National Health Interview Survey and the 1994 Bus Sante 2000 in Geneva, Switzerland. Samples included 10,366 US respondents and 698 Geneva respondents, aged 35 to 74 years. The analysis involved descriptive statistics, contingency tables, and linear regression models. RESULTS: In both the United States and Geneva, health consciousness was greater among women and more highly educated persons than among other groups. Compared with Americans, Genevans assigned more importance to avoiding salt, sugar, and overweight (odds ratio = 1.6, 2.9, and 5.9, respectively) and less importance to lowering cholesterol (odds ratio = 0.6). Genevans were more likely to recognize the relatively high fiber content of lettuce, carrots, and apples. Recognition of low-fat foods was slightly better in the United States. CONCLUSIONS: Knowledge and attitudes differed despite high general diet and health awareness in both populations. Identifying why generally similar dietary guidance messages are embraced to different extents across cultures may facilitate global implementation. [ABSTRACT FROM AUTHOR]

Special attention must be given to obesity as it occurs in and affects ethnic minorities (that is, black Americans, Hispanic Americans, Asian and Pacific Islander Americans, American Indians and Alaska Natives, and Native Hawaiians) in the United States. In most of these groups, the prevalence of obesity is substantially higher than in whites, especially among women. Poverty and lower educational attainment, which are associated with higher than average rates of female obesity (independent of ethnicity), affect proportionately more persons in these minority populations than in white populations. Diabetes mellitus and certain other obesity-related conditions occur to a markedly greater than average extent in many minority populations. A high-risk body fat distribution (upper body or central obesity) occurs to a greater extent in some minority populations than in whites. Because of situational and cultural factors, effective obesity prevention and treatment approaches may need to be defined on an ethnicity-specific basis. Increased attention to obesity as it occurs in and affects diverse ethnic groups can help to address critical minority health issues. Such efforts can also broaden and enrich aspects of obesity research for which models based on white populations are inappropriate or limited. [ABSTRACT FROM AUTHOR]

Recent blood pressure trends reflect progress in hypertension control, but prevalent drug therapy precludes direct estimation of the component due to primary prevention. In data gathered on persons aged 35-74 years in three successive US health examination surveys (1960-1980), systolic blood pressure levels assuming no drug therapy were imputed by reassigning blood pressure to the upper end of the distribution for respondents reporting use of antihypertensive medication. Blood pressure was partitioned into four ordinal categories based on weighted percentiles of the 1960-1962 distributions for 35- to 44-year-old males and females who reported no use of antihypertensive medication. Cumulative logit models (alpha = 0.01) were used to estimate age- and sex-specific trends for blacks and whites within two strata (<25 or > or =25) of body mass index (BMI) (weight (kg)/height (m)2). Before imputation, systolic blood pressure decreased between 1960 and 1980; after imputation, significant decreases remained only in 35- to 44-year-olds. Strong associations of black race and BMI > or =25 with higher blood pressures were present in models with and without drug therapy. Thus, according to the models, there has been little progress in decreasing racial or BMI-related blood pressure differentials. Above the age of 44 years, blood pressure trends were largely attributable to medication use. In contrast, data for 35- to 44-year-olds suggest progress in primary prevention. [ABSTRACT FROM AUTHOR]

I started my journey as a nutrition scholar in 1974 when I began PhD studies at Cornell University. My journey has been rich with opportunity. I engaged in research on diet-related risks for cardiovascular diseases, diabetes, and cancer, partly motivated by my strong commitment to addressing health disparities affecting Black Americans. Obesity became my major focus and would eventually involve both US and global lenses. This focus was also linked to other dietary intake issues and health disparities and drew on knowledge I had gained in my prior study and practice of social work. I positioned myself as a bridge builder across nutrition, epidemiology, and public health, advocating for certain new ways of thinking and acting in these spheres and in the academy itself. Life skills honed during my formative years living within racially segregated contexts have been critical to any successes I have achieved.

Introduction: Many in the U.S. are not up to date with cancer screening. This systematic review examined the effectiveness of interventions engaging community health workers to increase breast, cervical, and colorectal cancer screening., Methods: Authors identified relevant publications from previous Community Guide systematic reviews of interventions to increase cancer screening (1966 through 2013) and from an update search (January 2014-November 2021). Studies written in English and published in peer-reviewed journals were included if they assessed interventions implemented in high-income countries; reported screening for breast, cervical, or colorectal cancer; and engaged community health workers to implement part or all of the interventions. Community health workers needed to come from or have close knowledge of the intervention community., Results: The review included 76 studies. Interventions engaging community health workers increased screening use for breast (median increase=11.5 percentage points, interquartile interval=5.5‒23.5), cervical (median increase=12.8 percentage points, interquartile interval=6.4‒21.0), and colorectal cancers (median increase=10.5 percentage points, interquartile interval=4.5‒17.5). Interventions were effective whether community health workers worked alone or as part of a team. Interventions increased cancer screening independent of race or ethnicity, income, or insurance status., Discussion: Interventions engaging community health workers are recommended by the Community Preventive Services Task Force to increase cancer screening. These interventions are typically implemented in communities where people are underserved to improve health and can enhance health equity. Further training and financial support for community health workers should be considered to increase cancer screening uptake., (Published by Elsevier Inc.)

Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: ( a ) give equity issues higher priority, ( b ) adopt a health equity lens, ( c ) strengthen approaches by using health equity frameworks, ( d ) broaden the types of policies considered, and ( e ) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.

Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.

Background: There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice-health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity., Main Text: We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts., Conclusions: Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we "leave no one behind" and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

Context: The number of children who bicycle or walk to school has steadily declined in the U.S. and other high-income countries. In response, several countries responded in recent years by funding infrastructure and noninfrastructure programs that improve the safety, convenience, and attractiveness of active travel to school. The objective of this study is to synthesize the economic evidence for the cost and benefit of these programs., Evidence Acquisition: Literature from the inception of databases to July 2018 were searched, yielding 9 economic evaluation studies. All analyses were done in September 2018-May 2019., Evidence Synthesis: All the studies reported cost, 6 studies reported cost benefit, and 2 studies reported cost effectiveness. The cost-effectiveness estimates were excluded on the basis of quality assessment. Cost of interventions ranged widely, with higher cost reported for the infrastructure-heavy projects from the U.S. ($91,000-$179,000 per school) and United Kingdom ($227,000-$665,000 per project). Estimates of benefits differed in the inclusion of improved safety for bicyclists and pedestrians, improved health from increased physical activity, and reduced environmental impacts due to less automobile use. The evaluations in the U.S. focused primarily on safety. The overall median benefit‒cost ratio was 4.4:1.0 (IQR=2.2:1-6.0:1, 6 studies). The 2-year benefit-cost ratios for U.S. projects in California and New York City were 1.46:1 and 1.79:1, respectively., Conclusions: The evidence indicates that interventions that improve infrastructure and enhance the safety and ease of active travel to schools generate societal economic benefits that exceed the societal cost., (Published by Elsevier Inc.)

Objective: This study aimed to assess effects of emotional eating and stress on weight change among Black women in a culturally tailored weight-control program., Methods: SisterTalk, a cable-TV-delivered weight-control randomized trial, included 331 Black women (aged 18-75 years; BMI ≥ 25 kg/m 2 ) in Boston, Massachusetts. BMI and waist circumference (WC) were assessed at baseline and 3, 8, and 12 months post randomization. Frequency of "eating when depressed or sad" (EWD) and "eating to manage stress" (ETMS) (i.e., "emotional eating") and perceived stress were also assessed. Lagged analyses of data for intervention participants (n = 258) assessed associations of BMI and WC outcomes at each follow-up visit with EWD and ETMS frequency and stress measured at the most recent prior visit., Results: At 3 months (immediately post intervention), BMI decreased for women in all EWD and ETMS categories but increased at later follow-up for women reporting EWD and ETMS always/often. In addition, 8-month EWD and ETMS predicted 12-month BMI change (both P < 0.05). Higher perceived stress was associated with higher EWD and ETMS; however, stress was not associated with lagged BMI or WC at any time., Conclusions: Addressing emotional eating and related triggers may improve weight maintenance in interventions with Black women., (© 2020 The Obesity Society.)

Purpose: Heightened obesity risk among food-insecure food pantry clients is a health equity issue because the co-occurrence of obesity and hunger is deeply-rooted in systematic social disadvantage and historical oppression. This qualitative study examined key stakeholders' perspectives of the relationship between the U.S. food banking system and obesity disparities among food insecure clients., Methods: We conducted in-depth, semi-structured interviews with 10 key stakeholders (e.g., food bank director, food bank board member, advocate) who are familiar with food bank operations. Data were transcribed verbatim, coded in NVivo [v11], and analyzed using thematic analysis., Results: Multiple themes emerged drawing linkages between structural characteristics of the food banking system and disparities in the dual burden of food insecurity and obesity: [a] access to unhealthy food from donors; [b] federal emergency food policy and programming; [c] state-level emergency food policy and programming; [d] geography-based risk profiles; and [e] inadequate food supply versus client need. Interviewees also identified social challenges between system leaders and clients that maintain disparities in obesity risk among individuals with very low food security including: [a] media representation and stereotypes about food pantry clients; [b] mistrust in communities of color; [c] lack of inclusion/representation among food bank system leaders; and [d] access to information., Conclusion: Future efforts to alleviate obesity inequities among clients chronically burdened by food insecurity, especially among certain subpopulations of clients, should prioritize policy, systems, and environmental strategies to overcome these structural and social challenges within the food banking system., Competing Interests: The authors have declared that no competing interests exist.

Meta-analysis has been used to examine the effectiveness of childhood obesity prevention efforts, yet traditional conventional meta-analytic methods restrict the kinds of studies included, and either narrowly define mechanisms and agents of change, or examine the effectiveness of whole interventions as opposed to the specific actions that comprise interventions. Taxonomic meta-analytic methods widen the aperture of what can be included in a meta-analysis data set, allowing for inclusion of many types of interventions and study designs. The National Collaborative on Childhood Obesity Research Childhood Obesity Evidence Base (COEB) project focuses on interventions intended to prevent childhood obesity in children 2-5 years old who have an outcome measure of BMI. The COEB created taxonomies, anchored in the Social Ecological Model, which catalog specific outcomes, intervention components, intended recipients, and contexts of policies, initiatives, and interventions conducted at the individual, interpersonal, organizational, community, and societal level. Taxonomies were created by discovery from the literature itself using grounded theory. This article describes the process used for a novel taxonomic meta-analysis of childhood obesity prevention studies between the years 2010 and 2019. This method can be applied to other areas of research, including obesity prevention in additional populations.

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions ( N  = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention ( g  = 0.10, 95% CI = 0.02-0.18; k  = 55) and at the last follow-up ( g  = 0.17, 95% CI = 0.04-0.30; k  = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.

Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health., (© 2019 New York Academy of Sciences.)

One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity-promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.I propose a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. My core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health.I describe the framework rationale and elements and provide research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Background: Epidemic obesity poses a major threat to global health. This phenomenon reflects the inability of the average person to cope, biologically and behaviorally, with environmental contexts that promote caloric overconsumption and inadequate caloric expenditure. There is still much to be learned about how to improve these contexts nationally and within-countries for sociodemographic groups with above-average obesity risks., Methods: Higher obesity risks relative to respective white majority populations were identified among diverse indigenous, other native-born, or migrant 'racial' or ethnic minority (hereafter, ethnic minority) populations in the United States, Canada, Australia, New Zealand, and the Netherlands, using publicly available national survey data or other sources. Cross-national comparisons were of interest for identifying common risk pathways associated with social and economic inequities. Potential explanations were explored through a narrative review of peer-reviewed literature, informed by the World Health Organization's Conceptual Framework for Action on The Social Determinants of Health., Main Findings: Identifying viable solutions to the high risk of obesity in ethnic minority populations in these high-income countries requires examination of national-level social, economic, and health system contexts, food systems, and built environments for physical activity, as well as patterns of social stratification and cultural biases related to ethnicity, migration, and other determinants of social disadvantage. These factors can be linked to mediators of exposure or vulnerability to obesity-related risks, such as poverty, being an 'outsider', stress and trauma resulting from historical and current oppression, exposure to bias and discrimination, related biological or behavioral consequences, and inadequate health and social care., Conclusions: Focusing on ethnic minority populations in high-income countries is critical for public health efforts to address epidemic obesity. Mitigating intersecting risk pathways arising from stratification and bias based on ethnicity and migrant status should be prominent in these efforts., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: Think Health! ¡Vive Saludable! evaluated a moderate-intensity, lifestyle behavior-change weight-loss program in primary care over 2 years of treatment. Final analyses examined weight-change trajectories by treatment group and attendance., Methods: Adult primary care patients (n = 261; 84% female; 65% black; 16% Hispanic) were randomly assigned to Basic Plus (moderate intensity; counseling by primary care clinician and a lifestyle coach) or Basic (clinician counseling only). Intention-to-treat analyses used all available weight measurements from data collection, treatment, and routine clinical visits. Linear mixed-effects regression models adjusted for treatment site, gender, and age, and sensitivity analyses evaluated treatment attendance and the impact of loss to follow-up., Results: Model-based estimates for 24-month mean (95% CI) weight change from baseline were -1.34 kg (-2.92 to 0.24) in Basic Plus and -1.16 kg (-2.70 to 0.37) in Basic (net difference -0.18 kg [-2.38 to 2.03]; P = 0.874). Larger initial weight loss in Basic Plus was attenuated by a ~0.5-kg rebound at 12 to 16 months. Each additional coaching visit was associated with a 0.37-kg greater estimated 24-month weight loss (P = 0.01)., Conclusions: These findings in mostly black and Hispanic female primary care patients suggest that strategies to improve treatment attendance may improve weight loss resulting from moderate-intensity counseling., (© 2018 The Obesity Society.)

Public health interventions to increase supermarket access assume that shopping in supermarkets is associated with healthier food purchases compared to other store types. To test this assumption, we compared purchasing patterns by store-type for certain higher-calorie, less healthy foods (HCF) and lower-calorie, healthier foods (LCF) in a sample of 35 black women household shoppers in Philadelphia, PA. Data analyzed were from 450 food shopping receipts collected by these shoppers over four-week periods in 2012. We compared the likelihood of purchasing the HCF (sugar-sweetened beverages, sweet/salty snacks, and grain-based snacks) and LCF (low-fat dairy, fruits, and vegetables) at full-service supermarkets and six other types of food retailers, using generalized estimating equations. Thirty-seven percent of participants had household incomes at or below the poverty line, and 54% had a BMI >30. Participants shopped primarily at full-service supermarkets (55%) or discount/limited assortment supermarkets (22%), making an average of 11 shopping trips over a 4-week period and spending mean (SD) of $350 ($222). Of full-service supermarket receipts, 64% included at least one HCF item and 58% at least one LCF. Most trips including HCF (58%) and LCF (60%) expenditures were to full-service or discount/limited assortment supermarkets rather than smaller stores. Spending a greater percent of total dollars in full-service supermarkets was associated with spending more on HCF (p = 0.03) but not LCF items (p = 0.26). These findings in black women suggest a need for more attention to supermarket interventions that change retailing practices and/or consumer shopping behaviors related to foods in the HCF categories examined.

Objective: To develop and test a family-centered behavioral weight loss intervention for African American adults with type 2 diabetes., Methods: In this randomized trial, dyads consisting of an African American adult with overweight or obesity and type 2 diabetes (index participant) paired with a family partner with overweight or obesity but not diagnosed with diabetes were assigned in a 2:1 ratio to a 20-week special intervention (SI) or delayed intervention (DI) control group. The primary outcome was weight loss among index participants at the 20-week follow-up., Results: One hundred eight participants (54 dyads-36 (SI) and 18 (DI) dyads) were enrolled: 81% females; mean age, 51 years; mean weight,103 kg; and mean BMI, 37 kg/m 2 . At post-intervention, 96 participants (89%) returned for follow-up measures. Among index participants, mean difference in weight loss between groups was -5.0 kg, P <0.0001 (-3.6 kg loss among SI; 1.4 kg gain in DI). SI index participants showed significantly greater improvements in hemoglobin A1c, depressive symptoms, family interactions, and dietary, physical activity, and diabetes self-care behaviors. SI family partners also had significant weight loss (-3.9 kg (SI) vs. -1.0 kg (DI), P = 0.02)., Conclusions: A family-centered, behavioral weight loss intervention led to clinically significant short-term weight loss among family dyads., Competing Interests: There are no conflicts of interest to declare., (© 2016 The Obesity Society.)

Food and beverage price promotions may be potential targets for public health initiatives but have not been well documented. We assessed prevalence and patterns of price promotions for food and beverage products in a nationwide sample of food stores by store type, product package size, and product healthfulness. We also assessed associations of price promotions with community characteristics and product prices. In-store data collected in 2010-2012 from 8959 food stores in 468 communities spanning 46 U.S. states were used. Differences in the prevalence of price promotions were tested across stores types, product varieties, and product package sizes. Multivariable regression analyses examined associations of presence of price promotions with community racial/ethnic and socioeconomic characteristics and with product prices. The prevalence of price promotions across all 44 products sampled was, on average, 13.4% in supermarkets (ranging from 9.1% for fresh fruits and vegetables to 18.2% for sugar-sweetened beverages), 4.5% in grocery stores (ranging from 2.5% for milk to 6.6% for breads and cereals), and 2.6% in limited service stores (ranging from 1.2% for fresh fruits and vegetables to 4.1% for breads and cereals). No differences were observed by community characteristics. Less-healthy versus more-healthy product varieties and larger versus smaller product package sizes generally had a higher prevalence of price promotion, particularly in supermarkets. On average, in supermarkets, price promotions were associated with 15.2% lower prices. The observed patterns of price promotions warrant more attention in public health food environment research and intervention., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Insufficient evidence exists to support obesity prevention in paediatric primary care., Objectives: To test a theory-based behaviour modification intervention delivered by trained paediatric primary care providers for obesity prevention., Methods: Efficacy trial with cluster randomization (practice level) and a 12-session 12-month sweetened beverages decrease intervention or a comprehensive dietary and physical activity intervention, compared with a control intervention among children ages 8-12 years., Results: A low recruitment rate was observed. The increase in body mass index z-score (BMIz) for the 139 subjects (11 practices) randomized to any of the two obesity interventions (combined group) was less than that of the 33 subjects (five practices) randomized to the control intervention (-0.089, 95% confidence interval [CI]: -0.170 to -0.008, P = 0.03) with a -1.44 kg weight difference (95% CI: -2.98 to +0.10 kg, P = 0.095). The incidences of obesity and excess weight gain were lower in the obesity interventions, but the number of subjects was small. Post hoc analyses comparing the beverage only to the control intervention also showed an intervention benefit on BMIz (-0.083, 95% CI: -0.165 to -0.001, P = 0.048)., Conclusions: For participating families, an obesity prevention intervention delivered by paediatric primary care clinicians, who are compensated, trained and continuously supported by behavioural specialists, can impact children's BMIz., (© 2014 World Obesity.)

Public mobilisation is needed to enact obesity-prevention policies and to mitigate reaction against their implementation. However, approaches in public health focus mainly on dialogue between public health professionals and political leaders. Strategies to increase popular demand for obesity-prevention policies include refinement and streamlining of public information, identification of effective obesity frames for each population, strengthening of media advocacy, building of citizen protest and engagement, and development of a receptive political environment with change agents embedded across organisations and sectors. Long-term support and investment in collaboration between diverse stakeholders to create shared value is also important. Each actor in an expanded coalition for obesity prevention can make specific contributions to engaging, mobilising, and coalescing the public. The shift from a top-down to a combined and integrated bottom-up and top-down approach would need an overhaul of current strategies and reprioritisation of resources., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Differentiating trajectories of weight change and identifying associated baseline predictors can provide insights for improving behavioral obesity treatment outcomes., Methods: Secondary, observational analyses using growth mixture models were conducted in pooled data for 604 black American, primarily female adults in three completed clinical trials. Covariates of identified patterns were evaluated., Results: The best fitting model identified three patterns over 2 years: 1) mean weight loss of approximately 2 kg (n = 519); 2) mean weight loss of approximately 3 kg at 1 year, followed by ∼4 kg regain (n = 61); and 3) mean weight loss of ∼20 kg at 1 year followed by ∼4 kg regain (n = 24, with 23 from one study). In final multivariate analyses, higher BMI predicted having pattern 2 (OR [95% CI]) 1.10 [1.03, 1.17]) or 3 (OR [95% CI] 1.42 [1.25, 1.63]), and higher dietary fat score was predictive of a lower odds of having patterns 2 (OR [95% CI] 0.37[0.15, 0.94]) or 3 (OR [95% CI] 0.23 [0.07, 0.79])., Conclusions: Findings were consistent with moderate, clinically non-significant weight loss as the predominant pattern across all studies. Results underscore the need to develop novel and more carefully targeted and tailored approaches to facilitating weight loss in black American adults., (© 2014 The Obesity Society.)

Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer-reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (~8%) included ≥ 50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child-focused interventions in school or child care settings for obesity- or physical activity-related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity-income group differences in intervention effects., (© 2014 World Obesity.)

Obesity prevalence in black/African American children and adults of both sexes is high overall and compared with US whites. What we know, and do not know, about how to enhance the effectiveness of obesity prevention and treatment interventions in African Americans is the focus of the 10 articles in this special issue of Obesity Reviews. The evidence base is limited in quantity and quality and insufficient to provide clear guidance. With respect to children, there is relatively consistent, but not definitive support for prioritizing the systematic implementation and evaluation of child-focused interventions in pre-school and school settings and outside of school time. For adults or all ages, developing and refining e-health approaches and faith-based or other culturally and contextually relevant approaches, including translation of the Diabetes Prevention Program intervention to community settings is indicated. Major evidence gaps were identified with respect to interventions with black men and boys, ways to increase participation and retention of black adults in lifestyle behaviour change programmes, and studies of the impact of environmental and policy changes on eating and physical activity in black communities. Bold steps related to research funding priorities, research infrastructure and methodological guidelines are recommended to improve the quantity and quality of research in this domain., (© 2014 World Obesity.)

The prevalence of obesity is high in the United States, and highest among racial and ethnic minority groups. This special issue of Obesity Reviews is based upon evidence reviews prepared for and presented at a national invited workshop convened by the African American Collaborative Obesity Research Network (AACORN) in August of 2012. A set of potential topics was developed, a priori, and AACORN network members and colleagues with relevant expertise were invited to lead evidence reviews. The result is 10 articles focused on providing a comprehensive picture of what is known and unknown about interventions to prevent and treat obesity or improve weight-related behaviours in African American adults and children. Evidence reviews included in this special issue focus on children and adolescents (n=2); adults from various perspectives (n=5); eHealth interventions (n=1); interventions within faith organizations (n=1); and environmental and policy change interventions (n=1). Overall, the reviews show a small evidence base for research on African Americans and call for additional prioritization of funding to include studies that can inform action and bring progress in obesity prevention and treatment in African Americans on par with the scope and seriousness of the problem., (© 2014 World Obesity.)

Introduction: The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity., Methods: Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers., Results: In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P ≥ .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P ≤ .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up., Conclusion: Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF.