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Background Routine screening mammography at two-year intervals is widely recommended for the prevention and early detection of breast cancer for women who are 50 years + . Racial and other sociodemographic inequities in routine cancer screening are well-documented, but less is known about how these long-standing inequities were impacted by the disruption in health services during the COVID-19 pandemic. Early in the pandemic, cancer screening and other prevention services were suspended or delayed, and these disruptions may have had to disproportionate impact on some sociodemographic groups. We tested the hypothesis that inequities in screening mammography widened during the pandemic. Methods A secondary analysis of patient data from a large state-wide, non-profit healthcare system in Washington State. Analyses were based on two mutually exclusive cohorts of women 50 years or older. The first cohort (n = 18,197) were those women screened in 2017 who would have been due for repeat screening in 2019 (prior to the pandemic’s onset). The second cohort (n = 16,391) were women screened in 2018 due in 2020. Explanatory variables were obtained from patient records and included race/ethnicity, age, rural or urban residence, and insurance type. Multivariable logistic regression models estimated odds of two-year screening for each cohort separately. Combining both cohorts, interaction models were used to test for differences in inequities before and during the pandemic. Results Significant sociodemographic differences in screening were confirmed during the pandemic, but these were similar to those that existed prior. Based on interaction models, women using Medicaid insurance and of Asian race experienced significantly steeper declines in screening than privately insured and white women (Odds ratios [95% CI] of 0.74 [0.58–0.95] and 0.76 [0.59–0.97] for Medicaid and Asian race, respectively). All other sociodemographic inequities in screening during 2020 were not significantly different from those in 2019. Conclusions Our findings confirm inequities for screening mammograms during the first year of the COVID-19 pandemic and provide evidence that these largely reflect the inequities in screening that were present before the pandemic. Policies and interventions to tackle long-standing inequities in use of preventive services may help ensure continuity of care for all, but especially for racial and ethnic minorities and the socioeconomically disadvantaged.

Background Previous studies demonstrated a relation between takeaway outlet exposure and health outcomes. Individual characteristics, such as eating behaviour traits, could make some people more susceptible to the influence of the food environment. Few studies have investigated this topic. We aimed to investigate the moderating role of eating behaviour traits (cognitive restraint, uncontrolled eating and emotional eating) in the association between neighbourhood exposure to hot food takeaway outlets (hereafter referred to as takeaway outlets), and takeaway food consumption and adiposity. Methods We used cross-sectional data from a cohort in Cambridgeshire, UK (The Fenland study). Takeaway outlet exposure was derived using participants’ residential address and data from local authorities and divided into quarters. The Three Factor Eating questionnaire (TFEQ-R18) was used to measure eating behaviour traits. Primary outcomes were consumption of takeaway-like foods (derived from food frequency questionnaire), and body fat percentage (measured using dual-energy X-ray absorptiometry). Results Mean age of participants (n = 4791) was 51.0 (SD = 7.2) and 53.9% were female. Higher exposure to takeaway outlets in the neighbourhood and higher eating behaviour trait scores were independently associated with greater takeaway consumption and body fat percentage. Uncontrolled eating did not moderate the associations between takeaway outlet exposure and takeaway consumption or body fat percentage. The association between takeaway outlet exposure and takeaway consumption was slightly stronger in those with higher cognitive restraint scores, and the association between takeaway outlet exposure and body fat percentage was slightly stronger in those with lower emotional eating scores. Conclusion Eating behaviour traits and exposure to takeaway outlets were associated with greater takeaway consumption and body fat, but evidence that individuals with certain traits are more susceptible to takeaway outlets was weak. The findings indicate that interventions at both the individual and environmental levels are needed to comprehensively address unhealthy diets. Trial registry ISRCTN72077169

Background FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends. Methods Descriptive time series analysis of food supply alignment (FSA), 1961–2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income. Findings FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income. Interpretation As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence., Highlights •F020 Little is known about how the food supply structurally supports population-level adherence to food based dietary guidelines. •F020 IResults demonstrated a general misalignment between domestic food supplies and national and international dietary guidelines. •F020 From 1961 to 2013 there has been greater alignment for fruit and vegetables but lesser alignment for sugar and red and processed meat. •F020 Alignment varied substantially between countries in different regions and income categories.

BackgroundPlant-based diets in lower-income countries are often associated with inadequate protein nutrition and adverse health outcomes.ObjectiveTo examine the diversity of protein food sources, in both animal and plant, across diverse socio-demographic groups in Indonesia as compared to Malaysia.DesignThe SCRiPT (Socio Cultural Research in Protein Transition) study was based on population-based samples recruited in Indonesia (N = 1665) and in Malaysia (N = 1604). Data from 24-h in-person dietary recalls in each country were used to construct the frequency counts of protein sources by food group. Protein sources were defined as fish, poultry, red meat (beef, pork, and mutton), eggs, dairy, and plants (cereals, pulses, and tubers). The percent reported frequencies for animal and plant proteins were compared across socio-demographic strata and by country. Analyses were based on one-way Anovas and general linear model regressions adjusting for covariates.ResultsAnimal protein frequency counts were 34% of total in Indonesia, but 50% in Malaysia's. Higher reported consumption frequencies for poultry and red meat in both countries were associated with urban living, greater modernization, and higher socioeconomic status, with stronger social gradients observed in Indonesia. Reported fish consumption was higher in Indonesia than in Malaysia. Fish was more likely to be listed by rural island populations in Indonesia and was associated with lower education and incomes. Consumption frequencies for plant-based proteins were associated with lower socio-economic status in Indonesia and in Malaysia.ConclusionsMore affluent groups in both countries reported higher frequencies for meat, eggs, and dairy as opposed to fish. Greater economic development in Southeast (SE) Asia is associated with more animal protein, particularly from poultry, which may displace fish, the traditional source of high quality protein for the region.

International audience; Economics represents one of the four dimensions of sustainable nutrition. Affordable nutrient density is a key indicator of access to sustainable healthy diets. While the nutritional value of foods is assessed using nutrient density metrics, affordability metrics assess energy content and nutritional value of foods in relation to their cost. To be nutrition-relevant, such economic indicators are normally expressed in terms of monetary cost per calorie or per nutrient, as opposed to food weight. Affordability of healthy foods can also be related to the relative cost of staple grains and linked to local wages, incomes, and community purchasing power. The same concepts can be extended to the carbon cost of food production. In parallel with the affordability metrics, greenhouse gas emissions and other environmental costs ought to be calculated per 1000 kcal or per nutrient rather than per kilogram of food. Foods and food patterns need to be nutrient-rich, affordable, culturally appropriate, and appealing, and with low impact on natural resources. In this perspective article, we critically reflect on the linkages between the economic and health dimensions of sustainable nutrition and discuss some of the inherent tensions and synergies among them. Finally, we propose an approach to better integrate economic and sustainability considerations in the nutrition policy. Policy goals should prioritize balancing the nutritional value of food against its monetary or environmental cost.

INTRODUCTION AND AIMS In states where recreational use of cannabis has been legalised, increasing numbers of cannabis licensed cannabis businesses resulted in concerns about their potential social and health impacts. This study examined spatiotemporal variations in availability of cannabis licensed cannabis businesses (i.e. producers, processors and retailers) in relation to area deprivation in Washington state from 2014 to 2017. DESIGN AND METHODS Data on licensed cannabis businesses were obtained from the Washington State Liquor and Cannabis Board. The number of licensed cannabis businesses was estimated for Washington's 1446 census tracts. Census tracts were stratified into tertiles based on the Singh's Area Deprivation Index showing socio-economic characteristics of communities (least-deprived, middle-deprived and most-deprived). The Integrated Nested Laplace Approximation approach allowed for the spatial and temporal characterisation of cannabis businesses, accounting for similarities based on neighbouring census tracts. RESULTS The density of all licensed cannabis outlets increased over time. Most-deprived areas have increased likelihood of licensed cannabis outlet density when compared to least-deprived areas. No differences were observed in the likelihood of licensed cannabis outlet density in middle-deprived areas when compared to least-deprived areas. DISCUSSION AND CONCLUSIONS The results of this study showed disparity with respect to licensed cannabis outlet density in Washington state over time. The findings call for initiatives, policies and research that decrease disparities in cannabis outlet locations.

© 2021 BMJ Publishing Group Ltd. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license. See: http://creativecommons.org/licenses/by-nc/4.0/

As the COVID-19 pandemic continues to surge in the United States, it has become clear that infection risk is higher in certain populations, particularly socially and economically marginalized groups. Social risk factors, together with other demographic and community characteristics, may reveal local variations and inequities in COVID risk that could be useful for targeting testing and interventions. Yet to date, rates of infection and estimations of COVID risk are typically reported at the county and state level. In this study we develop a small area vulnerability index based on publicly-available sociodemographic data and 668,428 COVID diagnoses reported in 4,803 ZIP codes in the United States (15% of all ZIP codes). The outcome was COVID-19 diagnosis rates per 100,000 people by ZIP code. Explanatory variables included sociodemographic characteristics obtained from the 2018 American Community Survey 5-year estimates. Bayesian multivariable techniques were used to capture complexities of spatial data and spatial autocorrelation and identify individual risk factors and derive their respective weights in the index. COVID-19 diagnosis rates varied from zero to 29,508 per 100,000 people. The final vulnerability index showed that higher population density, higher percentage of noninsured, nonwhite race and Hispanic ethnicity were positively associated with COVID-19 diagnosis rates. Our findings indicate disproportionate risk of COVID-19 infection among some populations and validate and expand understanding of these inequities, integrating several risk factors into a summary index reflecting composite vulnerability to infection. This index can provide local public health and other agencies with evidence-based metrics of COVID risk at a geographical scale that has not been previously available to most US communities.

Summary Food choices are complex decisions that are largely guided not only by perceptions of taste, cost, and convenience but also by consumer concerns about health, safety, and increasingly, the environment. The concept of taste refers to taste, aroma, texture, and the pleasure response to foods. The cost component covers food prices and the relative affordability of alternative food patterns. Convenience refers to ease of physical access to food sources and to the time spent buying and preparing food. The healthfulness of foods has been measured using nutrient density metrics. The environmental cost of food production is increasingly cited as a potential driver of future food choices and a predictor of future diets. While taste is an important driver of food choices, it is not the only one. The current emphasis in public health nutrition is on sustainable food systems and on the adequacy, quality, and, above all, affordability of the global food supply. All too often, good-tasting empty calories are cheap, whereas nutrient-rich foods are more expensive. Public health programs to improve nutrient density of population diets ought to consider taste, cost, and convenience among the key drivers of food choice and food consumption patterns.

Socio economic inequities in obesity have been attributed to individuals' psychosocial and behavioral characteristics. School environment, where children spend a large part of their day, may play an important role in shaping their health. This study aims to assess whether prevalence of overweight and obesity among elementary school students was associated with the school's social and built environments. Analyses were based on 28 public elementary schools serving a total of 10,327 children in the city of Spokane, Washington. Schools were classified by percentage of students eligible for free and reduced meals (FRM). Crime rates, density of arterial roads, healthy food access, and walkability were computed in a one-mile walking catchment around schools to characterize their surrounding neighborhood. In the unadjusted multilevel logistic regression analyses, age, sex, percentage of students eligible for FRM, crime, walkability, and arterial road exposure were individually associated with the odds of being overweight or obese. In the adjusted model, the odds of being overweight or obese were higher with age, being male, and percentage of students eligible for FRM. The results call for policies and programs to improve the school environment, students' health, and safety conditions near schools.

This cohort study investigates the rates of breast cancer screening before and during the COVID-19 pandemic among women in Washington State.

● In the United States, morbidity and mortality from COVID-19 infection varies substantially among populations and geographic regions ● Variation has been attributed to chronic disease burden, and certain sociodemographic factors ● We developed an index of COVID-19 vulnerability using a regression modeling approach with observed diagnosis at the Zipcode level in Washington State ● The resulting index can be used by policy makers for the targeting of public health and health care resources.

The aim of this study was to examine the relationship between estimated residential exposure to agricultural chemical application and premature mortality from Parkinson&rsquo, s disease (PD) in Washington State. Washington State mortality records for 2011&ndash, 2015 were geocoded using residential addresses, and classified as having exposure to agricultural land-use within 1000 meters. Generalized linear models were used to explore the association between land-use associated with agricultural chemical application and premature mortality from PD. Individuals exposed to land-use associated with glyphosate had 33% higher odds of premature mortality than those that were not exposed (Odds Ratio (OR) = 1.33, 95% Confidence Intervals (CI) = 1.06&ndash, 1.67). Exposure to cropland associated with all pesticide application (OR = 1.19, 95% CI = 0.98&ndash, 1.44) or Paraquat application (OR = 1.22, 95% CI = 0.99&ndash, 1.51) was not significantly associated with premature mortality from PD, but the effect size was in the hypothesized direction. No significant associations were observed between exposure to Atrazine (OR = 1.21, 95% CI = 0.84&ndash, 1.74) or Diazinon (OR = 1.07, 95% CI = 0.85&ndash, 1.34), and premature mortality from PD. The relationship between pesticide exposure and premature mortality aligns with previous biological, toxicological, and epidemiological findings. Glyphosate, the world&rsquo, s most heavily applied herbicide, and an active ingredient in Roundup&reg, and Paraquat, a toxic herbicide, has shown to be associated with the odds of premature mortality from PD.

High cost of healthy foods could be a barrier to healthy eating. We aimed to examine the association between dietary cost and adherence to the Mediterranean diet in a non-Mediterranean country. We evaluated cross-sectional data from 12 417 adults in the UK Fenland Study. Responses to 130-item FFQ were used to calculate a Mediterranean diet score (MDS). Dietary cost was estimated by matching food consumption data with retail prices of five major supermarkets. Using multivariable-adjusted linear regression, we examined the association of MDS and individual foods with dietary cost in absolute and relative scales. Subsequently, we assessed how much the association was explained by education, income, marital status and occupation, by conducting mediation analysis and testing interaction by these variables. High compared with low MDS (top to bottom third) was associated with marginally higher cost by 5·4 % (95 % CI 4·4, 6·4) or £0·20/d (95 % CI 0·16, 0·25). Participants with high adherence had higher cost associated with the healthier components (e.g. vegetables, fruits and fish), and lower cost associated with the unhealthy components (e.g. red meat, processed meat and sweets) (Pfor trendPinteraction

We examined the impact of regulatory action to reduce levels of artificial trans–fatty acids (TFAs) in food. We searched Medline, Embase, ISI Web of Knowledge, and EconLit (January 1980 to December 2012) for studies related to government regulation of food- or diet-related health behaviors from which we extracted the subsample of legislative initiatives to reduce artificial TFAs in food. We screened 38 162 articles and identified 14 studies that examined artificial TFA controls limiting permitted levels or mandating labeling. These measures achieved good compliance, with evidence of appropriate reformulation. Regulations grounded on maximum limits and mandated labeling can lead to reductions in actual and reported TFAs in food and appear to encourage food producers to reformulate their products.

Highlights • We use global cross-country panel data on soft drink prices, sales and health. • We assess the effect of relative soft drink prices and sales on health outcomes. • Soft drink sales are significantly positively related to BMI and to diabetes among the low and lower-middle income countries. • The expected inverse relationship between relative soft drink prices and weight-related turned out as not robust., We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999–2014, in order to assess the relationship of carbonated soft drinks’ sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity – but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m2 (p

ObjectiveTo test whether diets achieving recommendations from the UK’s Scientific Advisory Committee on Nutrition (SACN) were associated with higher monetary costs in a nationally representative sample of UK adults.DesignA cross-sectional study linking 4 d diet diaries in the National Diet and Nutrition Survey (NDNS) to contemporaneous food price data from a market research firm. The monetary cost of diets was assessed in relation to whether or not they met eight food- and nutrient-based recommendations from SACN. Regression models adjusted for potential confounding factors. The primary outcome measure was individual dietary cost per day and per 2000 kcal (8368 kJ).SettingUK.SubjectsAdults (n 2045) sampled between 2008 and 2012 in the NDNS.ResultsOn an isoenergetic basis, diets that met the recommendations for fruit and vegetables, oily fish, non-milk extrinsic sugars, fat, saturated fat and salt were estimated to be between 3 and 17 % more expensive. Diets meeting the recommendation for red and processed meats were 4 % less expensive, while meeting the recommendation for fibre was cost-neutral. Meeting multiple targets was also associated with higher costs; on average, diets meeting six or more SACN recommendations were estimated to be 29 % more costly than isoenergetic diets that met no recommendations.ConclusionsFood costs may be a population-level barrier limiting the adoption of dietary recommendations in the UK. Future research should focus on identifying systems- and individual-level strategies to enable consumers achieve dietary recommendations without increasing food costs. Such strategies may improve the uptake of healthy eating in the population.

U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses to estimate measured BMI (kg/m2), overweight (25 ≥ BMI < 30) and obesity (≥30), across participants’ highest educational attainment (three groups) and tertiles of street network distance (km) from home location to nearest supermarket. Jointly-classified models estimated combined associations of education and supermarket distance, and relative excess risk due to interaction (RERI). Participants farthest away from their nearest supermarket had higher odds of obesity (OR 1.33, 95% CI: 1.11, 1.58), relative to those living closest. Lower education was also associated with higher odds of obesity. Those least-educated and living farthest away had 3.39 (2.46–4.65) times the odds of being obese, compared to those highest-educated and living closest, with an excess obesity risk (RERI = 0.09); results were similar for overweight. Our results suggest that public health can be improved through planning better access to supermarkets, in combination with interventions to address socioeconomic barriers.

Background Low fruit and vegetable (FV) consumption is associated with cardiovascular disease and some cancers. The UK recommendation is that adults should consume at least 400 g (5 × 80 g portions) of FV per day. However, the most recent available data indicate that over 80% of UK adults do not adhere to the ‘5-a-day’ recommendation. This study investigates whether the level of adherence has changed over time. Further, we look at number of FV portions consumed by age, sex and socioeconomic position across the three time points between 1986 and 2012. Methods We used three surveys for this repeated cross-sectional analysis: the National Diet and Nutrition Survey (2000/01 and 2008/12) and a similar survey from 1986/87, the Dietary and Nutritional Survey for British Adults. These surveys employ multistage random sampling. FV intake was assessed using food diaries and demographic information collected by an interviewer. We included adults aged 19 to 64, who adequately completed a food diary, which gave sample sizes of 2047, 1724 and 1512, in 1986/87, 2000/01 and 2008/12 respectively. To test for socioeconomic inequalities, respondents were categorised into four groups (professional/managerial (I/II); skilled non-manual (IIINM), skilled manual (IIIM); partly skilled/unskilled (IV/V)) based on the Registrar General Social Class classification and we looked at absolute and relative differences between I/II and IV/V. To test differences in mean intake by demographic characteristics, we used t-tests and linear regression. All analyses were conducted in StataSE 13. Results Overall FV intake increased by 20% from 1986/87 (2.67 portions, 95% confidence interval [2.59,2.74]) to 2008/12 (3.21 portions [3.10,3.32]), but still fell short of the recommended 5 portions. We found higher FV intake in socioeconomic group I/II compared to IV/V across all years (difference of 0.96–1.28 portions; 26.09%–36.36%). FV intake also differed by age across all surveys, with older respondents eating more than younger respondents (1.03–2.08 portions; 51.76%–129.19%). Men ate significantly more FV than women in 1986/87 (0.18 portions; 6.52%) but there was no significant difference in the latter time points. Conclusion While FV consumption has increased in the UK since 1986, and sex differences in consumption have disappeared, socioeconomic and age-related inequalities persist. Population-level strategies to improve diet and increase FV intake are still needed in the promotion of public health. In order to redress inequalities, it is crucial that these strategies are at least or more effective in lower versus higher socioeconomic groups, and in younger versus older adults.

With 796,500 places available for children in England, pre-school nurseries could serve as an important setting for population-wide dietary intervention. It is critical to understand the determinants of healthy food provision in this setting, which may include access to food stores. This study examined the association between objective, GIS-derived supermarket proximity and fruit and vegetable serving frequency, using data from 623 English nurseries. Overall, 116 (18%) nurseries served fruits and vegetables infrequently (, Highlights • We examined the relationship between nursery supermarket access and the provision of fruits and vegetables to children. • We used data from a representative sample of 623 English nurseries, alongside objectively measured supermarket proximity. • 18% of nurseries served fruits and vegetables infrequently, but this differed systematically by supermarket proximity. • Nurseries farthest from their nearest supermarket were significantly less likely to serve fruits and vegetables frequently. • Supermarket access may be important for nurseries in meeting guidelines for the provision of fruits and vegetables.

U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses to estimate measured BMI (kg/m2), overweight (25 ≥ BMI < 30) and obesity (≥30), across participants’ highest educational attainment (three groups) and tertiles of street network distance (km) from home location to nearest supermarket. Jointly-classified models estimated combined associations of education and supermarket distance, and relative excess risk due to interaction (RERI). Participants farthest away from their nearest supermarket had higher odds of obesity (OR 1.33, 95% CI: 1.11, 1.58), relative to those living closest. Lower education was also associated with higher odds of obesity. Those least-educated and living farthest away had 3.39 (2.46–4.65) times the odds of being obese, compared to those highest-educated and living closest, with an excess obesity risk (RERI = 0.09); results were similar for overweight. Our results suggest that public health can be improved through planning better access to supermarkets, in combination with interventions to address socioeconomic barriers.

The dietary approaches to stop hypertension (DASH) diet could be an important population-level strategy to reduce cardiovascular disease (CVD) in the UK, but there is little UK-based evidence on this diet pattern in relation to CVD risk. We tested whether dietary accordance with DASH was associated with risk of CVD in a population-based sample of 23,655 UK adults. This prospective analysis of the EPIC-Norfolk cohort study analysed dietary intake (assessed using a validated food frequency questionnaire) to measure accordance with DASH, based on intakes of eight food groups and nutrients, ranking the sample into quintiles. Cox proportional hazards regression models tested for association between DASH accordance and incident stroke, ischemic heart disease (IHD) and total incident CVD (stroke and IHD only), as well as CVD mortality, non-CVD mortality and total mortality. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated adjusting for age, sex, behavioral and clinical risk factors and socioeconomic status. Over an average of 12.4 years follow-up, we ascertained 4129 incident CVD events, of which stroke accounted for 1011. Compared to participants with the least DASH-accordant diets, those with the most DASH-accordant diets had 20% lower risk of incident stroke (HR, 95% CI 0.80, 0.65–0.99) and 13% lower risk of total incident CVD (0.88, 0.79–0.99) but no lower risk of CHD (0.90, 0.79–1.02). CVD-related mortality also showed strong inverse associations with DASH accordance (0.72, 0.60–0.85). This study provides evidence for the cardioprotective effects of DASH diet in a UK context.

The United Kingdom (UK) is an island and its culture, including diet, is heavily influenced by the maritime resources. Dietary guidance in the UK recommends intake of fish, which provides important nutrients, such as long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA). This study was designed to describe the fish intake habits of UK children using a nationally representative sample. Dietary and socio-demographic data of children 2–18 (N = 2096) in the National Diet and Nutrition Survey Rolling Program (NDNS) Years 1–4 (2008–2012) were extracted. Average nutrient and food intakes were estimated. Logistic regression models were used to predict the meeting of fish intake recommendations, controlling for age, sex, income, total energy intake, and survey year. All analyses were conducted using survey routines and dietary survey weights. In this nationally representative study, 4.7% of children met the fish and 4.5% the oily fish intake recommendations; only 1.3% of the population met both recommendations. Fish intake levels did not significantly change with children’s increasing age. Higher vegetable but lower meat consumption predicted meeting the fish intake recommendations, indicating that children eating fish have better diet quality than non-consumers. Further research is needed to explore how intake behaviours can be changed to improve children’s diet quality.

Racial and socioeconomic inequalities in health are consistently reported, but less is known about the interplay between racial and deprivation-related inequities. We used geographically-localized data on all deaths recorded in Washington state 2011 to 2015 (n = 242,667 decedents) and multi-level regression models to examine premature (65 years) mortality by race and neighborhood deprivation separately and in combination. White versus non-white inequities in premature mortality did not vary substantially with increasing levels of deprivation. However, most non-white races from deprived neighborhoods had odds of premature mortality between three and eight times that of more-affluent whites. These findings may reflect the compounding of disadvantage stemming from social and environmental risk factors.

Socio-economic differences in diet are a potential contributor to health inequalities. The present study provides an up-to-date picture of socio-economic differences in diet in the UK, focusing on the consumption of three food groups and two nutrients of public health concern: fruit and vegetables; red and processed meat; oily fish; saturated fats; non-milk extrinsic sugars (NMES). We analysed data for 1491 adults (age ≥ 19 years) from the National Diet and Nutrition Survey 2008–2011. Socio-economic indicators were household income, occupational social class and highest educational qualification. Covariate-adjusted estimates for intakes of fruit and vegetables, red and processed meat, and both nutrients were estimated using general linear models. Covariate-adjusted OR for oily fish consumption were derived with logistic regression models. We observed consistent socio-economic gradients in the consumption of the three food groups as estimated by all the three indicators. Contrasting highest and lowest levels of each socio-economic indicator, we observed significant differences in intakes for the three food groups and NMES. Depending on the socio-economic indicator, highest socio-economic groups consumed up to 128 g/d more fruit and vegetables, 26 g/d less red and processed meat, and 2·6 % points less NMES (P

Objective To ascertain prospectively gender-specific associations between types and amounts of financial hardship and weight gain, and investigate potential behavioral mechanisms. Methods Prospective study of 3701 adult British civil servants with repeated measures of difficulty paying bills or insufficient money to afford adequate for food/clothing (1985-1988; 1989-1990; 1991-1993; 1997-1999), and weight (1985-1988; 1997-1999). Results Persistent hardships were associated with adjusted mean weight change in women over 10.9 years, but no consistent pattern was seen in men. During follow-up, 46% of women gained ≥5 kg. Women reporting persistent insufficient money for food/clothing had a significantly greater odds of gaining ≥5 kg (1.42 [1.05, 1.92]) compared to no hardship history, which remained after socioeconomic status (SES) adjustment (1.45 [1.05, 2.01]). The association between persistent difficulty paying bills and odds of excess weight gain was also significant (1.42 [1.03, 1.97]) but attenuated after considering SES (1.39 [0.98, 1.97]). Four health behaviors as single measures or change variables did not attenuate associations. Conclusions Results suggested strategies to tackle obesity must address employed women's everyday financial troubles which may influence weight through more biological pathways than classical correlates of economic disadvantage and weight.