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BackgroundRecent evidence links ambient air pollution to COVID-19 incidence, severity, and death, but few studies have analyzed individual-level mortality data with high quality exposure models.MethodsWe sought to assess whether higher air pollution exposures led to greater risk of death during or after hospitalization in confirmed COVID-19 cases among patients who were members of the Kaiser Permanente Southern California (KPSC) healthcare system (N=21,415 between 06-01-2020 and 01-31-2022 of whom 99.85 % were unvaccinated during the study period). We used 1 km resolution chemical transport models to estimate ambient concentrations of several common air pollutants, including ozone, nitrogen dioxide, and fine particle matter (PM2.5). We also derived estimates of pollutant exposures from ultra-fine particulate matter (PM0.1), PM chemical species, and PM sources. We employed Cox proportional hazards models to assess associations between air pollution exposures and death from COVID-19 among hospitalized patients.FindingsWe found significant associations between COVID-19 death and several air pollution exposures, including: PM2.5 mass, PM0.1 mass, PM2.5 nitrates, PM2.5 elemental carbon, PM2.5 on-road diesel, and PM2.5 on-road gasoline. Based on the interquartile (IQR) exposure increment, effect sizes ranged from hazard ratios (HR) = 1.12 for PM2.5 mass and PM2.5 nitrate to HR ∼ 1.06-1.07 for other species or source markers. Humidity and temperature in the month of diagnosis were also significant negative predictors of COVID-19 death and negative modifiers of the air pollution effects.InterpretationAir pollution exposures and meteorology were associated the risk of COVID-19 death in a cohort of patients from Southern California. These findings have implications for prevention of death from COVID-19 and for future pandemics.

ObjectiveThe purpose of this study was to model weight trajectories over a 5-year time period (2012-2016) and their association with behavioural and psychosocial characteristics and health care-related experiences using data from the Patient Outcomes Research to Advance Learning (PORTAL) overweight/obesity cohort.MethodsWeight trajectories for each eligible patient in the PORTAL overweight/obesity cohort (n = 2864) were identified first using growth modelling; trajectories were then grouped using a hierarchical cluster analysis. Weight trajectory clusters that emerged were compared on demographics, and predictors of cluster membership were examined. Clusters were also compared on responses to a survey assessing health behaviours, quality of life, and health care experience completed in 2015 by 49% of the total sample (n = 1391).ResultsSeven distinct weight trajectory clusters were identified: (a) significant weight loss then maintenance; (b) higher stable weight; (c) moderate stable weight; (d) steady weight loss then relapse; (e) weight gain then weight loss; (f) steady weight gain then maintenance; and (g) lower stable weight. Age, sex, race/ethnicity, and body mass index at baseline predicted patient's weight trajectory (P < .001). Over two thirds of patients maintained their weight over the 5-year period. Significant weight loss then maintenance, weight gain then weight loss, and higher stable weight patients were more likely to report receiving weight counselling from their provider. Patients in the significant weight loss then maintenance and lower stable weight clusters were more likely to be physically active than the other clusters.ConclusionFindings suggest variability in patterns of weight change among adults with overweight or obesity who have access to health care and that these patterns differ on demographic, behavioural and psychosocial factors, and health care experience.

Background: Physical education (PE) can improve physical fitness; however, little research has evaluated PE's long-term influence. The purpose is to determine PE's longitudinal effects on fitness in a group of adolescent girls and to determine whether body mass index (BMI) status influenced any potential effects. Methods: Participants were enrolled in daily PE throughout their ninth grade. Data were collected at baseline and at the end of 9th, 10th, and 11th grades. BMI (kg/m[superscript 2]) was classified into Centers for Disease Control and Prevention percentiles. Fitness was estimated from a 3-stage step test (change in exercise heart rate (HR) indicated improved fitness) and analyzed using repeated measures general linear modeling with adjustments for baseline BMI, baseline age, ethnicity, intervention status, and moderate-to-vigorous physical activity outside PE. Results: Complete data were available for 131 girls (61% of sample) who were predominantly African American, 13.8 plus or minus 0.4 years, mean BMI 24.7 plus or minus 6.1 kg/m[superscript 2] at the ninth-grade baseline. Overall, stage 1 HR (bpm) decreased from baseline to 9th grade (-5.5 plus or minus 1.3, p less than 0.0001), baseline to 10th grade (-7.2 plus or minus 1.4, p less than 0.0001), and baseline to 11th grade (-7.0 plus or minus 1.5, p less than 0.0001). Change differed by BMI status; fitness improvement was significant for normal and overweight, but not obese girls. After 2 years, change in stage 1 HR (bpm) was significantly different between BMI categories: normal-weight girls versus obese girls (-10.0 plus or minus 3.2, p = 0.002) and overweight girls versus obese girls (-9.3 plus or minus 3.9, p = 0.02). Conclusion: Fitness differences by BMI exist after a PE program in adolescent girls: fitness improved and was maintained in normal-weight and overweight girls, whereby obese girls had no improvement in fitness. (Contains 4 figures and 1 table.)

Background: This study examined physical activity opportunities and barriers at 36 geographically diverse middle schools participating in the Trial of Activity for Adolescent Girls. Methods: Principals, physical education and health education department heads, and program leaders were interviewed to assess policies and instructional practices that support physical activity. Results: Schools provided approximately 110 hours per year in physical education instruction. Approximately 20% of students walked or bicycled to school. Eighty-three percent of schools offered interscholastic sports and 69% offered intramural sports. Most schools offered programs for girls, but on average, only 24 girls (approximately 5%) in the schools attended any programs. Only 25% of schools allowed after school free play. An overall score created to assess school environmental support for physical activity indicated that, on average, schools met 6.7 items of 10 items. Free/reduced lunch program participation versus not (p = 0.04), perceived priority of physical education instruction over coaching (p = 0.02), and safety for walking/bicycling to school (p = 0.02) predicted environmental support score. Conclusions: Schools have policies and practices that support physical activity, although unfavorable practices exist. Schools must work with community partners and officials to provide environments that optimally support physical activity, especially schools that serve low-income students.

Objective: This study evaluates whether changes in weight among school‐aged youth in California due to the COVID‐19 lockdown vary by social constructs of race/ethnicity and associated social factors. Methods: Including 160,472 youth aged 5 to 17 years enrolled at Kaiser Permanente Southern California, mixed effects models stratified by age group were fitted to estimate changes in distance from the median BMI‐for‐age from March 2020 to January 2021 (lockdown) compared with the same period before the pandemic. Results: Excess pandemic weight gain was higher among Black and Hispanic youth aged 5 to 17 years than among White and Asian youth; this difference was most pronounced in those aged 5 to 11 years. In youth aged 5 to 11 years, the distance from the median BMI‐for‐age increased by 1.72 kg/m2 (95% CI: 1.61‐1.84) in Hispanic and 1.70 kg/m2 (95% CI: 1.47‐1.94) in Black youth during the lockdown compared with 1.16 kg/m2 (95% CI: 1.02‐1.29) in non‐Hispanic White youth. The excess weight gain was also higher in youth with fewer neighborhood parks and those with state‐subsidized health insurance. Conclusions: The COVID‐19 pandemic lockdown led to a gain of excess body weight, particularly for Black and Hispanic youth; this weight gain varied by social factors associated with race and ethnicity. [ABSTRACT FROM AUTHOR]