Body mass index and sociodemographic predictors of school lunch purchase behavior during a year-long environmental intervention in middle school

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children's diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students' food choice behaviors

Race, ethnicity, community-level socioeconomic factors, and risk of COVID-19 in the United States and the United Kingdom

BACKGROUND: There is limited prior investigation of the combined influence of personal and community-level socioeconomic factors on racial/ethnic disparities in individual risk of coronavirus disease 2019 (COVID-19). METHODS: We performed a cross-sectional analysis nested within a prospective cohort of 2,102,364 participants from March 29, 2020 in the United States (US) and March 24, 2020 in the United Kingdom (UK) through December 02, 2020 via the COVID Symptom Study smartphone application. We examined the contribution of community-level deprivation using the Neighborhood Deprivation Index (NDI) and the Index of Multiple Deprivation (IMD) to observe racial/ethnic disparities in COVID-19 incidence. ClinicalTrials.gov registration: NCT04331509. FINDINGS: Compared with non-Hispanic White participants, the risk for a positive COVID-19 test was increased in the US for non-Hispanic Black (multivariable-adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18–1.47) and Hispanic participants (OR, 1.42; 95% CI, 1.33–1.52) and in the UK for Black (OR, 1.17; 95% CI, 1.02–1.34), South Asian (OR, 1.39; 95% CI, 1.30–1.49), and Middle Eastern participants (OR, 1.38; 95% CI, 1.18–1.61). This elevated risk was associated with living in more deprived communities according to the NDI/IMD. After accounting for downstream mediators of COVID-19 risk, community-level deprivation still mediated 16.6% and 7.7% of the excess risk in Black compared to White participants in the US and the UK, respectively. INTERPRETATION: Our results illustrate the critical role of social determinants of health in the disproportionate COVID-19 risk experienced by racial and ethnic minorities. FUNDING: Please refer to the Funding section at the end of the article

Obesity and sarcoidosis: Consequence or contributor?

Purpose of review: Sarcoidosis is a multisystem disease of unknown cause. Obesity can affect many physiological factors. The relationship between obesity and sarcoidosis is unclear, and can been described as posing a \u27chicken and egg\u27 scenario for the patient as it is not always clear whether it is a consequence of, or a risk factor for any disease. The purpose of this review is to examine the dual roles of obesity on sarcoidosis morbidity and the incidence. Recent findings: Obesity magnifies the symptoms of sarcoidosis and corticosteroid therapy increases BMI. Prospective epidemiologic studies started to explore the role of obesity as a potential risk factor for sarcoidosis. Three studies in the United States, and one study in Denmark, have demonstrated significantly increased risks of sarcoidosis among obese compared with nonobese patients; risk estimates ranged from 1.42 [95% confidence interval (CI), 1.07-1.89] to 3.59 (95% CI, 2.31-5.57). Summary: Obesity can be both a consequence of sarcoidosis treatment, and a contributor to disease risk likely through the pro-inflammatory environment of obesity. Prospective epidemiologic cohort studies are needed to explore the cause of sarcoidosis and insight into possible avenues of treatment development and prevention

Neighborhood racial composition and perceptions of racial discrimination: Evidence from the Black Women\u27s Health Study

Little is known about the effects of social context or place factors (e.g., characteristics of local populations) on African Americans\u27 perceptions and experiences of racism. Using data from 42,445 U.S. black women collected during the 1997 follow-up wave of the Black Women\u27s Health Study, we investigated the association between neighborhood racial composition ( percent black at the block-group level in 2000 Census data) and perceptions of racial discrimination. Perceived racial discrimination was measured using self-reports of the frequency of discrimination in everyday settings (e.g., being treated as if you are dishonest) and lifetime occurrences of discrimination on the job, in housing, and by the police. There was a linear inverse relationship between neighborhood percent black and perceived discrimination, i.e., higher percent black was associated with lower levels of discrimination. Our results support the conclusions that, relative to contexts in which blacks are a small minority, more evenly-mixed (i.e., integrated) contexts result in lower levels of discrimination (contact hypothesis), and mostly black contexts evidence the lowest levels of discrimination (ethnic density hypothesis)

Obesity and weight gain in relation to incidence of sarcoidosis in US black women: Data from the Black Women\u27s Health Study

BACKGROUND: Sarcoidosis, a systemic disorder characterized by chronic granulomatous infl ammation, occurs more frequently among US black women, as do overweight and obesity. Little is known about the relation of overweight and obesity, which induce chronic infl ammation, to incidence of sarcoidosis. METHODS: We assessed the relation of obesity and weight gain to the incidence of sarcoidosis in the Black Women\u27s Health Study, a follow-up study of 59,000 US black women aged 21 to 69 years at baseline in 1995. Information on weight at age 18 years, height, current weight, incident sarcoidosis, and covariates was collected at baseline and on biennial follow-up questionnaires. Cox regression models adjusted for age, education, geographic region, smoking, alcohol consumption, and physical activity were used to estimate incidence rate ratios (IRRs) and 95% CIs. RESULTS: From 1995 through 2011, 454 incident cases of sarcoidosis occurred during 707,557 person-years of follow-up. The incidence of sarcoidosis increased with increasing BMI and weight gain. The IRR was 1.40 (95% CI, 0.88-2.25) for BMI ≥ 30 kg/m 2 at age 18 years relative to 20 to 24 kg/m2 (P trend =.18), 1.42 (95% CI, 1.07-1.89) for BMI ≥ 35 kg/m2 at baseline relative to 20 to 24 kg/m2 (P trend =.01), and 1.47 (95% CI, 1.10-1.97) for a weight gain between age 18 years and baseline of ≥ 30 kg relative to 0 to 9 kg (P trend =.16). In stratified analyses, there were significant trends of sarcoidosis incidence with increasing BMI and weight gain in women aged ≥ 45 years and ever smokers. CONCLUSIONS: The present study provides evidence that weight gain and obesity during adulthood are associated with increased sarcoidosis incidence

The Training of Epidemiologists and Diversity in Epidemiology: Findings from the 2006 Congress of Epidemiology Survey

PURPOSE: In the past decade, we have witnessed increasing numbers of individuals entering the field of epidemiology. With the increase also has come a diversity of training and paths by which individuals entered the field. The purpose of this survey was characterization of the epidemiology workforce, its job diversity, and continuing education needs. METHODS: The Minority Affairs and Membership committees of the American College of Epidemiology (ACE) prepared and administered a workforce survey to identify racial/ethnic diversity, demographic background, workplace type, credentials, income, subspecialties, and continuing education needs of epidemiologists. The survey was self-administered to attendees of the Second North American Congress of Epidemiology in June 2006. RESULTS: A sample of 397 respondents of the 1348 registered for the Congress was captured (29.5% response). Epidemiologists who participated were from 36 states and 18 countries; 54.6% were trained at the doctoral level; 19.1% earned $120,001 or more a year. A wide range of epidemiology subspecialties and continuing education needs were identified. CONCLUSIONS: This preliminary snapshot of epidemiologists indicates a wide range of training mechanisms, workplace sites, and subspecialties. Results indicate a need for examination of the core graduate training needs of epidemiologist as well as responding to desired professional development needs through the provision of continuing educations efforts

Relation Between Neighborhood Median Housing Value and Hypertension Risk Among Black Women in the United States

Objectives. We examined the relation between median housing value and hypertension risk among US Black women. Methods. We gathered data from the Black Women’s Health Study, a prospective follow-up of 59000 Black women aged 21 to 69 years in 1995. Median housing value from US census data was used to measure neighborhood socioeconomic status. Cases of hypertension were identified through postal questionnaires mailed in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios. Results. During 180294 person-years of observation, 3780 cases of hypertension were reported. A significant inverse, graded association was found between median housing value and hypertension. The incidence rate ratio for women living in low median housing value neighborhoods relative to high was 1.29 (95% confidence interval=1.14, 1.45) after adjustment for individual risk factors. The association was evident even at higher individual levels of income and education. Conclusions. Median housing value is inversely associated with hypertension in Black women, independent of individual risk factors. Lowering hypertension risk in Black women will require a greater understanding of the underlying social inequalities that adversely affect health

Reproductive and hormonal factors in relation to incidence of sarcoidosis in US black women

The authors assessed the relation of hormonal and pregnancy-related factors to the incidence of sarcoidosis in the Black Women\u27s Health Study. On biennial questionnaires, participants (US black women aged 2169 years at baseline) reported data on diagnoses of sarcoidosis, reproductive history, and medication use. Cox regression models, adjusted for age, education, geographic region, smoking, and body mass index, were used to estimate incidence rate ratios and 95 confidence intervals. During 694,818 person-years of follow-up from 1995 through 2009, 452 incident cases of sarcoidosis were identified. The incidence of sarcoidosis decreased as age at menopause increased (P-trend 0.03). Both later age at first full-term birth and having a more recent birth were associated with a reduced incidence of sarcoidosis. In models that included both factors, the incidence rate ratios were 0.60 (95 confidence interval: 0.37, 0.97) for age at first birth \u3c30 years versus \u3c20 years (P-trend 0.05) and 0.73 (95 confidence interval: 0.43, 1.24) for \u3c5 years since last birth versus \u3c15 years (P-trend 0.15). No significant associations were observed with age at menarche, parity, lactation, oral contraceptive use, or female hormone use. These results suggest that later full-term pregnancy and longer exposure to endogenous female hormones may be related to a reduced risk of sarcoidosis