Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic

Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the Lifespan and Life Course Research: integrating strategies Un-Meeting to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations

Dietary patterns and associations with body mass index in low-income, ethnic minority youth in the United States according to baseline data from four randomized controlled trials

Few studies have derived data-driven dietary patterns in youth in the United States (US). This study examined data-driven dietary patterns and their associations with BMI measures in predominantly low-income, racial/ethnic minority US youth. Data were from baseline assessments of the four Childhood Obesity Prevention and Treatment Research (COPTR) Consortium trials: NET-Works (N=534; 2–4-year-olds), GROW (N=610; 3–5-year-olds), GOALS (N=241; 7–11-year-olds), and IMPACT (N=360; 10–13-year-olds). Weight and height were measured. Children/adult proxies completed 3 24-hour dietary recalls. Dietary patterns were derived for each site from 24 food/beverage groups using k-means cluster analysis. Multivariable linear regression models examined associations of dietary patterns with BMI and percentage of the 95th BMI percentile. Healthy (produce and whole grains) and Unhealthy (fried food, savory snacks, and desserts) patterns were found in NET-Works and GROW. GROW additionally had a dairy and sugar-sweetened beverage based pattern. GOALS had a similar Healthy pattern and a pattern resembling a traditional Mexican diet. Associations between dietary patterns and BMI were only observed in IMPACT. In IMPACT, youth in the Sandwich (cold cuts, refined grains, cheese, and miscellaneous [e.g., condiments]) compared to Mixed (whole grains and desserts) cluster had significantly higher BMI [β=0.99 (95% CI: 0.01, 1.97)] and percentage of the 95th BMI percentile [β=4.17 (95% CI: 0.11, 8.24)]. Healthy and Unhealthy patterns were the most common dietary patterns in COPTR youth, but diets may differ according to age, race/ethnicity, or geographic location. Public health messages focused on healthy dietary substitutions may help youth mimic a dietary pattern associated with lower BMI

Abstract P128: Predicting BMI Percentile in Hispanic/Latino Youth Using a Machine Learning Approach: Findings From the Hispanic Community Children's Health Study/Study of Latino Youth

Byline: Madison N LeCroy, NYU Grossman Sch of Medicine, New York, NY; Ryung S Kim, Albert Einstein College of Medicine, Bronx, NY; David B Hanna, Albert Einstein College of Medicine, Bronx, NY; Krista M Perreira, Univ of North Carolina Sch of Medicine, Chapel Hill, NC; Linda C Gallo, San Diego State Univ, Chula Vista, CA; Maria M Llabre, Univ of Miami, Coral Gables, FL; Linda Van Horn, Northwestern Univ Feinberg Sch of Medicine, Chicago, IL; Martha L Daviglus, Univ of Illinois Chicago, Chicago, IL; Gregory A Talavera, San Diego State Univ, Chula Vista, CA; Daniela Sotres-Alvarez, Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Carmen R Isasi, Albert Einstein College of Medicine, Bronx, NY Introduction: Among 2-19-year-olds in the United States (US), 26.2% of Hispanic/Latino youth vs. 16.6% of non-Hispanic White youth experience obesity (body mass index [BMI] percentile [greater than or equal] age- and sex-specific 95th BMI percentile). While health behaviors are important, psychological and sociocultural measures vary across racial/ethnic groups and may underpin obesity disparities. Machine learning is one statistical approach that can be used to identify determinants of obesity. However, few studies have applied these methods to childhood obesity research, with most studies only examining traditional risk factors and creating a single model across all racial/ethnic groups. Our objective was to identify key predictors of BMI percentile in Hispanic/Latino youth to help design childhood obesity interventions that reduce health disparities. Hypothesis: We hypothesized that a BMI percentile prediction model developed for Hispanic/Latino youth would identify both traditional and novel risk factors as important determinants. Methods: Hispanic/Latino 8-16-year-olds from the 4 US sites of the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) were examined (n=1,466). BMI percentiles were determined via measured height and weight and CDC growth charts. A supervised machine learning approach, Least Absolute Shrinkage and Selection Operator (LASSO) regression, was used with BMI percentile as the outcome. There were 98 predictor variables examined spanning demographics; health behaviors; and environmental, psychological, and sociocultural measures. LASSO-selected variables were entered into a multivariable linear regression model to obtain effect estimates. P-values were adjusted for both multiple testing and the variable selection process and assessed with ð$5 weekly on snacks/beverages/fast food (ð=-4.62 [95% CI: -19.18, -2.09]) was associated with a lower BMI percentile. Conclusions: Psychological and parental factors predicted higher BMI percentile and greater money spent on snacks/beverages/fast food predicted lower BMI percentile among Hispanic/Latino youth in the US. Addressing Hispanic/Latino youth's relationships with food, body weight, and parents may be important in obesity interventions. Longitudinal research is needed to clarify directionality and replicate novel findings.Professiona

Abstract P151: Acculturation Predicts Activity-specific Parenting Practices In Hispanic/Latino Youth

Background: Hispanic youth are less physically active and more sedentary than non-Hispanic youth, contributing to relatively high rates of obesity among the nation’s largest ethnic minority group. Though parents can influence children’s behavior, it is unclear whether parenting practices related to the child’s physical activity are associated with activity in Hispanic/Latino youth, and whether cultural and environmental contexts predict the use of these parenting practices. Objective: We assessed 1) whether activity-specific parenting practices (ASPPs) are associated with moderate-to-vigorous physical activity (MVPA) and sedentary activity among Hispanic/Latino youth, and 2) if higher parental acculturation and greater perceived neighborhood-level socioeconomic challenges are associated with the use of less effective ASPP patterns. Methods: Youth from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth; n=976) were examined. Activity was assessed using 7-day accelerometer data. ASPPs were identified from the Parenting strategies for Eating and Activity Scale (PEAS) using exploratory and confirmatory factor analysis of the ten items on activity. We used survey-weighted linear regression models to assess whether derived ASPPs predicted mean daily MVPA and sedentary time. K-means cluster analysis was used to group individuals based on ASPP use. Finally, we used survey-weighted multinomial logistic regression models to examine the association of parent acculturation-related measures and perceived neighborhood socioeconomic status and barriers to activity with ASPP cluster membership. Results: Factor analysis of the activity-specific PEAS items identified three ASPPs: Limit Setting, Discipline, and Monitoring/Reinforcement. Discipline predicted higher MVPA in females only (β 1.89 [95% CI 0.11-3.67]), and Monitoring/Reinforcement predicted higher MVPA in males only (β 4.71 [95% CI 0.68-8.74]). There was no association between Limit Setting and MVPA or any ASPPs and sedentary activity. K-cluster analysis revealed three ASPP patterns: Restrictive (high scores for Limit Setting and Discipline), Supportive (high scores for Limit Setting and Monitoring/Reinforcement) and Permissive (low score across ASPPs). Higher Anglo-orientation on the Brief ARSMA-II acculturation measure predicted membership in the Supportive compared to Permissive cluster (p= 0.03), while perceived neighborhood characteristics did not predict ASPP cluster membership. Conclusions: ASPPs are associated with MVPA in sex-specific ways but have no association with sedentary activity in Hispanic/Latino youth. Among acculturation and neighborhood characteristics, only Anglo-orientation predicted ASPPs patterns. More research is needed to understand how acculturation is influencing ASPPs and if ASPPs can be leveraged to change children’s activity

Cultural and neighborhood characteristics associated with activity-specific parenting practices in Hispanic/Latino youth: a secondary analysis of the Hispanic Community Children's health study/study of Latino youth

Hispanic/Latino youth are less physically active than non-Hispanic/Latino youth. We assessed whether activity-specific parenting practices relate to moderate-to-vigorous physical activity (MVPA) and sedentary behavior among Hispanic/Latino youth, and whether cultural (acculturation) and neighborhood characteristics (perceived barriers to activity) relate to the use of parenting practice patterns. Using the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth, n=976 8-16-year-olds), we modeled linear regression associations between parenting practices and mean daily MVPA and sedentary behavior. Parenting practice patterns were then developed using k-means cluster analysis, and regressed on parental acculturation and neighborhood characteristics. Discipline predicted higher MVPA in females (beta 1.89 [95% CI 0.11-3.67]), while Monitoring/Reinforcement predicted higher MVPA in males (beta 4.71 [95% CI 0.68-8.74]). Three patterns were then identified: Negative Reinforcement (high Limit Setting and Discipline use), Positive Reinforcement (high Limit Setting and Monitoring/Reinforcement use), and Permissive Parenting (low parenting practice use). Higher acculturation predicted use of Positive Reinforcement. Activity-specific parenting practices are associated with activity in sex-specific ways among Hispanic/Latino youth, and cultural factors predict the use of parenting practices

Abstract MP03: The Association of the Parent-Child Acculturation Gap With Obesity and Cardiometabolic Risk in Hispanic/Latino Youth: Results From the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Introduction: Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of pre-diabetes and dyslipidemia. Acculturation may help explain this elevated cardiometabolic risk. Within immigrant families, parents and children acculturate at different rates. A difference in the degree of acculturation, known as the “acculturation gap”, between parents and their children has been associated with behaviors that may increase cardiometabolic risk in youth. However, no previous studies have investigated the association between the parent-child acculturation gap and cardiometabolic health. Hypothesis: We tested whether greater gaps in parent-child acculturation were associated with worse cardiometabolic health in Hispanic/Latino youth. Methods: Hispanic/Latino youth ( n =1466, 8-16-year-olds) and parents from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores on the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) Anglo and Latino Orientation Scales (AOS and LOS, respectively) were used to represent parent and youth acculturation. The Brief ARSMA-II primarily assesses language use patterns on a 5-point Likert-type scale, with higher scores on the AOS indicating a preference for English and higher scores on the LOS indicating a preference for Spanish. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, fasting glucose, HOMA-IR, HbA1c, cholesterol, triglycerides, and hsCRP. Missing data were addressed using multiple imputation. Survey-weighted multivariable linear regression examined associations of youth, parent, and youth x parent (the acculturation gap) scores for the AOS and LOS scales separately with each cardiometabolic marker. Results: On average, compared to their parents, youth reported a greater preference for English and a lower preference for Spanish (AOS=4.2 vs. 2.7; LOS=3.1 vs. 4.2, respectively). Greater discordance (i.e., an acculturation gap) in parent and youth AOS scores was associated with elevated BMI percentile only (p-for-interaction≤0.001). The LOS acculturation gap was not associated with any cardiometabolic measures. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth’s diet and physical activity did not alter the findings. Removal of non-significant acculturation gaps indicated an inverse association between parent AOS score and youth SBP percentile (β=-2.47, 95% CI: -4.73, -0.21) and between parent LOS score and youth total cholesterol (β=-2.87, 95% CI: -5.52, -0.21). Conclusions: Discrepancies in English language use in parent-child dyads may relate to increased obesity risk in Hispanic/Latino youth. Future studies are needed to identify mediators of this association, such as general stress and English language fluency

The Association of the Parent-Child Language Acculturation Gap with Obesity and Cardiometabolic Risk in Hispanic/Latino Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth)

Hispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of prediabetes and dyslipidemia. Differences in parent and child acculturation related to language use and preference (i.e., language acculturation) are associated with adverse cardiometabolic health behaviors, but no study has examined associations with cardiometabolic markers. To determine whether discordance in parent-child language acculturation (parent-child acculturation gap) was associated with poor youth cardiometabolic health. Hispanic/Latino 8-16-year-olds (n = 1,466) and parents from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores for the Brief ARSMA-II's Anglo (AOS) and Latino (LOS) Orientation Scales represented language acculturation. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, and dysglycemia and hyperlipidemia measures. Missing data were imputed. Survey-weighted multivariable linear regression examined the association of youth, parent, and youth × parent (the acculturation gap) AOS and LOS scores separately with each cardiometabolic marker. Youth reported greater English and lower Spanish use than parents. Greater discordance in AOS scores was associated with elevated BMI percentile only (p-for-interaction < .01). The LOS acculturation gap was not associated with any outcome. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth's diet and physical activity did not alter findings. Removal of nonsignificant acculturation gaps did not indicate an association between individual youth or parent AOS or LOS scores and any cardiometabolic marker. Discordance in Hispanic/Latino parent-child dyads' English use may relate to increased risk for childhood obesity. Future studies should identify mediators of this association

Abstract MP01: Life-Course Socioeconomic Status and the Gut Microbiome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract only Introduction: Socioeconomic status (SES) in childhood and beyond may influence the gut microbiome (GMB), with implications for disease risk. Studies evaluating the relationship between life-course SES and the gut microbiome (GMB) are sparse, particularly among Hispanic/Latino individuals, who have a high prevalence of low SES. Hypothesis: Low life-course SES indicators are associated with less diversity and overall composition of the gut microbiome in United States (U.S.) Hispanic/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-site population-based cohort study conducted in the U.S. Childhood sanitation conditions (plumbing, sewer/septic tank), childhood SES (parental education and childhood hardship), adulthood neighborhood SES, and adulthood SES (education, income, and economic hardship) were used as life-course SES indicators. Shotgun sequencing was performed on stool samples (n=1057). Alpha-diversity was measured by the Shannon diversity index. Permutational multivariate analysis of variance was used to assess the association of SES indicators with overall microbiome composition, as measured using the Jensen-Shannon Divergence distance. Analysis of Compositions of Microbiomes was used to identify associations of life-course SES indicators with GMB species, adjusting for age, sex, BMI, U.S. or foreign-born, study center, Hispanic/Latino background, type of stool, diet quality, smoking, alcohol consumption, depressive and anxiety symptoms, diabetes, hypertension, cardiovascular disease, dyslipidemia, and antibiotic use. Results: Low sanitation and low SES during childhood were reported by 32% (342 of 1053) and 37% (330 of 884) of participants, respectively. In adulthood, 56% (585 of 1053) lived in a low SES neighborhood and 45% (447 of 1002) had low SES. Life-course SES indicators were not associated with GMB diversity. However, overall microbiome composition differed significantly according to childhood SES (R2 =0.28%, P = 0.04). Low childhood sanitation was associated with higher abundance of Ruminococcus torques and Clostridium lactatifermentans , and depleted abundance of Prevotella species. Low childhood SES was associated with higher abundance of species from genus Streptococcus (S. salivarius, S. parasanguinis, and S. infantis), Veillonella parvula, Prevotella stercorea, and Roseburia intestinalis. Low adulthood SES was associated with depleted abundance of species from Bacteroides, and living in a low adulthood neighborhood SES was associated with depleted abundance of species from Rikenella . Conclusion: Low childhood SES was associated with an altered GMB composition in U.S. Hispanic/Latino adults. Early-life SES may have long-term effects on GMB composition, underscoring another biological mechanism linking early childhood factors to adulthood disease

Dietary intake and habits of South Asian immigrants living in Western countries

Previous reviews have indicated that immigration from South Asian to Western countries leads to unhealthy changes in diet; however, these reviews have been limited by the methods used in some included studies. This critical narrative review summarizes findings from original research articles that performed appropriate statistical analyses on diet data obtained using culturally appropriate diet assessment measures. All studies quantitatively compared the diets of South Asian immigrants with those of residents of Western or South Asian countries or with those of South Asian immigrants who had varying periods of time since immigration. Most studies examined total energy and nutrient intake among adults. Total energy intake tended to decrease with increasing duration of residence and immigrant generation, and immigrants consumed less protein and monounsaturated fat compared with Westerners. However, findings for intakes of carbohydrate, total fat, saturated fat, polyunsaturated fat, and micronutrients were mixed. Studies that examine food group intake and include South Asians living in South Asia as a comparison population are needed