Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD).

BACKGROUND: Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood. METHODS: Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991-2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018-2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26-31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking). RESULTS: In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (ß=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (ß=-0.0014, p <.05) and diet quality (ß=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05). CONCLUSIONS: Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.

Circadian Timing, Information processing and Metabolism (TIME) study: protocol of a longitudinal study of sleep duration, circadian alignment and cardiometabolic health among overweight adults.

BACKGROUND: Both short sleep duration and circadian rhythm misalignment are risk factors for metabolic dysfunction, but the underlying mechanisms are unknown. The goal of this study is to examine how sleep duration and circadian alignment predict changes in cardiometabolic risk factors over a 12-month period, and test cognitive function and hedonic eating tendencies as potential mechanisms. METHODS: We will recruit a sample of 120 working aged adults with BMI 25-35 kg/m2 (overweight to class I obesity). The protocol includes 5 visits over a 12-month period. Study visits include wrist actigraphy to measure sleep behaviors, 24-h diet recalls, dim light melatonin collection, a computerized neurobehavioral assessment, eating in the absence of hunger task, and frequently sampled IV glucose tolerance test. DISCUSSION: The results of the TIME study will advance the understanding of how both short sleep duration and circadian misalignment contribute to behavioral aspects of obesity and metabolic dysfunction. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT04759755 , registered retrospectively February 13, 2021.

Antibiotics prior to age 2 years have limited association with preschool growth trajectory.

BACKGROUND: Prior studies of early antibiotic use and growth have shown mixed results, primarily on cross-sectional outcomes. This study examined the effect of oral antibiotics before age 24 months on growth trajectory at age 2-5 years. METHODS: We captured oral antibiotic prescriptions and anthropometrics from electronic health records through PCORnet, for children with ≥1 height and weight at 0-12 months of age, ≥1 at 12-30 months, and ≥2 between 25 and 72 months. Prescriptions were grouped into episodes by time and by antimicrobial spectrum. Longitudinal rate regression was used to assess differences in growth rate from 25 to 72 months of age. Models were adjusted for sex, race/ethnicity, steroid use, diagnosed asthma, complex chronic conditions, and infections. RESULTS: 430,376 children from 29 health U.S. systems were included, with 58% receiving antibiotics before 24 months. Exposure to any antibiotic was associated with an average 0.7% (95% CI 0.5, 0.9, p < 0.0001) greater rate of weight gain, corresponding to 0.05 kg additional weight. The estimated effect was slightly greater for narrow-spectrum (0.8% [0.6, 1.1]) than broad-spectrum (0.6% [0.3, 0.8], p < 0.0001) drugs. There was a small dose response relationship between the number of antibiotic episodes and weight gain. CONCLUSION: Oral antibiotic use prior to 24 months of age was associated with very small changes in average growth rate at ages 2-5 years. The small effect size is unlikely to affect individual prescribing decisions, though it may reflect a biologic effect that can combine with others.

The relative contributions of adiposity and activity levels to physical performance in children with excess weight.

OBJECTIVE: This study examined predictors of physical performance, a key aspect of quality of life, in children with excess weight. METHODS: Participants were 269 children aged 6-12 years with a body mass index above the 85th percentile. Children completed a standardized physical performance task capturing lower extremity strength, balance, and gait speed. Height, weight, and waist circumference were objectively measured, and daily moderate-vigorous physical activity (min/day) and sedentary time (% of day) were assessed with a 7-day accelerometer protocol. RESULTS: Physical performance task completion averaged 15.0 (SD = 2.5) seconds. Children with higher body mass index z-scores and waist circumferences had significantly longer task completion times. The task took 1.8 additional seconds per 1.0 body mass index z-score (p < .001), and 1.2 additional seconds for every 20 cm higher waist circumference (p < .001). Daily moderate-vigorous physical activity and sedentary time were unrelated to physical performance, and did not moderate its associations with the adiposity measures. CONCLUSION: Among children with excess weight, physical performance declines with increasing levels of total and central adiposity. Daily activity levels do not moderate this association. Interventions that directly target weight reduction would likely yield the greatest improvement in physical performance in children with overweight or obesity.

Early Life Adversity and Pubertal Timing: Implications for Cardiometabolic Health.

OBJECTIVE: To identify early life adversity (ELA) risk factors for earlier pubertal timing, itself a risk factor for poor cardiometabolic health, and to determine whether such ELA-related risk may be mediated by pre-pubertal body mass index (BMI). METHODS: Subjects included 426 female participants in a prospective birth cohort study, the NICHD Study of Early Child Care and Youth Development. Survival analysis models were fit to examine ELA exposures, representing childhood socioeconomic status (SES), maternal sensitivity, mother-child attachment, and negative life events, along with child health indicators and covariates, in relation to pubertal timing outcomes, including age at menarche and ages at Tanner stage II for breast and pubic hair development. RESULTS: Higher childhood SES emerged as an independent predictor of older age at menarche, showing each one standard deviation increase in childhood SES corresponded to a 1.3% increase in age at menarche (factor change = 1.013; 1.003-1.022; p < .01), but did not predict breast or pubic hair development (ps > .05). In mediation analyses, indirect (mediated) effects of mother-child attachment on the pubertal timing outcomes, via pre-pubertal BMI, were all statistically significant (ps < .05). CONCLUSIONS: Higher childhood SES predicted directly, and secure (vs. insecure) mother-child attachment predicted indirectly (via pre-pubertal BMI), later pubertal timing, suggesting these factors may protect girls from earlier pubertal development. By extension, clinical implications are that intervention strategies designed to lessen ELA- and pre-pubertal obesity-related risk may be effective in remediating life course pathways linking ELA, accelerated pubertal development, and cardiometabolic risk.

Preexisting Executive Function Deficits and Change in Health Behaviors During the COVID-19 Pandemic.

BACKGROUND: Executive functions (EF) support engagement in goal-directed behaviors, including several health behaviors. Stressful and cognitively demanding events can disrupt EFs and interfere with health behavior, possibly to a greater extent in those with preexisting EF deficits. This study examined the association between preexisting EF deficits and subsequent negative changes in eating patterns, physical activity, sedentariness, and alcohol/substance use during the COVID-19 pandemic. METHOD: Participants were 374 young adults in a follow-up study of the longitudinal, multisite Study of Early Child Care and Youth Development (SECCYD). Preexisting EF deficits were assessed with the Barkley Deficits in Executive Function Scales-Short Form, and personally impactful negative changes in four health behaviors (physical activity, unhealthy eating, sedentary time, alcohol/substance use) during the COVID-19 pandemic were subsequently assessed with the Epidemic-Pandemic Impacts Inventory. RESULTS: In ordered logistic regression models, higher preexisting total EF deficits were associated with greater negative impactful changes in physical activity and unhealthy eating, independent of sociodemographic variables, obesity, and (as relevant) accelerometer-based physical activity and pre-COVID-19 diet quality. Socioeconomic status moderated the association between total EF deficits and impactful change in alcohol/substance use, with EF deficits linked to greater impactful change in alcohol/substance use only in higher socioeconomic strata. CONCLUSION: Individuals with preexisting EF deficits appear more vulnerable to the negative impact of the COVID-19 pandemic on several key health behaviors. As the pandemic unfolds, strategies may be needed to identify those with EF deficits (e.g., screening tools) and provide them with tailored support for chronic disease risk reduction.

Western Dietary Pattern Derived by Multiple Statistical Methods Is Prospectively Associated with Subclinical Carotid Atherosclerosis in Midlife Women.

BACKGROUND: The menopause has adverse effects on cardiometabolic profiles that are linked to an increased risk of atherosclerosis in women. A healthy diet during the menopausal transition may counteract the menopause-induced atherosclerotic risk. OBJECTIVE: This prospective cohort study aimed to examine the associations between empirically derived dietary patterns and subclinical carotid atherosclerosis in midlife women. METHODS: A total of 1246 midlife women (average age at baseline: 46.3 y) from the Study of Women's Health Across the Nation who completed dietary assessments and had a carotid ultrasound scan were included. Dietary data were collected at 3 time points, during 1996-1997, 2001-2003, and 2005-2007. Measures of carotid atherosclerosis included common carotid artery intima-media thickness (CCA-IMT), adventitial diameter (AD), and carotid plaque index collected during 2009-2013. Three statistical methods, including principal component analysis (PCA), reduced rank regression (RRR), and partial least squares regression (PLS), were used to identify dietary patterns. RESULTS: A Western dietary pattern was identified from each method and a Prudent dietary pattern from PCA. High adherence to the Western pattern was associated with higher CCA-IMT. Women in the fourth quartile of the Western pattern identified by PCA, RRR, and PLS had 0.042 mm (95% CI: 0.011, 0.073), 0.033 mm (95% CI: 0.0086, 0.057), and 0.049 mm (95% CI: 0.025, 0.074), respectively, larger CCA-IMT than women in the first quartile; these differences correspond to 30%, 24%, and 35% of the sample SD, respectively. The Prudent pattern was not significantly associated with CCA-IMT. No significant associations were found between the identified dietary patterns and AD or carotid plaque. CONCLUSIONS: The positive association between the Western diet and CCA-IMT was robust under different dietary pattern derivation methods. The adoption of a diet low in red meat, processed meat, deep-fried products, and sugar-sweetened beverages among midlife women is associated with a lower future risk of atherosclerosis.

Body mass index versus bioelectrical impedance analysis for classifying physical function impairment in a racially diverse cohort of midlife women: the Study of Women's Health Across the Nation (SWAN).

BACKGROUND: Body composition strongly influences physical function in older adults. Bioelectrical impedance analysis (BIA) differentiates fat mass from skeletal muscle mass, and may be more useful than body mass index (BMI) for classifying women on their likelihood of physical function impairment. AIMS: This study tested whether BIA-derived estimates of percentage body fat (%BF) and height-normalized skeletal muscle mass (skeletal muscle mass index; SMI) enhance classification of physical function impairment relative to BMI. METHOD: Black, White, Chinese, and Japanese midlife women (N = 1482) in the Study of Women's Health Across the Nation (SWAN) completed performance-based measures of physical function. BMI (kg/m2) was calculated. %BF and SMI were derived through BIA. Receiver-operating characteristic (ROC) curve analysis, conducted in the overall sample and stratified by racial group, evaluated optimal cutpoints of BMI, %BF, and SMI for classifying women on moderate-severe physical function impairment. RESULTS: In the overall sample, a BMI cutpoint of ≥ 30.1 kg/m2 correctly classified 71.1% of women on physical function impairment, and optimal cutpoints for %BF (≥ 43.4%) and SMI (≥ 8.1 kg/m2) correctly classified 69% and 62% of women, respectively. SMI did not meaningfully enhanced classification relative to BMI (change in area under the ROC curve = 0.002; net reclassification improvement = 0.021; integrated discrimination improvement = - 0.003). Optimal cutpoints for BMI, %BF, and SMI varied substantially across race. Among Black women, a %BF cutpoint of 43.9% performed somewhat better than BMI (change in area under the ROC curve = 0.017; sensitivity = 0.69, specificity = 0.64). CONCLUSION: Some race-specific BMI and %BF cutpoints have moderate utility for identifying impaired physical function among midlife women.

Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes.

BACKGROUND: African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. RESEARCH DESIGN AND METHODS: This randomized controlled trial (n = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. RESULTS: At 6 months, A1c decreased significantly more in the intervention group than the control group (- 0.76 vs - 0.21%, p = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months - 0.63 intervention vs - 0.45 control, p = 0.52). There was a decrease in A1c over 18 months in both the intervention (ß = - 0.026, p = 0.003) and the comparison arm (ß = - 0.018, p = 0.048) but no difference in trend (p = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p = 0.002) and diet quality (4.0 vs - 0.5 point change, p = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p < 0.05) at 12 months. CONCLUSIONS: The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months. NIH TRIAL REGISTRY NUMBER: NCT01901952.

Nutrition quality of food purchases varies by household income: the SHoPPER study.

BACKGROUND: Lower household income has been consistently associated with poorer diet quality. Household food purchases may be an important intervention target to improve diet quality among low income populations. Associations between household income and the diet quality of household food purchases were examined. METHODS: Food purchase receipt data were collected for 14 days from 202 urban households participating in a study about food shopping. Purchase data were analyzed using NDS-R software and scored using the Healthy Eating Index 2010 (HEI 2010). HEI total and subscores, and proportion of grocery dollars spent on food categories (e.g. fruits, vegetables, sugar sweetened beverages) were examined by household income-to-poverty ratio. RESULTS: Compared to lower income households, after adjusting for education, marital status and race, higher income households had significantly higher HEI total scores (mean [sd] = 68.2 [13.3] versus 51.6 [13.9], respectively, adjusted p = 0.05), higher total vegetable scores (mean [sd] = 3.6 [1.4] versus 2.3 [1.6], respectively, adjusted p < .01), higher dairy scores (mean [sd] = 5.6 [3.0] versus 5.0 [3.3], p = .05) and lower proportion of grocery dollars spent on frozen desserts (1% [.02] versus 3% [.07], respectively, p = .02). CONCLUSIONS: Lower income households purchase less healthful foods compared with higher income households. Food purchasing patterns may mediate income differences in dietary intake quality. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02073643.

Psychosocial factors associated with treatment outcomes in women with obesity and major depressive disorder who received behavioral activation for depression.

Behavioral activation is an empirically supported treatment for depression, but much is unknown about factors associated with treatment response. The present study aimed to determine whether baseline levels and subsequent changes in psychosocial factors were associated with improvement in depression in women with comorbid obesity who received behavioral activation treatment for depression and a lifestyle intervention. Multilevel modeling was used to estimate the associations between psychosocial factors and change in depression scores during the first 10 weeks of treatment and associations between changes in psychosocial factors from baseline to 6-month follow-up and change in depression over the same time period. No baseline psychosocial factors were associated with depression improvement during treatment (p = 0.110-0.613). However, greater improvement in hedonic capacity (p = 0.001), environmental reward (p = 0.004), and social impairment (p = 0.012) were associated with greater reductions in depression over 6 months. Findings highlight the differential relationship specific psychosocial factors have with depression treatment outcomes.

Leveraging delay discounting for health: Can time delays influence food choice?

Delay discounting, the tendency to choose smaller immediate rewards over larger delayed rewards, is theorized to promote consumption of immediately rewarding but unhealthy foods at the expense of long-term weight maintenance and nutritional health. An untested implication of delay discounting models of decision-making is that selectively delaying access to less healthy foods may promote selection of healthier (immediately available) alternatives, even if they may be less desirable. The current study tested this hypothesis by measuring healthy versus regular vending machine snack purchasing before and during the implementation of a 25-s time delay on the delivery of regular snacks. Purchasing was also examined under a $0.25 discount on healthy snacks, a $0.25 tax on regular snacks, and the combination of both pricing interventions with the 25-s time delay. Across 32,019 vending sales from three separate vending locations, the 25-s time delay increased healthy snack purchasing from 40.1% to 42.5%, which was comparable to the impact of a $0.25 discount (43.0%). Combining the delay and the discount had a roughly additive effect (46.0%). However, the strongest effects were seen under the $0.25 tax on regular snacks (53.7%) and the combination of the delay and the tax (50.2%). Intervention effects varied substantially between vending locations. Importantly, time delays did not harm overall vending sales or revenue, which is relevant to the real-world feasibility of this intervention. More investigation is needed to better understand how the impact of time delays on food choice varies across populations, evaluate the effects of time delays on beverage vending choices, and extend this approach to food choices in contexts other than vending machines. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02359916.

To what extent do food purchases reflect shoppers' diet quality and nutrient intake?

BACKGROUND: Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake. METHODS: Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data. RESULTS: HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39). CONCLUSIONS: Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02073643 . Retrospectively registered.

Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies.

Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.

Organized Sports and Unstructured Active Play as Physical Activity Sources in Children From Low-Income, Chicago Households.

PURPOSE: This study tested associations of organized sports participation and unstructured active play with overall moderate and vigorous physical activity (MVPA) in low-income children and examined factors associated with participation frequency. METHOD: Research staff visited 88 low-income Chicago households with children ages 6-13 years. MVPA was assessed through 7-day accelerometry. Researchers documented the home availability of physical activity equipment. Caregivers reported on child participation in organized sports and unstructured active play, family support for physical activity, perceived neighborhood safety, and access to neighborhood physical activity venues. RESULTS: Despite similar participation in organized sports and unstructured active play, boys accumulated more MVPA than girls. MVPA was predicted by an interaction between gender and unstructured active play. Boys accumulated 23-45 additional minutes of weekday MVPA and 53-62 additional minutes of weekend MVPA through unstructured active play, with no such associations in girls. Higher reported neighborhood safety and family support for physical activity were associated with engagement in unstructured active play for both genders, and with participation in organized sports for girls. CONCLUSION: Physical activity interventions for low-income, urban children should emphasize unstructured active play, particularly in boys. Fostering family support for physical activity and safe play environments may be critical intervention components.

Meal preparation and cleanup time and cardiometabolic risk over 14 years in the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE: To determine whether baseline levels and longitudinal changes in meal preparation and cleanup time are associated with changes in cardiometabolic risk factors in midlife women. METHODS: Subjects were 2755 midlife women enrolled in the Study of Women's Health Across the Nation, a multi-ethnic, longitudinal cohort study in the United States. The five diagnostic components of the metabolic syndrome and meal preparation/cleanup time were assessed repeatedly across 14 years of follow-up (spanning 1996-2011) at seven U.S. sites. Mixed-effects logistic and ordered logistic models tested associations between meal preparation/cleanup time and odds of meeting criteria for metabolic syndrome and its individual diagnostic components. RESULTS: Women who spent more time preparing and cleaning up meals at baseline, or demonstrated greater increases in this activity, had greater increases over time in their odds of having metabolic syndrome and in the number of metabolic syndrome components for which they met criteria. Adjusted associations were observed between meal preparation/cleanup time and hypertension, impaired fasting glucose, hypertriglyceridemia, and low high-density lipoprotein cholesterol, but not abdominal obesity. CONCLUSIONS: In midlife women, greater meal preparation/cleanup time is associated with the development of an adverse cardiometabolic risk profile. Public health interventions should place greater emphasis on cooking healthfully, not just cooking frequently.

Neighborhood socioeconomic status during childhood versus puberty in relation to endogenous sex hormone levels in adult women.

BACKGROUND: Socioeconomic adversity in early life is related to cardiovascular risk in adulthood; however, no studies have examined whether such adversity may be related to endogenous sex hormones, which are themselves associated with cardiovascular outcomes, or whether the timing of adversity exposures (childhood vs. puberty) matters. OBJECTIVE: The goal of the current study was to separately examine neighborhood socioeconomic status (SES) during periods of childhood and puberty in relation to adulthood levels of endogenous sex hormones (estradiol [E2], testosterone), sex hormone binding globulin (SHBG), and a derived index of bioavailable testosterone (free androgen index). METHODS: In a sample of 143 premenopausal women (mean age = 36.8 [SD = 5.5]; 51.7% White, 32.2% African American, 5.6% Latina, 7.0% Chinese, and 3.5% Filipina), retrospective reports of residential address information in designated periods of childhood and puberty were used to derive U.S. census-based neighborhood SES composite scores characterizing the socioeconomic environments of women during these periods. RESULTS: In covariate-adjusted analyses, higher neighborhood SES in puberty predicted higher levels of SHBG in adulthood, but neighborhood SES during childhood did not (standardized regression coefficient = .24, p = .01 vs. standardized regression coefficient = .04, p = .75, respectively). Neighborhood SES was not predictive of other hormones (E2, testosterone, and free androgen index). DISCUSSION: The current findings suggest that puberty may be a time of particular vulnerability to the effects of neighborhood SES on SHBG levels, which have been linked to cardiovascular risk factor profiles and atherosclerotic disease progression.

Body image satisfaction and depression in midlife women: the Study of Women's Health Across the Nation (SWAN).

With aging, women's bodies undergo changes that can affect body image perception, yet little is known about body image in midlife. The purpose of this study was to examine associations between body image and depressive symptoms in Caucasian and African-American midlife women from the Study of Women's Health Across the Nation (SWAN) Chicago site. Body image was measured using the Stunkard Adult Female Figure Rating Scale, and a clinically significant level of depressive symptoms was defined as Center for Epidemiologic Studies Depression Scale (CES-D) score of ≥16 (N=405; N=63 (15.6%) with clinically significant levels of depressive symptoms). Differences between perceived actual, perceived ideal, and actual body size and responses to questions concerning weight satisfaction and attractiveness were examined using logistic regression for associations with a CES-D score of ≥16. Women with body image dissatisfaction (odds ratio (OR)=1.91; p=0.04) or who perceived themselves as "unattractive" (OR=7.74; p<0.01) had higher odds of CES-D of ≥16. We found no significant difference by race. Our results were not confounded by BMI. These results suggest that midlife women with poor body image may be more likely to have clinically significant levels of depressive symptoms. Larger prospective studies are needed to better understand this association.

The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time.

BACKGROUND: Childhood obesity disproportionally affects children from low-income households. With the aim of informing interventions, this study examined pathways through which the physical and social home environment may promote childhood overweight/obesity in low-income households. METHODS: Data on health behaviors and the home environment were collected at home visits in low-income, urban households with either only normal weight (n = 48) or predominantly overweight/obese (n = 55) children aged 6-13 years. Research staff conducted comprehensive, in-person audits of the foods, media, and sports equipment in each household. Anthropometric measurements were collected, and children's physical activity was assessed through accelerometry. Caregivers and children jointly reported on child sleep duration, screen time, and dietary intake of foods previously implicated in childhood obesity risk. Path analysis was used to test direct and indirect associations between the home environment and child weight status via the health behaviors assessed. RESULTS: Sleep duration was the only health behavior associated with child weight status (OR = 0.45, 95% CI: 0.27, 0.77), with normal weight children sleeping 33.3 minutes/day longer on average than overweight/obese children. The best-fitting path model explained 26% of variance in child weight status, and included paths linking chaos in the home environment, lower caregiver screen time monitoring, inconsistent implementation of bedtime routines, and the presence of a television in children's bedrooms to childhood overweight/obesity through effects on screen time and sleep duration. CONCLUSIONS: This study adds to the existing literature by identifying aspects of the home environment that influence childhood weight status via indirect effects on screen time and sleep duration in children from low-income households. Pediatric weight management interventions for low-income households may be improved by targeting aspects of the physical and social home environment associated with sleep.

Food preparation supplies predict children's family meal and home-prepared dinner consumption in low-income households.

Frequent family meals and home food preparation are considered important for children's nutritional health and weight maintenance. This cross-sectional study tested whether these parent-driven behaviors are related to the availability of food preparation supplies in low-income urban households. Caregivers of children ages 6-13 provided information on family meal frequency, child consumption of home-prepared dinners, household food insecurity, and attitudes towards cooking. Researchers used a newly developed Food Preparation Checklist (FPC) to assess the availability of 41 food preparation supplies during a physical audit of the home environment. Caregivers and children provided anthropometric measurements and jointly reported on child dietary intake. In ordinal logistic regression models, greater home availability of food preparation supplies was associated with more frequent family meals and child consumption of home-prepared dinners. Associations were independent of household financial strain, food insecurity, caregiver attitudes toward cooking, and sociodemographic characteristics. Fewer food preparation supplies were available in households characterized by greater food insecurity, lower income, and negative caregiver attitudes towards cooking, but did not differ by child or caregiver weight status. As in prior studies, more frequent family meals and consumption of home-prepared dinners were associated with healthier child dietary intake in several areas. We conclude that food preparation supplies are often limited in the most socioeconomically disadvantaged households, and their availability is related to the frequency with which children consume family meals and home-prepared dinners. The potential role of food preparation supplies as contributors to socioeconomic disparities in child nutritional health and obesity deserves further study.