"Struggle at night - He doesn't let me sleep sometimes": a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity.

BACKGROUND: Hispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents' nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers. METHODS: This qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018-2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes. RESULTS: Mothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn't bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors. CONCLUSIONS: Pediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are "practical." Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.

The early effects of cumulative and individual adverse childhood experiences on child diet: Examining the role of socioeconomic status.

Adverse Childhood Experiences (ACEs) have been associated with detrimental long-term health outcomes, including obesity risk. Existing research has yet to examine whether early life ACEs are associated with diet in early childhood within socioeconomic subgroups. Data were drawn from the Early Childhood Longitudinal Study-Birth Cohort (2001-2002). Mother-child dyads (n = 7000) were recruited when children were 9-months old, and followed longitudinally at 2 years, and 4 years. Mothers reported children's exposure to five ACEs at 9-months and 2 years and children's daily intake of fruits, vegetables, sweet snacks, and sugar-sweetened beverages (SSBs) at 4 years. Weighted multiple linear regression models tested the effect of cumulative and individual ACEs on child diet in full, low-, and high-SES samples. Cumulative ACE score was inversely associated with frequency of fruit intake in full (b = -0.08, p = 0.005) and low-SES samples (b = -0.10, p < 0.001). Domestic violence was associated with less frequent fruit intake in full (b = -0.21, p = 0.01) and low-SES samples (b = -0.29 p = 0.008). In the full sample, incarceration was associated with less frequent fruit intake (b = -0.24, p = 0.02), and domestic violence was associated with higher sweet snack (b = 0.22, p = 0.01) and SSB intake (b = 0.27, p = 0.009). Results provide preliminary evidence on the association between cumulative and specific ACEs and child diet, and how this relationship varies by SES context. Future research is needed to understand the complex multi-level mechanisms operating along this pathway in order to inform interventions supporting behavior change and to build evidence for policies that may reduce diet-related disparities in ACE exposure.

Faith Communities' Improvements in Readiness to Engage in Addictions Resilience and Recovery Support Programming.

Spirituality and religion are well-documented components of prevention, treatment and recovery of substance use disorders. Faith communities are in a distinct position to support recovery and resilience regarding substance use disorders-not only in times of crisis, but every day. We conducted an exploratory study of congregational (i.e., organizational) "levers" that can drive change readiness in implementing recovery and resilience programming for substance use disorders within faith communities. Findings point to enhanced effectiveness post-intervention and the importance of developing awareness of resources to help with someone who has an alcohol or other drug problem.

Understanding feeding practices of Latinx mothers of infants and toddlers at risk for childhood obesity: A qualitative study.

Infancy and toddlerhood are critical stages for the development of habits that can lead to future obesity, and caregivers have an important influence on these habits. We conducted this qualitative semistructured interview study to explore the feeding practices of Latinx mothers of young children who are at risk for childhood obesity in order to identify targets for obesity prevention. We interviewed Latinx mothers (N = 14) of a child ages 6-18 months with a weight-for-length ratio > 85th percentile at the time of recruitment. Two researchers independently read through the interviews, identified sections of the interviews pertaining to feeding, and used constant comparative methods to identify the following common themes: mothers overwhelmingly reported permissive feeding styles, driving overfeeding and frequent night-time feeding. Mothers expressed some difficulty with transitioning to solid foods and reported desiring to feed their child healthy foods by minimizing juice and giving vegetables. Paediatricians and WIC staff were viewed by mothers as trustworthy sources of nutrition information. Most identified a connection between their child's weight and diet, but many lacked the insight or capacity to change their current practices. The mothers in our study provide insight into factors that may predispose young children to obesity and thus potential avenues to support these families. Healthcare providers can better serve them by giving clear, actionable advice on healthy feeding practices for their child, while understanding constraints that may make healthy habits difficult to implement. Paediatricians should be honest about their child's weight status early on to allow time for intervention.

Interleukin 27 polymorphisms, their association with insulin resistance and their contribution to subclinical atherosclerosis. The GEA Mexican study.

Our previous data suggest that the heterodimeric interleukin-27 (IL-27) could participate in the developing of insulin resistance (IR). Our aim was to assess the participation of IL-27p28 gene single nucleotide polymorphisms (SNPs) as markers for IR, subclinical atherosclerosis (SA) and cardiovascular risk factors in a Mexican population. Five IL-27p28 SNPs (rs153109, rs40837, rs17855750, rs26528 and rs181206) were genotyped in 856 individuals with IR and 644 participants without IR. Under inheritance models adjusted for confounding factors, the rs153109A (0.78[0.64-0.94] Padditive = 0.008, 0.58[0.41-0.82] Precessive = 0.002, 0.57[0.38-0.83] Pcodominant2 = 0.004), rs26528T (0.78[0.64-0.94] Padditive = 0.008, 0.61[0.43-0.88] Precessive = 0.007, 0.57[0.38-0.84] Pcodominant2 = 0.004) and rs40837A (0.76[0.63-0.92] Padditive = 0.004; 0.60[0.42-0.86] Precessive = 0.005; 0.54[0.37-0.80] Pcodominant2 = 0.002) alleles were related with a decreased risk of IR. Moreover, AAATA haplotype that contains the protector alleles was related with 17% lower risk of presenting IR (0.83 [0.71-0.98], P = 0.023). After adjusting for potential confounding variables, IL-27p28 SNPs were not associated with SA. However, some SNPs were associated with hypertension (rs26528 and rs40837) and increased total abdominal fat (rs17855750) in non-IR individuals, whereas in IR subjects we observed an association of rs26528 and rs40837 with hypoadiponectinemia. Our evidence suggests that rs40837A, rs153109A, and rs26528T alleles could be envisaged as protective markers for IR. Some polymorphisms showed an association with hypertension, low adiponectin levels, and increased total abdominal fat.

Assessing how alcohol use patterns relate to obesity among American adolescents from rural and urban areas: Five years of pooled data.

BACKGROUND: Obesity is associated with locality and alcohol use; however, less is known about how the interaction of these two factors may compound the risk of obesity among adolescents. OBJECTIVES: This study examines the relationship between alcohol use and obesity among adolescents from rural and urban areas in the United States. METHODS: Data came from a sample of American adolescents aged 12-17 years from the National Survey on Drug Use and Health (2015-2019; n = 39,489). Obesity was regressed on age, sex, race/ethnicity, income, cigarette smoking, locality, and alcohol use, with an interaction term to examine locality x alcohol use. Predicted probabilities were plotted to assess the interaction. RESULTS: Compared to adolescents from urban areas, those from rural areas had 1.35 times higher odds of being obese (95% CI 1.25, 1.47). Predicted probabilities indicated that the probability of being obese was higher for rural adolescents at lower levels of drinking, up to about 40 drinks in the past 12 months. CONCLUSIONS: Findings suggest rural-urban differences at the intersection of alcohol use and obesity could depend on the frequency of use, but overall adolescents from rural areas may be more at risk.

Family resilience mediates exposure to adverse childhood experiences on insufficient sleep among children: findings from a population-based study.

Background: Sleep plays a vital role in the well-being of children and adolescents. Researchers have identified adverse childhood experiences (ACEs) as an important factor associated with poor sleep among adolescents. The objective of this study was to examine the mediating role of family resilience on the association between ACEs and insufficient sleep among adolescents in the United States. Methods: Data for this study came from the 2018-2019 National Survey of Children's Health (N = 28,097). The outcome variable in this study was insufficient sleep, and the main explanatory variable was exposure to ACEs. The mediating variable was family resilience. Data were analyzed using binary logistic regression. Results: Based on parent reports, one in five (22.4%) adolescents did not meet the recommended sleep hours on an average night. About half of the adolescents had no ACEs, 24.2% had one ACE, and 14.6% had three or more ACEs. Controlling for the effect of other factors and family resilience, the odds of having insufficient sleep were 1.63 times higher for children exposed to three or more ACEs (AOR = 1.63, 95% CI = 1.30-2.05). Family resilience partially mediates the association between exposure to ACEs and insufficient sleep. Each additional increase in family resilience decreased the odds of having insufficient sleep by a factor of 12% (AOR = 0.88, 95% CI = 0.86-0.91). Conclusions: Family resilience partially mediated exposure to ACEs on insufficient sleep. There are modifiable factors that may improve sleep outcomes among adolescents who have been exposed to adversity. Future research can help elucidate findings and establish the directionality of this association.

Social Inequalities in Multiple Chronic Disease Risk Factors among a population-based Sample of Latinas in California.

Data from 1,248 Latina mothers who participated in the Geographic Research on Wellbeing (GROW) study were used to examine associations between SES, neighborhood-level Latinx concentration, neighborhood-level poverty and having two or more modifiable behavioral risk factors (e.g., smoking, drinking) for chronic disease. Logistic regression models were estimated stratified by nativity and adjusted for age and marital status. Among immigrants, low SES was associated with higher odds of multiple risk factors (Adjusted Odds Ratio [AOR] = 1.66, 95% Confidence Interval [CI] = 1.17-2.38). Among US-born women, low neighborhood-level Latinx concentration was associated with lower odds of multiple risk factors (AOR = 0.43, 95% CI = 0.22-0.84), and high neighborhood-level poverty (AOR = 2.83, 95% CI = 1.61-4.99) and low SES (AOR = 1.72, 95% CI = 1.02-2.92) were associated with higher odds, respectively. Heterogeneous effects between nativity and social factors may produce risk for chronic disease among Latinas.

Socioeconomic disparities in health outcomes in the United States in the late 2010s: results from four national population-based studies.

BACKGROUND: Despite the importance of monitoring health disparities by multiple socioeconomic categories, there have been no recent updates on the prevalence of general health indicators by socioeconomic categories. The present study aims to update the prevalence estimates of health indicators by education and income categories across three age groups (children, young and middle-aged adults, and older adults) in the late 2010s by using four nationally representative data sources. We also examine socioeconomic differences in health by race/ethnicity subgroups. METHODS: Data were obtained from four nationally representative data sources from the U.S.: The National Health Interview Survey (2015-2018); the National Health and Nutrition Examination Survey, NHANES (2017-2020); the Behavioral Risk Factor Surveillance System (2016-2020); and the Health & Retirement Study (2016). Respondent-rated health and obesity were selected as the health indicators of interest. Socioeconomic factors included percentages of the federal poverty level and years of educational attainment. We conducted logistic regression analyses to calculate adjusted prevalence rates of respondent-rated (or measured, in the case of obesity in NHANES) poor health and obesity by income and education categories after controlling for sociodemographic characteristics. The complex sampling designs were accounted for in all analyses. RESULTS: Prevalence rates across racial/ethnic groups and age groups demonstrated clear and consistent socioeconomic gradients in respondent-rated poor health, with the highest rates among those in the lowest income and education categories, and decreased rates as income and education levels increased. On the other hand, there were less evident socioeconomic differences in obesity rates across all data sources, racial/ethnic groups, and age groups. CONCLUSIONS: Our results confirmed earlier, persistent evidence indicating socioeconomic disparities in respondent-rated poor health across all age and race/ethnicity groups by using four nationally representative datasets. In comparison to a decade earlier, socioeconomic disparities in poor health appeared to shrink while they emerged or increased for obesity. The results suggest an urgent need for action to alleviate pervasive health disparities by socioeconomic status. Further research is needed to investigate potentially modifiable factors underlying socioeconomic disparities in health, which may help design targeted health promotion programs.

Individualistic Versus Collaborative Learning in an eHealth Literacy Intervention for Older Adults: Quasi-Experimental Study.

BACKGROUND: Older adults tend to have insufficient health literacy, which includes eHealth literacy-the ability to access, assess, and use digital health information. Interventions using methods such as collaborative learning (CL) and individualistic learning (IL) may be effective in addressing older adults' low eHealth literacy, but little is known about the short- and long-term effects of CL versus IL on older adults' eHealth literacy. OBJECTIVE: The objective of this study was to use a 3 × 2 × 3 mixed factorial design to examine older adults' learning with CL versus IL for eHealth literacy. METHODS: Older adults (N=466; mean age 70.5, SD 7.2; range 60-96 years) from diverse racial and ethnic groups were randomly assigned to either the CL or IL group (233/466, 50% in each). The intervention consisted of 4 weeks of training in 2-hour sessions held twice a week. Using ANOVA and multiple regression, we focused on the main effects of learning condition and interaction between learning condition and previous computer experience. Learning method (CL or IL) and previous computer experience (experienced, new, or mixed) were between-subject variables, and time of measurement (pretest measurement, posttest measurement, and 6-month follow-up) was the within-subject variable. Primary outcome variables were eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills. Control variables were age, sex, education, health status, race and ethnicity, income, primary language, and previous health literacy. RESULTS: eHealth literacy efficacy, computer and web knowledge, basic computer and web operation skills, information-seeking skills, and website evaluation skills improved significantly (P<.001 in all cases) from before to after the intervention. From postintervention measurement to 6-month follow-up, there was a significant interaction between learning condition and previous computer experience based on 1 outcome measure, computer and web operation skills (F2,55=3.69; P=.03). To maintain computer and web operation skills 6 months after the intervention, it was more effective for people with little to no previous computer experience to learn individually, whereas for people with more previous computer experience, it was more effective to learn collaboratively. From postintervention measurement to 6-month follow-up, statistically significant decreases were found in 3 of the 5 outcome measures: eHealth literacy efficacy, computer and web knowledge, and basic computer and web operation skills (P<.001 for all 3 cases). CONCLUSIONS: Older adults' eHealth literacy can be improved through effective intervention, and the IL or CL condition may have little effect on short-term outcomes. However, to maintain long-term benefits, it may be best to learn collaboratively with others who have similar previous computer experience. eHealth literacy is multidimensional, with some components retained better over time. Findings suggest a need for resources to provide continuous training or periodic boosting to maintain intervention gains.

From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update.

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.

The co-occurrence of adverse childhood experiences and mental health among Latina/o adults: A latent class analysis approach.

Adverse childhood experiences (ACEs) have been linked to poor mental health among Latina/os. Few studies, however, have attempted to understand the extent to which ACEs co-occur and whether different forms of ACE co-occurrence differentially shape poor mental health patterns among Latina/os. The present study begins to address this gap by (1) identifying latent classes of ACEs and (2) determining whether and how different ACE classes shape high depressive symptoms among Latina/o adults. Data were drawn from two waves of the Hispanic Community Health Study/Study of Latinos, a longitudinal, community-based sample of Latina/os living in four urban communities. Latent Class Analysis (LCA) was used to identify subgroups of Latina/os who were exposed to co-occurring forms of maltreatment. Results from the LCA revealed four classes: (1) high ACEs, (2) emotional and physical abuse, (3) low ACEs, and (4) household alcohol/drug use and parental separation/divorce. Regression analyses indicate, when compared to the low ACEs class, Latina/os in the high ACEs class and emotional/physical abuse class were more likely to report high depressive symptoms. Findings from this study demonstrate ACEs co-occur in distinct classes of maltreatment and different combinations of ACEs uniquely shape the risk of poor mental health among Latina/os. Results from this study can help inform tailored mental health interventions for Latina/os that have a history of ACE exposure.

Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region.

As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.

Alors que les mesures d'urgence de santé publique liées au COVID-19 prennent fin, les communautés socialement vulnérables ont un accès réduit aux ressources permettant de remédier aux disparités sociales et de la santé créées ou exacerbées par la pandémie. Les travailleurs sociaux doivent défendre l'accès aux soins de santé en tant que droit humain dans l'ère post-pandémique en réduisant la vulnérabilité sociale et en renforçant la résilience des communautés pour répondre aux futures urgences sanitaires et catastrophes naturelles. Cet article s'appuie sur les expériences d'une équipe de chercheurs, d'étudiants et de praticiens en travail social engagés dans des efforts visant à diffuser des informations sur les mesures préventives du COVID et à faciliter l'accès aux ressources santé et sociales locales. Ce projet, basé dans l'une des zones métropolitaines urbaines à la croissance la plus rapide des États-Unis, faisait partie de la réponse fédérale en matière de recherche visant à promouvoir l'engagement communautaire dans les régions les plus touchées de manière disproportionnée par la pandémie de COVID-19. Grâce à notre participation à des foires sur la santé et à des événements communautaires ciblant les personnes ayant un accès limité aux ressources de santé, nous avons recueilli des informations essentielles sur la manière de renforcer les capacités communautaires pour un engagement communautaire significatif. En nous appuyant sur un modèle conceptuel pour évaluer les stratégies d'engagement communautaire, nous décrivons trois principaux obstacles à la sensibilisation communautaire collaborative : une communication et une coordination organisationnelles faibles, des stratégies incohérentes pour demander des services de santé sur place et une faible sensibilisation du quartier aux événements de sensibilisation. Nous proposons des stratégies d'amélioration qui engagent les organisations communautaires, les systèmes de santé, les organisations de base et les membres de la communauté dans des activités ciblées visant à renforcer la résilience communautaire. Cela comprend la communication inter-organisationnelle lors de la planification des événements de sensibilisation, les processus formels visant à promouvoir une plus grande utilisation des services de santé mobiles, la communication centralisée des événements et la promotion des événements de sensibilisation au niveau local.

Breastfeeding, socioeconomic status, and long-term postpartum weight retention.

BACKGROUND: Almost half of all pregnant women in the United States gain weight above Institute of Medicine gestational weight gain guidelines. Breastfeeding has been shown to reduce weight retention in the first year postpartum; however, women with lower socioeconomic status (SES) tend to initiate breastfeeding less often than women with higher SES. We investigated associations between duration of breastfeeding with mother's long-term postpartum weight status at 4-10 years and evaluated whether the associations varied by SES. METHODS: Maternal and infant dyads (N = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), 2012-2013, a long-term, cross-sectional follow-up of the Maternal and Infant Health Assessment (MIHA) based in California, USA. Pre-pregnancy body mass index (BMI) was obtained from self-report of height and weight during MIHA, while breastfeeding history and self-report of current body weight was collected at the 4-10 year GROW postpartum visit. SES score was derived from a composite score of percent federal poverty level and education and was dichotomized into High and Low SES groups at a score of three. Multivariable linear regression was used to examine association between breastfeeding and maternal weight status, and to examine for effect modification by SES. RESULTS: Average long-term weight retention 4-10 years postpartum was 4.0 kg. Fewer lower SES vs. higher SES women breast fed at least six months (51% versus 70%, p < .001) or ever breastfed (74% versus 89%, P < .001). Women who breastfed at least six months had lower long-term postpartum weight retention compared to those who did not (b = -1.06 kg, (-1.93, 0.25); p = 0.01); however, these association did not vary by SES. CONCLUSION: Six months of breastfeeding is associated with lower BMI at 4-10 years and lower body weight, and effects do not vary by SES. Future policies and guidelines should consider building an infrastructure that is supportive of longer breastfeeding duration. Moreover, further research is needed to identify the impact of additional behavioral and environmental factors on long-term maternal weight status. Understanding the drivers of excessive weight retention pospartum can help us not only improve the pregnant person's health but the health of their children.

Mental Health Trajectories of Latinx Female Caregivers and Young Children During COVID-19: A Longitudinal Analysis.

Studies of the impact of COVID-19 on mental health symptoms suggest that there may be a unique impact of COVID-19 on minoritized individuals, young children (children five and younger), and their caregivers. Longitudinal studies with representative samples including minoritized populations are needed to accurately reflect the experience of families during COVID-19. The current study used a longitudinal design to assess trajectories of mental health among Latinx female caregivers and their young children over time, beginning prior to the onset of the COVID-19 pandemic and over the course of 12 months. In fall of 2019, Latinx female caregivers (N = 213; 93.0% biological mother) of young children (M age = 5.38, SD = 0.34) reported on their own and their child's (52.6% female) mental health symptoms, as well as parenting stress, at three time points through Fall of 2020. Growth curve models showed that self-report of caregiver global mental health worsened over time, though caregiver depression and parenting stress did not change significantly, nor did caregiver-report of their children's mental health. Results suggest that while female caregiver well-being was adversely affected by COVID-19, caregivers showed resilience in the face of this pandemic, which in turn may have buffered the impact of the pandemic on Latinx child mental health. Methodological and contextual implications of these results are considered.

Investigating the co-occurrence of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation.

This study investigated the co-occurrent association of marijuana use and prescription opioid misuse with multiple suicide attempts among adolescents with a history of suicidal ideation. Data came from the 2019 Youth Risk Behavior Survey. The sample was comprised of adolescents ages 14-18 who reported suicidal ideation during the past year (n = 2,562). Multinomial logistic regression was used to examine the co-occurring association of marijuana use and prescription opioid misuse with multiple suicide attempts. Of the 2,562 adolescents who experienced suicidal ideation, 19.2 % also attempted suicide multiple times during the past year and 19.0 % reported ever using marijuana and misusing prescription opioids, 8.8 % misused prescription opioids only, and 33.3 % used marijuana only. In the multivariate model, for adolescents who used marijuana and misused prescription opioid, the risk of attempting suicide once was 1.77 times higher (RRR = 1.77, 95 % CI = 1.22-2.59) and the risk of multiple suicide attempts was 3.23 times higher (RRR = 3.23, 95 % CI = 1.95-5.33) when compared to adolescents who had never used marijuana nor misused prescription opioid. The risk of multiple suicide attempts was greater for bisexual and racial/ethnic minority adolescents and adolescents who felt sad or hopeless. Interventions that prevent prescription opioid misuse among adolescents may be effective in mitigating suicide attempts.

How Does Consistency of Food and Nutrition Support Effect Daily Food Consumption among Children Living in Poverty? Recession-Era Implications.

Underutilization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance (SNAP) food safety net programs may compromise child nutritional benefits for families with limited incomes. Using a sample of children surveyed before (2003−2006) and after the Great Recession (2007−2009), we examine whether consistent access to WIC and SNAP during times of increased economic stress moderated the association between poverty level (i.e., income-needs ratio [INR]) and fruits and vegetables (FV) or foods high in saturated fats and added sugars (SFAS). Fragile Families and Child Wellbeing Study income-eligible mothers/children (≤185% of poverty) with available FV and SFAS data at the 5- (2003−2006) and 9-year (2007−2010) waves (n = 733) were included. Main effects of INR and interaction effects of consistency of WIC, SNAP, and dual WIC and SNAP support from birth through age 5 were examined. INR was associated with decreased FV consumption frequency from age 5 to 9, conditional upon consistency of dual WIC/SNAP enrollment. FV declined when there was low consistency (<1 year) of dual support. FV consumption was stable across INR when combined WIC/SNAP support lasted at least 2 years. Results can inform strategies for optimizing the nutritional impact of WIC and SNAP by focusing on those most at risk for underutilization of multiple benefits.

Adversity and child body mass index in Fragile Families over 15 years: Do type and timing matter?

Background: Weight status has been linked to adverse childhood experiences. Existing research, however, is limited to unidimensional assessments of cumulative risk and does not account for the complex nature of adversity experienced by children in high-risk settings. We fill existing gaps by assessing how four subtypes of adversity across two primary dimensions of threat and deprivation-based adversity are associated with changes in body mass index (BMI) across child ages 3 through 15 years. Method: U.S. mothers and fathers (n = 2412) in the Fragile Families and Child Wellbeing Study were interviewed when children were born, and again at ages 1, 3, 5, 9, and 15 years. Independent variables include interpersonal (e.g., domestic violence), family (e.g., mental health), economic (e.g., housing insecurity), and community (e.g., witness/victim of violence) adversity from ages 1 through 9 years. Path analysis regressed changes in BMIz from ages 3 through 15 on past adversity exposures. Results: Increased interpersonal and community adversity subtypes from ages 3 to 5 were associated with decreased BMIz from ages 5-9 years. Increased economic adversity from age 3 to 5 was associated with increased BMIz from ages 5 to 9, adjusted for mother age, race, and education. Conclusion: Findings highlight the differential influence of past adversity type and timing on child BMI. Interpersonal and community adversity were associated with decreased BMIz, and economic adversity with increased BMIz. Differences in directionality of associations suggest research should capture multiple dimensions of adversity in early childhood and possible positive and negative trends in effects on child weight as children grow from early to mid-childhood.

A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes.

Objective: To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods: The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results: The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion: Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.

Examining School and Neighborhood Effects of Socioeconomic Status on Childhood Obesity in the U.S.

Obesity amongst Kindergartners in Texas is above the national average, particularly among Hispanic students. Research on the impact of school and neighborhood-level SES on obesity in childhood using multilevel models is lacking. Survey data were collected from Hispanic caregivers of pre-kindergarten students in Fall 2019 (n = 237). Students were clustered in thirty-two neighborhoods and twelve schools. The dependent variable was the child's body mass index z-score (BMIz). Covariates included the child's sex, primary caregiver's marital status, education level, relationship to the child, and family income. Level-two variables included neighborhood poverty and school SES. CTableross-classified multilevel linear regression models were conducted to examine the unique associations of neighborhood poverty and school SES with individual student BMIz, and how they interact. Twenty-four percent of students were classified as overweight, and five percent were classified as obese. The models resulted in a significant association between school SES and BMIz (B = −0.13; SE = 0.06; p < 0.05) and between neighborhood poverty and BMIz (B = −1.41; SE = 0.49; p < 0.01). Individual students' BMIz decreased as school SES increased and decreased as neighborhood poverty increased. Neighborhood poverty and school SES appear to play a role in the development of obesity in childhood, although in differing directions.