Evaluating the Validity of the PortionSize Smartphone Application for Estimating Dietary Intake in Free-Living Conditions: A Pilot Study.

OBJECTIVE: Evaluate the validity of the PortionSize application. METHODS: In this pilot study, 14 adults used PortionSize to record their free-living food intake over 3 consecutive days. Digital photography was the criterion measure, and the main outcomes were estimated intake of food (grams), energy (kilocalories), and food groups. Equivalence tests with ±25% equivalence bounds and Bland-Altman analysis were performed. RESULTS: Estimated gram intake from PortionSize was equivalent (P < 0.001) to digital photography estimates. PortionSize and digital photography estimated energy intake, however, were not equivalent (P = 0.08), with larger estimates from PortionSize. In addition, PortionSize and digital photography were equivalent for vegetable intake (P = 0.01), but PortionSize had larger estimates of fruits, grains, dairy, and protein intake (P >0.07; error range 11% to 23%). CONCLUSIONS AND IMPLICATIONS: Compared with digital photography, PortionSize accurately estimated food intake and had reasonable error rates for other nutrients; however, it overestimated energy intake, indicating further application improvements are needed for free-living conditions.

Validity of the PortionSize application compared with that of MyFitnessPal for accurately estimating intake: a randomized crossover laboratory-based evaluation.

BACKGROUND: PortionSize offers real-time feedback on dietary intake, including intake of MyPlate food groups but requires further evaluation on a larger sample in a laboratory-based setting. MyFitnessPal (MFP) is a commonly used commercial dietary assessment application, and to our knowledge, no known studies have evaluated MFP in a laboratory setting. OBJECTIVES: The overall objective was to test the validity of PortionSize and MFP to accurately measure intake compared with that of weighed food (WB) and to compare error between applications. A secondary objective was to test usability, satisfaction, and user preference between applications. METHODS: This randomized crossover study was completed between February and October 2021. Participants (N = 43) used both applications to estimate intake in a laboratory setting. Participants were provided with a preweighed plated meal and plated leftovers. Two 1-sided t tests assessed equivalence (±21% bounds) between simulated intake from PortionSize and WB, and MFP and WB. The primary outcome was energy intake, and secondary outcome measures were portion size (in grams), food groups, and other nutrients. Differences in relative absolute error, usability, satisfaction, and user preference between applications were evaluated using dependent samples t tests. Cohen d assessed effect size. RESULTS: For PortionSize, energy and portion size were underestimated by 13.3% and 14.0%, respectively, and were not equivalent to WB. For MFP, energy was overestimated by 7.0%, and equivalent to WB (P = 0.04). Relative absolute error for energy did not differ between applications. For PortionSize, Cohen d was small (<0.2) for fruits, grains, protein foods, and specific nutrients. No differences were seen with usability, and the only difference for satisfaction was that participants found it easier to use MFP to find foods consumed (P = 0.019), and participants preferred using MFP (P = 0.014). CONCLUSIONS: PortionSize requires further updates to improve energy estimates and usability but demonstrates clinical utility for tracking food group and nutrient intake. PortionSize did not outperform MFP for measuring energy intake. CLINICAL TRIAL REGISTRY: This trial was registered at clinicaltrials.gov as NCT04700904 (https://classic. CLINICALTRIALS: gov/ct2/show/NCT04700904).

COVID-19 Implications on Worksite Wellness Programming.

Seven of the top ten leading causes of death in the United States are due to chronic diseases and treating these accounts for 86 percent of our nation's health care costs. The workplace offers an environment to implement chronic disease prevention strategies, such as worksite wellness programs, due to the large amount of time spent at the worksite daily by employees. As a result of COVID-19, many organizations began to change their workdays (i.e., working from home). This research sought to understand what, if any, implications the COVID-19 epidemic had on worksite wellness programming. Semistructured interviews were employed and recorded via Zoom conferencing to gather qualitative data. Four themes were identified: (a) relationship building among remote employees, (b) creativity in how to carry out program components, (c) increased physical activity and work-life balance, and (d) increased knowledge of health issues and mental health resources. Both challenges and successes were reported within themes. The main finding from this research indicates a mostly positive experience for worksite wellness programs during the COVID-19 epidemic. Many organizations have continued nontraditional work environments and the lessons learned from this study can both encourage and provide ideas for how to create and continue a worksite wellness program outside of the normal face-to-face working environment.

Validity of an Artificial Intelligence-Based Application to Identify Foods and Estimate Energy Intake Among Adults: A Pilot Study.

Background: The commercial application Openfit allows for automatic identification and quantification of food intake through short video capture without a physical reference marker. There are no known peer-reviewed publications on the validity of this Nutrition Artificial Intelligence (AI). Objectives: To test the validity of Openfit to identify food automatically and semiautomatically (with user correction), test the validity of Openfit at quantifying energy intake (kcal) automatically and semiautomatically, and assess satisfaction and usability of Openfit. Methods: During a laboratory-based visit, adults (7 male and 17 female), used Openfit to automatically and semiautomatically record provided meals, which were covertly weighed. Foods logged were identified as an "exact match," "far match," or an "intrusion" using Food and Nutrient Database for Dietary Studies (FNDDS) codes. Descriptive data were stratified by meal, food item, and FNDDS group, and presented with or without beverages. Bland-Altman analyses assessed errors over levels of energy intake. Participants completed a User Satisfaction Survey (USS) and the Computer Systems Usability Questionnaire (CSUQ). Open-ended questions were assessed with qualitative methods. Results: Exact matches, far matches, and intrusions were 46%, 41%, and 13% for automated identification, and 87%, 23%, and 0% for semiautomated identification, respectively. Error for automated and semiautomated energy estimates were 43% and 33% with beverages, and 16% and 42% without beverages. Bland-Altman analyses indicated larger error for higher energy meals. Overall mean scores were 2.4 for the CSUQ and subscale means scores ranged from 4.1 to 5.5. for the USS. Participants recommended improvements to Openfit's Nutrition AI, manual estimation, and overall app. Conclusion: Openfit worked relatively well for automatically and semiautomatically identifying foods. Error in automated energy estimates was relatively high; however, after excluding beverages, error was relatively low (16%). For semiautomated energy estimates, error was comparable to previous studies. Improvements to the Nutrition AI, manual estimation and overall application may increase Openfit's usability and validity.This trial was registered at clinicaltrials.gov as NCT05343585.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium.

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.

An examination of the relationships between the neighborhood social environment, adiposity, and cardiometabolic disease risk in adolescence: a cross-sectional study.

BACKGROUND: Disadvantaged neighborhood environments are a source of chronic stress which undermines optimal adolescent health. This study investigated relationships between the neighborhood social environment, specifically, chronic stress exposures, adiposity, and cardiometabolic disease risk factors among 288 Louisiana adolescents aged 10 to 16 years. METHODS: This cross-sectional study utilized baseline data from the Translational Investigation of Growth and Everyday Routines in Kids (TIGER Kids) study. Adolescent data were obtained using self-reported questionnaires (demographics and perceived neighborhood disorder), anthropometry, body imaging, and a blood draw while objective neighborhood data for the concentrated disadvantage index were acquired from the 2016 American Community Survey five-year block group estimates, 2012-2016. Multilevel linear regression models were used to examine whether neighborhood concentrated disadvantage index and perceived neighborhood disorder were associated with body mass index, waist circumference, body fat, adipose tissue, blood pressure, and lipids. We performed multilevel logistic regression to determine the odds of elevated adiposity and cardiometabolic disease risk for adolescents living in neighborhoods with varying levels of neighborhood concentrated disadvantage and disorder. RESULTS: Adolescents living in neighborhoods with higher disadvantage or disorder had greater waist circumference and total percent body fat compared to those in less disadvantaged and disordered neighborhoods (p for trend < 0.05). Neighborhood disadvantage was also positively associated with percentage of the 95th Body Mass Index percentile and visceral abdominal adipose tissue mass while greater perceived neighborhood disorder was related to higher trunk fat mass and diastolic blood pressure (p for trend < 0.05). Living in the most disadvantaged was associated with greater odds of obesity (OR: 2.9, 95% CI:1.3, 6.5) and being in the top tertile of body fat mass (OR: 3.0, 95% CI: 1.4, 6.6). Similar results were found with neighborhood disorder for odds of obesity (OR: 2.1, 95% CI:1.1, 4.2) and top tertile of body fat mass (OR: 2.1, 95% CI:1.04, 4.1). CONCLUSIONS: Neighborhood social environment measures of chronic stress exposure were associated with excess adiposity during adolescence, and relationships were most consistently identified among adolescents living in the most disadvantaged and disordered neighborhoods. Future studies should account for the influences of the neighborhood environment to stimulate equitable improvements in adolescent health. CLINICAL TRIALS REGISTRATION: # NCT02784509.

Exploring barriers to SARS-CoV-2 testing uptake in underserved black communities in Louisiana.

OBJECTIVE: To collect qualitative data on approaches that can potentially reduce barriers to, and create strategies for, increasing SARS-CoV-2 testing uptake in underserved Black communities in Louisiana. METHODS: A series of eight focus groups, including 41 participants, were conducted in primarily Black communities. The Nominal Group Technique (NGT) was used to determine perceptions of COVID-19 as a disease, access to testing, and barriers limiting testing uptake. RESULTS: Common barriers to SARS-CoV-2 testing were identified as lack of transportation, misinformation/lack of information, lack of time/long wait times, fear of the test being uncomfortable and/or testing positive, the cost of testing, and lack of computer/smartphone/internet. The most impactful approaches identified to increase testing uptake included providing testing within the local communities; testing specifically in heavily traveled areas such as supermarkets, churches, schools, and so forth; providing incentives; engaging local celebrities; and providing information to the community through health fairs, or through churches and schools. The strategies that were deemed to be the easiest to implement revolved around communication about testing, with suggested strategies involving churches, local celebrities or expert leaders, social media, text messages, public service announcements, post cards, or putting up signs in neighborhoods. Providing transportation to testing sites, providing incentives, and bringing the testing to neighborhoods and schools were also identified as easy to implement strategies. CONCLUSIONS: Several strategies to increase testing uptake were identified in this population. These strategies need to be tested for effectiveness in real-world settings using experimental and observational study designs.

Association between Sleep, Sedentary Time, Physical Activity, and Adiposity in Adolescents: A Prospective Observational Study.

PURPOSE: This study aimed to examine the effects of substituting sedentary time with sleep or physical activity on adiposity in a longitudinal sample of adolescents. METHODS: Adolescents (10-16 yr) were recruited for a prospective observational cohort. Parents and adolescents reported demographic characteristics and pubertal development. Accelerometry was used to measure sleep, physical activity, and sedentary time. Adiposity was quantified with imaging techniques. Isotemporal substitution modeling was conducted to examine the effect of substituting 10 min of sedentary time with sleep or differing intensities of physical activity. Results were stratified by sex and race and adjusted for covariates. RESULTS: A total of 217 adolescents provided complete measures at both baseline and 2 yr later (58.1% White, 51.8% girls; 12.9 ± 1.9 yr at baseline). Sleep was negatively related to adiposity 2 yr later when considering other movement behaviors, but substituting baseline sedentary time with sleep was not related to future adiposity ( P > 0.05). In boys and non-White adolescents, substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity 2 yr later ( P < 0.05). Substituting sedentary time for moderate- to vigorous-intensity physical activity was not associated with future adiposity. CONCLUSIONS: Substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity in later adolescence in certain groups. Opportunities to promote an adequate balance of sleep, sedentary time, and physical activity in all adolescents are encouraged for optimal development.

Exploring Successful Implementation of Organizational Supports at the Worksite Environment: A Mixed Methods Approach.

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

The mediating effects of barriers to vaccination on the relationship between race/ethnicity and influenza vaccination status in a rural Southeastern Louisiana medical center.

Introduction: Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched. Methods: Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted. Results: The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p = 0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p < 0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value = 0.02, proportion mediated = 0.71). Conclusions: Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered.

The COVID-19 pandemic and associated increases in experiences of assault violence among black men with low socioeconomic status living in Louisiana.

Background: The COVID-19 pandemic has had mental health, social, and economic implications among communities with high levels of social disadvantage; this may have impacted community violence rates. The objective of this study was to characterize overall trends in assault and social disadvantage of patients experiencing assault before and during the COVID-19 pandemic. Methods: All trauma activations at a level one trauma center serving the entire southeast Louisiana region were included during March-August pre-COVID (2018-2019) and during COVID (2020). ICD-10 E-codes were used to identify trauma intent (assault vs. other). Assaults in this context are defined as physical injuries caused by an act of violence wherein the perpetrator was suspected or confirmed to have intended harm, injury, or death to the victim. Social disadvantage was assessed using the Area Deprivation Index (ADI). Change in the monthly rate of assault-trauma activations was assessed using negative binomial regression with adjustment for race, gender, and injury intent. The study was reviewed and approved by the Louisiana State University Health Sciences Institutional Review Board. Results: A total of 4,233 trauma activations were included. The majority of activations occurred among men. Assaults increased from 27.5% of all activations pre-Covid to 35.6% during the pandemic. Penetrating trauma similarly increased from 29.5% to 35.7% of all activations. Negative binomial regression demonstrated that in addition to this increase in proportion of assaults relative to all activations, the monthly assault rate also increased by 20% during the pandemic. These increases were driven primarily by increased assaults among Black men. ADI rank did not change between study periods. Conclusions: Health disparities in violence worsened during the pandemic: increased cases of assault occurred disproportionately among Black men, and assaults persisted in occurring primarily among low-ADI communities where burden had been high pre-pandemic. There is a critical need for resources and support to Black men, to mitigate violence and improve racial heath equity.

Assessing influenza vaccination coverage and predictors in persons living with HIV/AIDS in Louisiana, June 2002-June 2013.

Background: Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. Methods: We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. Results: Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. Conclusions: Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.

Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study.

BACKGROUND: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. OBJECTIVE: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. METHODS: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. RESULTS: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). CONCLUSIONS: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback.

The Potential for Bias across GPS-Accelerometer Combined Wear Criteria among Adolescents.

Physical activity has many health benefits, yet a large portion of our population is not meeting recommendations. Using accelerometry and global positioning systems (GPS) to accurately measure where people are active and to identify barriers and facilitators of activity across various settings will inform evidence-based policies and interventions to improve activity levels. Criteria for sufficient accelerometry data (e.g., number of days, minimum hours in a day) to accurately monitor free-living physical activity in adults and children have been widely studied, implemented, and reported by researchers. However, few best practice recommendations for researchers using GPS have been established. Therefore, this paper examined the impact of three co-wear criteria of varying stringency among a sample of children aged 10 to 16 years in Baton Rouge, Louisiana. Overall and location-based physical activity was consistent across the samples even within sociodemographic subgroups. Despite the lack of significant subgroup-specific mean differences in physical activity across the three samples, associations between sociodemographics and weight status and physical activity were significantly different depending on the device time-matching "co-wear" criteria applied. These differences demonstrate the critical impact co-wear criteria may have on conclusions drawn from research examining health disparities. There is a need for additional research and understanding of ideal co-wear criteria that reduce bias and accurately estimate free-living location-based physical activity across diverse populations.

PTSD treatment reduces risk of trauma recidivism in a diverse community at a safety-net hospital: A propensity score analysis of data from a level one trauma center.

BACKGROUND: Physically-traumatic injuries result in PTSD for approximately 10% of Americans, and this rate is higher among individuals of color and those living in poverty. Individuals of color living in poverty experience lower access to PTSD and other mental health services. Untreated PTSD is associated with increased risk of trauma recidivism, but it is unknown if provision of treatment is actually associated with a subsequent reduction in recidivism risk. METHODS: For this observational cross-sectional study, data were collected retrospectively from the Trauma Registry of a level one trauma center, safety-net hospital in New Orleans between 2018 and 2020. Receipt of outpatient PTSD treatment at this same hospital was evaluated via chart review of the electronic health record. Propensity score matching was used to balance confounding variables of trauma type (assault vs. non-assault), gender, and race. McNemar test and Cox proportional hazard model were used with the propensity-balanced dataset to assess differences in trauma recidivism according to PTSD treatment status. RESULTS: Among 5916 trauma activations that occurred in the study period, 92 instances of recidivism occurred. 91 pairs were established after balancing with the propensity score. 1-year recidivism was 2.2% (n = 2) of all treated individuals versus 15.4% (n = 14) of non-treated individuals (p < 0.0001). The marginal risk from the Cox proportional hazard model demonstrated an 82% reduction in risk of recidivism (p = 0.02). CONCLUSIONS: This study demonstrated that mental health treatment can be used to reduce trauma recidivism. These data were shown among a high-risk population of disproportionately Black men living in a low-income community. Ensuring access to quality mental health care is one way to address the health disparities associated with physically-traumatic injuries.

Association of Night-Time Screen-Viewing with Adolescents' Diet, Sleep, Weight Status, and Adiposity.

Night-time screen-viewing (SV) contributes to inadequate sleep and poor diet, and subsequently excess weight. Adolescents may use many devices at night, which can provide additional night-time SV. Purpose: To identify night-time SV patterns, and describe differences in diet, sleep, weight status, and adiposity between patterns in a cross-sectional and longitudinal manner. Methods: Adolescents (10-16 y) reported devices they viewed at night and completed food recalls. Accelerometry, anthropometrics, and imaging were conducted to measure sleep, weight status, and adiposity, respectively. Latent class analysis was performed to identify night-time SV clusters. Linear regression analysis was used to examine associations between clusters with diet, sleep, weight status, and adiposity. Results: Amongst 273 adolescents (12.5 ± 1.9 y, 54% female, 59% White), four clusters were identified: no SV (36%), primarily cellphone (32%), TV and portable devices (TV+PDs, 17%), and multiple PDs (17%). Most differences in sleep and adiposity were attenuated after adjustment for covariates. The TV+PDs cluster had a higher waist circumference than the no SV cluster in cross-sectional analysis. In longitudinal analysis, the primarily cellphone cluster had less change in waist circumference compared to the no SV cluster. Conclusions: Directing efforts towards reducing night-time SV, especially TV and PDs, may promote healthy development.

Association of the Neighborhood Built Environment With Incident and Prevalent Depression in the Rural South.

INTRODUCTION: A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS: We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS: Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION: The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.

Association Between Bitter Taste Receptor Phenotype and Clinical Outcomes Among Patients With COVID-19.

Importance: Bitter taste receptors (T2Rs) have been implicated in sinonasal innate immunity, and genetic variation conferred by allelic variants in T2R genes is associated with variation in upper respiratory tract pathogen susceptibility, symptoms, and outcomes. Bitter taste receptor phenotype appears to be associated with the clinical course and symptom duration of SARS-CoV-2 infection. Objective: To evaluate the association between T2R phenotype and patient clinical course after infection with SARS-CoV-2. Design, Setting, and Participants: A prospective cohort study was performed from July 1 through September 30, 2020, at a tertiary outpatient clinical practice and inpatient hospital in the United States among 1935 participants (patients and health care workers) with occupational exposure to SARS-CoV-2. Exposure: Exposure to SARS-CoV-2. Main Outcomes and Measures: Participants underwent T2R38 phenotype taste testing to determine whether they were supertasters (those who experienced greater intensity of bitter tastes), tasters, or nontasters (those who experienced low intensity of bitter tastes or no bitter tastes) and underwent evaluation for lack of infection with SARS-CoV-2 via polymerase chain reaction (PCR) testing and IgM and IgG testing. A group of participants was randomly selected for genotype analysis to correlate phenotype. Participants were followed up until confirmation of infection with SARS-CoV-2 via PCR testing. Phenotype of T2R38 was retested after infection with SARS-CoV-2. The results were compared with clinical course. Results: A total of 1935 individuals (1101 women [56.9%]; mean [SD] age, 45.5 [13.9] years) participated in the study. Results of phenotype taste testing showed that 508 (26.3%) were supertasters, 917 (47.4%) were tasters, and 510 (26.4%) were nontasters. A total of 266 participants (13.7%) had positive PCR test results for SARS-CoV-2. Of these, 55 (20.7%) required hospitalization. Symptom duration among patients with positive results ranged from 0 to 48 days. Nontasters were significantly more likely than tasters and supertasters to test positive for SARS-CoV-2 (odds ratio, 10.1 [95% CI, 5.8-17.8]; P < .001), to be hospitalized once infected (odds ratio, 3.9 [1.5-10.2]; P = .006), and to be symptomatic for a longer duration (mean [SE] duration, 23.7 [0.5] days vs 13.5 [0.4] days vs 5.0 [0.6] days; P < .001). A total of 47 of 55 patients (85.5%) with COVID-19 who required inpatient admission were nontasters. Conversely, 15 of 266 patients (5.6%) with positive PCR test results were supertasters. Conclusions and Relevance: This cohort study suggests that T2R38 receptor allelic variants were associated with participants' innate immune response toward SARS-CoV-2. The T2R phenotype was associated with patients' clinical course after SARS-CoV-2 infection. Nontasters were more likely to be infected with SARS-CoV-2 than the other 2 groups, suggesting enhanced innate immune protection against SARS-CoV-2.

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study.

BACKGROUND: Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies. METHODS: Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations. RESULTS: Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics. CONCLUSIONS: Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.