Impact of social environment on sexual behaviors of adolescent girls in 12 sub-Saharan African countries: a cross-sectional study.

BACKGROUND: Early sexual debut among adolescent girls may result in teenage pregnancy and sexually transmitted diseases. In sub-Saharan Africa (SSA), pregnancy among adolescent girls may adversely impact the continuation of their education, general health status, and birth outcomes. However, few cross-national studies have examined the role that the social environment plays in adolescent girls' sexual behaviors in SSA. In this study, we explored adolescent girls' social environment and the impact on their sexual behaviors.. METHODS: The country selection was based on availability of Global School-Based Student Health Survey (GSHS) national data (2003-2015). The total analytic sample was 22,067 adolescent girls from 12 countries in SSA. Descriptive statistics were generated to determine the characteristics of adolescent girls and independent samples t-test analysis were performed to determine whether there were differences between the social environment and age of sexual debut and sexual partners. Logistic regression models were used to determine the association between adolescent girls' social environment and sexual debut. RESULTS: The study results showed variations across the 12 countries. Almost one in five (19.9%) adolescent girls reported to have ever engaged in sexual intercourse. Their mean age of sexual debut was 13.21 (13.04-13.37) years and mean number of sexual partners was 2.19 (2.08-2.29). We found that adolescent girls who reported not being connected with their parents were more likely to debut sex (aOR = 1.32, 95% CI, 1.14-1.53, p < 0.000). Parental monitoring was significantly associated with sexual debut but after controlling for the confounding variables (age, class grade and drug use), the association was no longer significantly positively associated. Adolescent girls who felt supported by their peers had a significantly higher number of sexual partners than those who did not feel supported by their peers. CONCLUSION: The social environment of adolescent girls plays a very important role in sexual debut, age of sexual debut, and the number of sexual partners. Sexual health policies targeting adolescent girls are likely to achieve positive impacts if they focus on improving parental connectedness and peer support.

Adolescent girls in sub-Saharan Africa are at risk of dropping out of school when they get pregnant. There are also several health risks associated with adolescent pregnancies. This study explored factors in the adolescent girl's social environment which could impact their sexual behaviors. We examined data from adolescent girls in 12 sub-Saharan African Countries, namely, Kenya, Tanzania, Uganda, Ghana, Mauritania, Senegal, Swaziland, Zambia, Botswana, Namibia, Seychelles and Mozambique. After analyzing the data, we found that adolescent girls who reported not being close with their parents were more likely to debut sex. Adolescent girls who felt supported by their friends had a higher number of sexual partners. Thus, support from parents and peers play a vital role in the sexual behaviors of adolescent girls.

Disparities in the distribution of COVID-19 testing sites in black and Latino areas in new York City.

In New York City (NYC), there are disproportionately more cases and deaths from COVID-19 for Blacks and Latinos compared to Whites. Using data from the NYC coronavirus data repository and the 2018 American Community Survey 5-year census estimates, we examined the distribution of testing sites across NYC areas (zip code tabulation areas) by race in May 2020. ArcGIS was used to create majority race zip code-level maps showing the distribution of testing sites on May 1, 2020 and May 17, 2020 in NYC. t-tests were used to determine whether significant differences existed in the number of testing sites by the majority race of zip codes. Between May 1, 2020 and May 17, 2020, testing sites in majority Black areas increased by more than 240% from nine to 31, and more than 90% from 16 to 31 in majority Latino areas. Black (M = 1257.7) and Latino (M = 1662.3) areas had significantly more COVID-19 cases (p < 0.05) compared to White areas. Nonetheless, White (n = 70; 38.9%) areas had most of the 180 testing sites on May 17, 2020, compared to Black (n = 31;17.2%) and Latino (n = 31;17.2%) areas. Due to the socio-economic and underlying health conditions that may place Blacks and Latinos at high risk for COVID-19, it is imperative that access to testing is improved for vulnerable groups.

Greenspace exposure and sleep: A systematic review.

Green space is considered a critical environmental factor for sleep quality and quantity. However, no systematic review exploring this relationship exists. The purpose of this systematic review was to 1) explore research related to green space and sleep, and 2) examine the impact of green space exposure on sleep quality and quantity. Papers from eight electronic databases were eligible for inclusion if they met the following criteria: well-designed, any analysis exploring green space and sleep, provided sleep and green space measurement, published in peer-reviewed journals, and written in English. Thirteen eligible studies related to green space and sleep were selected after peer-review procedures. Cross-sectional studies (n = 7) used either a questionnaire or the combination of Geographic Information Systems and remote sensing images for green space measurement, while questionnaires were primarily used to measure both sleep quality and quantity. Intervention studies (n = 5) were categorized into three types: walking program, gardening, and working in a forest. Eleven out of thirteen studies concluded that green space exposure was associated with improvement in both sleep quality and quantity. The findings support the evidence of a positive association between green space exposures and sleep quality and quantity, and also suggest green exercise and therapeutic gardening as possible intervention methods to improve sleep outcomes.

Factors Associated with Parental Intent not to Circumcise Daughters in Enugu State of Nigeria: An Application of the Theory of Planned Behavior.

This study explored intention of parents not to circumcise daughters in Enugu State, Nigeria using theory of planned behavior (TPB) as a framework. A survey of 1345 parents was carried out using structured questionnaire with FGM question items based on TPB constructs of attitude, subjective norm (SN), perceived behavioral control (PBC), and intention. Intention was dichotomized into two categories and logistic regression analysis was performed to examine the association between the constructs of TPB while controlling for some socio-demographic factors. 70% of respondents did not intend circumcising daughters. Constructs of TPB associated significantly, at p < 0.0001, with intention not to perform FGM on daughters with PBC having the strongest association. Having a post-secondary education (OR = 3.94; CI = 2.73-5.67) and absence of history of FGM in family (OR = 3.39; CI = 2.62-4.39) are the socio-demographic variables most significantly associated with the intention not to circumcise daughters. Homer-Lemeshow goodness-of-fit statistics indicated logistic regressions model 1 was significant (p < 0.05) making TPB a good theoretical basis for study of FGM. Intervention activity should focus on improving attitude of parents and especially those with less than post-secondary education and those with cases of FGM in their household.

Mammography-Seeking Practices of Central Illinois Amish Women.

Motivated by compelling, but scant, literature on high rates of breast cancer mortality among the United States Amish, a survey was conducted to examine mammography-seeking practices among Amish women. Inclusion criteria included age 40-70 years and membership of the Arthur, Illinois Amish community. Data were collected from this unique, socially isolated group through a mail questionnaire focusing on health history, mammography practices, and beliefs surrounding breast health. Sample mammography adherence and "ever mammogram" rates were compared with both the general population of the United States (U.S.) and other Amish communities in the U.S. Logistic regression on the "ever mammogram" variable showed that Amish women with knowledge of screening guidelines experienced an adjusted odds ratio (OR) of 5.26 [confidence interval (CI) 1.79, 15.45] for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer experienced an OR of 4.27 (CI 1.39, 13.11) for mammography and those who believed physical injury caused breast cancer had an OR of 3.86 (CI 1.24, 12.04) compared to women who do not hold these beliefs. Future research is needed to confirm and extend these results.

Predicting Risk of Type 2 Diabetes by Using Data on Easy-to-Measure Risk Factors.

INTRODUCTION: Statistical models for assessing risk of type 2 diabetes are usually additive with linear terms that use non-nationally representative data. The objective of this study was to use nationally representative data on diabetes risk factors and spline regression models to determine the ability of models with nonlinear and interaction terms to assess the risk of type 2 diabetes. METHODS: We used 4 waves of data (2005-2006 to 2011-2012) on adults aged 20 or older from the National Health and Nutrition Examination Survey (n = 5,471) and multivariate adaptive regression splines (MARS) to build risk models in 2015. MARS allowed for interactions among 17 noninvasively measured risk factors for type 2 diabetes. RESULTS: A key risk factor for type 2 diabetes was increasing age, especially for those older than 69, followed by a family history of diabetes, with diminished risk among individuals younger than 45. Above age 69, other risk factors superseded age, including systolic and diastolic blood pressure. The additive MARS model with nonlinear terms had an area under curve (AUC) receiver operating characteristic of 0.847, whereas the 2-way interaction MARS model had an AUC of 0.851, a slight improvement. Both models had an 87% accuracy in classifying diabetes status. CONCLUSION: Statistical models of type 2 diabetes risk should allow for nonlinear associations; incorporation of interaction terms into the MARS model improved its performance slightly. Robust statistical manipulation of risk factors commonly measured noninvasively in clinical settings might provide useful estimates of type 2 diabetes risk.

Spatial spillover and the socio-ecological determinants of diabetes-related mortality across US counties.

The spatial structure of diabetes-related mortality in US counties is evident from previous studies. However, it is not clear if spatial variation in diabetes-related mortality is associated with spatial variation in socioecological factors. We analyze the spatial spillover effect of changes in socioeconomic gradients (education, employment, household income), retail food environments, and access to health care, on diabetes-related mortality rates across the United States. Seven-year aggregates of multiple cause mortality data from the CDC WONDER compressed mortality database were merged with several sources of county-level data to examine mortality clusters, factors associated with the clusters, and spatial spillover effects in 3109 continuous US counties. The results suggest that high diabetes-related mortality cluster counties are located throughout the Southern Plains, Southeastern, and Appalachian regions. Lower socioeconomic status, a high density of fast food restaurants, a lack of access to grocery stores, a high proportion of Blacks, and low physical activity characterize high diabetes-related mortality rates clusters. The impacts from improvements in socioeconomic gradients and the retail food environment in neighboring counties spill over, and reduce the diabetes-related mortality rate in a particular county. This result implies that improvements in socioeconomic status and access to healthy food would significantly reduce diabetes-related mortality rates in contiguous US counties.

Sleep insufficiency and the natural environment: Results from the US Behavioral Risk Factor Surveillance System survey.

BACKGROUND: Exposure to the natural environment may improve health behaviors and mental health outcomes such as increased levels of physical activity and lower levels of depression associated with sleep quality. Little is known about the relationship between insufficient sleep and the natural environment. PURPOSE: To determine whether exposure to attributes of the natural environment (e.g., greenspace) attenuates the likelihood of reporting insufficient sleep among US adults. METHODS: Multiple logistic regression models were used to explore the association between self-reported days of insufficient sleep (in the past 30days) and access to the natural environment in a multi-ethnic, nationally representative sample (n=255,171) of US adults ≥18years of age enrolled in the 2010 Behavioral Risk Factor Surveillance System. RESULTS: Using 1-to-6days of insufficient sleep as the referent group for all analyses, lower odds of exposure to natural amenities were observed for individuals reporting 21-to-29days (OR=0.843, 95% confidence interval (CI)=0.747, 0.951) of insufficient sleep. In stratified analyses, statistically significant lower odds of exposure to natural amenities were found among men reporting 7-to-13-days (OR=0.911, 95% CI=0.857, 0.968), 21-to-29-days (OR=0.838, 95% CI=0.759, 0.924), and 30-days (OR=0.860, 95% CI=0.784, 0.943) of insufficient sleep. Greenspace access was also protective against insufficient sleep for men and individuals aged 65+. CONCLUSIONS: In a representative sample of US adults, access to the natural environment attenuated the likelihood of reporting insufficient sleep, particularly among men. Additional studies are needed to examine the impact of natural environment exposure on sleep insufficiency across various socio-demographic groups.

Residential Segregation and Diabetes Risk among Latinos.

OBJECTIVE: To examine whether residence in ethnically segregated metropolitan areas is associated with increased diabetes risk for Latinos in the United States. METHODS: Population data from the 2005 Behavioral Risk Factor Surveillance System and the 2005 American Community Survey were used to determine whether higher levels of Latino-White segregation across metropolitan statistical areas (MSAs) in the United States is associated with increased diabetes risk among Latinos (n=7462). RESULTS: No significant relationship (P<.05) between levels of segregation and diabetes risk was observed. CONCLUSION: The research literature examining the impact of residential segregation on health outcomes remains equivocal for Latinos.

Greenspace, stress, and health: how is epigenetics involved?

Most expositions of the association between green space and overall health and well-being focus on psychosocial mechanisms. However, discussions of the biological underpinnings of the exposure to green space and health implications are limited. In this paper, we highlight the role epigenetics plays in the manifestation or suppression of stress, in addition to some of the proposed epigenetic mechanisms through which green space mitigates stress. The Health: Epigenetics, Greenspace and Stress (HEGS) model is introduced to explicate this association, and suggestions for research to build the evidence base in this area are discussed.

Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics.

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

COVID-19, green space exposure, and mask mandates.

INTRODUCTION: Mask-wearing and social distancing are critical prevention measures that have been implemented to stem the spread of COVID-19. The degree to which these measures are adhered to in the US, however, may be influenced by access to outdoor resources such as green space, as well as mask mandates that may vary by state. PURPOSE: To examine the association between the presence or absence of statewide mask mandates and green space exposure with COVID-19 cumulative incidence in the US. METHODS: In October 2020, COVID-19 case data for each US county was downloaded from USA Facts, in addition to statewide mask mandates from a database maintained by the American Association of Retired Persons. The Normalized Difference Vegetation Index from the US Geological Survey (USGS), was used as a measure of greenspace, while the 2016 National Land Cover Database was used to assess tree canopy exposure as an alternative measure of greenspace. We performed generalized linear regression to evaluate associations with COVID-19 incidence, adjusting for potential confounders such as other environmental factors (i.e., air pollution and climate) and socio-economic factors derived from the CDC social vulnerability index. In addition, we also performed spatial regression analyses to account for spatial autocorrelation across counties. RESULTS: Counties with mandatory mask-wearing policies had a lower cumulative incidence of COVID-19 (B = -0.299, SE = 0.038). Among environmental factors, precipitation (B = 0.005, SE = 0.001) and PM 2.5 (B = 0.072, SE = 0.012) were associated with a higher incidence of COVID-19, while tree canopy (B = -0.501, SE = 0.129) was associated with a lower risk of COVID-19. COVID-19 incidence was higher in counties with socially vulnerable populations regarding socioeconomic status, minority status, and housing and transportation. CONCLUSION: Mandatory mask regulation, exposure to green space, and reduced exposure to air pollution may reduce COVID-19 incidence in the US. Additional public health policies should consider ways to mitigate environmental conditions that may contribute to the risk of COVID-19, especially for vulnerable populations.

US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study.

Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts.

Maternal Experiences with Discussing Complementary Feeding in Primary Care.

Complementary feeding practices promote healthy eating habits and food preferences later in life. Little is known about how US pediatricians communicate infant feeding practices to caregivers or how caregivers respond to this information. The purpose of this study is to explore mothers' experiences and perceptions of the complementary feeding recommendations they receive in primary care settings. English- and Spanish-speaking mothers of infants were recruited from Special Supplemental Nutrition for Women, Infants, and Children offices in Rhode Island, US, and snowball sampling. Semi-structured telephone interviews were conducted to investigate mothers' discussions with pediatricians about complementary feeding and their overall impressions of wellness visits. Thematic analysis was informed by the Fundamentals of Care theoretical framework. The mean age of the sample (n = 13) was 30.5 years and 62% self-identified as Latina. Four themes emerged from the analysis: (1) wellness visits are mostly positive experiences, (2) not all infant feeding recommendations are easy to follow, (3) alternative sources of infant feeding recommendations can be just as helpful, and (4) there is room for improvement at wellness visits. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote adherence to evidence-based practices.

COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Where they live, how they play: neighborhood greenness and outdoor physical activity among preschoolers.

BACKGROUND: Emerging empirical evidence suggests exposure to "green" environments may encourage higher levels of physical activity among children. Few studies, however, have explored this association exclusively in pre-school aged children in the United States. We examined whether residing in neighborhoods with higher levels of greenness was associated with higher levels of outdoor physical activity among preschoolers. In addition, we also explored whether outdoor playing behaviors (e.g., active vs. quiet) were influenced by levels of neighborhood greenness independent of demographic and parental support factors. RESULTS: Higher levels of neighborhood greenness as measured by the Normalized Difference Vegetation Index (NDVI) was associated with higher levels of outdoor playing time among preschool-aged children in our sample. Specifically, a one unit increase in neighborhood greenness increased a child's outdoor playing time by approximately 3 minutes. A dose-response relationship was observed between increasing levels of parental support for physical activity (e.g., time spent playing with children) and child outdoor physical activity (p < 0.01). CONCLUSIONS: Consistent with previous studies, neighborhood greenness influences physical activity behavior. However, for preschoolers, parental involvement may be more critical for improving physical activity levels.

Do Spatial Boundaries Matter for Exploring the Impact of Community Green Spaces on Health?

Green space exposure is thought to have a positive influence on physical activity behavior and overall health. However, the literature remains equivocal, and green space measurement methods remain complicated. Using data from the Illinois Behavioral Risk Factor Surveillance System, this study examines the influence of green space on health-related factors, such as exercise, physical health, and mental health. Moreover, we explore the methods for measuring community green space via various spatial boundaries and green space resources. The results show that combining two contextually designated census boundaries and a measure of green space with seasonality were the best spatial conceptualizations for capturing community green space. Moreover, the findings showed a positive influence of green space exposure on health outcomes. These findings highlight the importance of considering geographic contexts of daily human behaviors and green space seasonality in providing a better understanding of the influence of community activity space on environmental exposure measurement. Further, this work contributes to community planning for encouraging health-promoting behaviors.

Impact of Pokémon Go on Physical Activity: A Systematic Review and Meta-Analysis.

CONTEXT: Pokémon Go is a popular mobile augmented reality game that requires players to travel to different locations to capture virtual characters. This study systematically reviews and quantifies Pokémon Go in relation to physical activity engagement among players. EVIDENCE ACQUISITION: A keyword search was conducted in PubMed, Web of Science, Scopus, EBSCO, SPORTDiscus, PsycINFO, ScienceDirect, and Cochrane Library for articles published between July 2016 and October 2018. Meta-analysis was performed to estimate the pooled effect of playing Pokémon Go on physical activity outcome. EVIDENCE SYNTHESIS: From the keyword search, 17 studies (16 observational and 1 pre-post) were identified, with a total sample of 33,108 participants. A comparison between Pokémon Go players and nonplayers and between pre- and post-play time points revealed an increase in walking duration, distance walked, and number of steps/day. Pokémon Go players were also found to engage in less sedentary behavior. Playing Pokémon Go was associated with an increase in the number of steps per day by 1,446 steps (95% CI=953, 1,939; I2=81%). CONCLUSIONS: Playing Pokémon Go was associated with a statistically significant but clinically modest increase in the number of daily steps taken among game players. One challenge for future physical activity interventions using Pokémon Go is to retain active engagement once the initial novelty wears off. Additional studies with longer follow-up periods and experimental study design are needed to assess to what extent Pokémon Go and other augmented reality games can be used to promote physical activity at the population level for a sustained time period.

Do Fruit and Vegetable Policies, Socio-Environmental Factors, and Physical Activity Influence Fruit and Vegetable Intake Among Adolescents?

PURPOSE: Several factors are known to influence the intake of fruits and vegetables (FV) among adolescents. However, few studies have examined the role that FV policies and associated factors (such as availability of food at home, parental support, and physical activity) play on consumption of FV, particularly among adolescents in low- and middle-income countries (LMICs). METHOD: Adolescent data (except for FV policy status) were obtained from the Global School-based Student Health Survey from 2004 to 2013. Information on FV policies was obtained from government ministries, World Health Organization databases, Scopus, and PubMed. Countries were designated as having the policy if the policy was issued at least a year before Global School-based Student Health Survey data collection (n = 13 LMICs). Countries without FV policies were based on the absence of a policy between 2004 and 2013 (n = 11 LMICs). The total analytic sample included 89,843 adolescents from 24 countries. RESULTS: Logistic regression models revealed a positive association between the presence of FV policy and the adequate consumption of FV (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI]: 1.74-2.40; p-value < .001). Parental supervision was positively associated with sufficient intake of FV (AOR = 1.62; 95% CI: 1.42-1.84; p-value < .001). Physical activity was also positively associated with adolescents consuming ≥5 servings of FV daily (AOR = 1.30; 95% CI: 1.13-1.50; p-value < .001). CONCLUSION: Adolescents' physical environment (presence of FV policies, unavailability of food), social environment (parental connectedness, supervision, and bonding), and physical activity behavior are all significant predictors of adolescents' intake of FV.

Sex and racial/ethnic differences in sleep quality and its relationship with body weight status among US college students.

Objective: To examine sex and racial/ethnic differences in sleep quality and the association between sleep quality and body weight status among US college students. Participants: A nationally representative sample (N = 324,767) of college students from 2011 to 2015. Methods: A secondary data analysis of cross-sectional data. Results: Women showed poorer sleep quality (nights per week getting enough sleep to feel rested) than men (4.00 versus 4.34 days; p < .001). In both men and women, compared with non-Hispanic whites, racial/ethnic minorities showed lower sleep quality (p < .001). Compared with normal weight participants, overweight participants had poorer sleep quality (p = .007) among men, and both overweight (p = .004) and obese participants (p < .001) had lower sleep quality among women. Conclusions: Understanding sex and racial/ethnic sleep differences and the association between sleep and body weight status is important for colleges to promote college students' healthy sleep.