Lean legacy, heavy heritage: family history of diabetes and its association with young adult body mass index.

Substantial intergenerational transmission of diabetes mellitus (DM) risk exists. However, less is known regarding whether parental DM and DM among extended family members relate to adult offspring's body mass index (BMI), and whether any of these associations vary by sex. Using data from the National Longitudinal Study of Youth 1997 cohort (NLSY97), we assess the sex-specific relationship between DM present in first-degree parents and second-degree relatives and BMI among the parents' young adult offspring.Multivariate regressions reveal a positive relationship between parental DM and young adults' BMI for both daughters and sons, and the magnitude of coefficients is somewhat larger for the same-sex parent. Further, we observe that the link between parental DM and young adults' BMI is strongest when both parents have diagnosed diabetes. In contrast, the relationship between second-degree relatives with DM and the respondent's BMI is weaker and appears to be sex-specific, through same-sex parent and respondent. Logistic regressions show the association is especially strong when assessing how parental DM status relates to young adults' obesity risk. These results generally persist when controlling for parental BMI. The findings of this study point to the need to better distinguish the role of shared family environments (e.g., eating and physical activity patterns) from shared genes in order to understand factors that may influence young adults' BMI. Young adult offspring of parents with diabetes should be targeted for obesity prevention efforts in order to reduce their risks of obesity and perhaps diabetes.

The medical costs of low leisure-time physical activity among working-age adults: Gender and minority status matter.

This study analyzes the direct medical costs of low physical activity by race/ethnicity and gender. Average health expenditures based on physical activity status for Black non-Hispanics (NH), Asian NHs, and Hispanics were compared to White NHs. Data from the National Health Interview Survey were merged with the Medical Expenditure Panel Survey for years 2000-2010 and 2001-2011, respectively, and weights were applied to ensure generalizability to the larger US population. The sample was restricted to non-pregnant adults between the ages of 25 and 64, with a final sample size of 44,953. The multivariate estimates reveal statistically significant lower annual health care expenditures among physically active men and women in five out of eight racial/ethnic groups relative to their inactive counterparts: on average, for men, $1041 less is spent among White NHs, $905 less is spent for Black NHs and $876 less is spent for Asian NHs. Among women, medical expenditures were $956 per year less among active White non-Hispanics relative to their inactive counterparts, and $815 per year among Hispanics. Essentially, the average reduction in health care expenditures is relatively consistent for five out of the eight groups. The absence of any reduction in average health care expenditures for three of the groups, however, suggests that there may be environmental factors at play for certain groups that mitigate the impact of physical activity on health expenditures.

The nexus between health and time use among racially and ethnically diverse women.

OBJECTIVES: Ethnic and racial health disparities have been well-documented in the scholarly literature. In recent years, evidence about time spent in physical (in)activity and its relationship to physical and mental health has also emerged. This study assesses if observed ethnic/racial health differences were associated with differences in time use. DESIGN: Our analyses utilized baseline data from 510 Utah women who enrolled in one of two community-based, participatory research intervention studies between 2012 and 2015. The distinct racial/ethnic groups included African immigrants, African Americans, Latinas, Native Hawaiians/Pacific Islanders, American Indians/Alaskan Natives, and rural White, Non-Latina women. In the baseline survey, respondents reported the typical time they spent in paid employment, television/movie viewing, physical activity, food preparation/clean-up, and sleep. Cluster analysis was used to identify seven distinct patterns of time use within these five activities. We related these time use patterns along with race/ethnicity, socio-demographics, and other potentially contributing health-related factors (e.g. smoking status) to two health outcomes: (1) self-reported health status, and (2) depression. RESULTS: Our time use clusters revealed heterogeneity by racial/ethnic groups, suggesting that some of the health effects that may have been previously ascribed to group membership should instead be attributed to (un)healthy patterns of time use. In particular, spending too much time in sedentary activities such as watching television/movies and too little time sleeping both linked to poor physical and mental health, independently of racial/ethnic group membership. CONCLUSIONS: Researchers and policy makers designing culturally sensitive physical activity health-related interventions should consider patterns of time use that are associated with poor health. Programs designed to improve sleep time and reduce sedentary television-viewing time may be as important as interventions designed to increase physical activity time. These broader patterns of time use mediated the relationships between race/ethnicity and physical and mental health for the women in our study.

Putting it off: family breast cancer history and women's retirement planning.

OBJECTIVE: Cancer diagnoses have significant consequences that extend beyond the individual to family members. Our research builds on prior research by examining how a family history of breast cancer is related to women's retirement preparations. METHODS: Taking guidance from the stress process model, we generate and test hypotheses using multivariate logistic regression and unique data on retirement planning and familial cancer histories for 467 women. We supplement this analysis with the qualitative findings from two focus groups. RESULTS: We find consistent evidence that women with a mother and/or sister who had a breast cancer diagnosis are significantly less likely to engage in retirement preparation activities than otherwise similar women with no family history. The same effect is not observed when other first-degree relatives have different cancer diagnoses. The face validity of these quantitative findings is confirmed by the focus group analysis. CONCLUSIONS: Our research suggests that the stressors experienced by close female relatives of women who have had breast cancer may lead to behaviors and attitudes that have consequences for their post-retirement quality of life.

Harvesting more than vegetables: the potential weight control benefits of community gardening.

OBJECTIVES: We examined the association of participation in community gardening with healthy body weight. METHODS: We examined body mass index (BMI) data from 198 community gardening participants in Salt Lake City, Utah, in relationship to BMI data for 3 comparison groups: neighbors, siblings, and spouses. In comparisons, we adjusted for gender, age, and the year of the BMI measurement. RESULTS: Both women and men community gardeners had significantly lower BMIs than did their neighbors who were not in the community gardening program. The estimated BMI reductions in the multivariate analyses were -1.84 for women and -2.36 for men. We also observed significantly lower BMIs for women community gardeners compared with their sisters (-1.88) and men community gardeners compared with their brothers (-1.33). Community gardeners also had lower odds of being overweight or obese than did their otherwise similar neighbors. CONCLUSIONS: The health benefits of community gardening may go beyond enhancing the gardeners' intake of fruits and vegetables. Community gardens may be a valuable element of land use diversity that merits consideration by public health officials who want to identify neighborhood features that promote health.

Re-visiting the relationship between neighbourhood environment and BMI: an instrumental variables approach to correcting for residential selection bias.

BACKGROUND: A burgeoning literature links attributes of neighbourhoods' built environments to residents' physical activity, food and transportation choices, weight, and/or obesity risk. In cross-sectional studies, non-random residential selection impedes researchers' ability to conclude that neighbourhood environments cause these outcomes. METHODS: Cross-sectional data for the current study are based on 14,689 non-Hispanic white women living in Salt Lake County, Utah, USA. Instrumental variables techniques are used to adjust for the possibility that neighbourhoods may affect weight but heavier or lighter women may also choose to live in certain neighbourhoods. All analyses control for the average BMI of siblings and thus familial predisposition for overweight/obesity, which is often an omitted variable in past studies. RESULTS: We find that cross-sectional analyses relating neighbourhood characteristics to BMI understate the strength of the relationship if they do not make statistical adjustments for the decision to live in a walkable neighbourhood. Standard cross-sectional estimation reveals no significant relationship between neighbourhood walkability and BMI. However, the instrumental variables estimates reveal statistically significant effects. CONCLUSIONS: We find evidence that residential selection leads to an understatement of the causal effects of neighbourhood walkability features on BMI. Although caution should be used in generalizing from research done with one demographic group in a single locale, our findings support the contention that public policies designed to alter neighbourhood walkability may moderately affect the BMI of large numbers of individuals.

The changing food environment and neighborhood prevalence of type 2 diabetes.

In this ecological study, we used longitudinal data to assess if changes in neighborhood food environments were associated with type 2 diabetes mellitus (T2DM) prevalence, controlling for a host of neighborhood characteristics and spatial error correlation. We found that the population-adjusted prevalence of fast-food and pizza restaurants, grocery stores, and full-service restaurants along with changes in their numbers from 1990 to 2010 were associated with 2015 T2DM prevalence. The results suggested that neighborhoods where fast-food restaurants have increased and neighborhoods where full-service restaurants have decreased over time may be especially important targets for educational campaigns or other public health-related T2DM interventions.

Thx 4 the msg: Assessing the Impact of Texting on Student Engagement and Persistence.

As colleges and universities strive to increase persistence and aid students in reaching graduation, they are utilizing alternative communication strategies like text messaging. Behavioral economics researchers suggest personalized, regular nudges can help college students make decisions that positively impact their college career and keep them on track for graduation. The current study presents the results of a randomized field experiment where a text messaging program was implemented in a large college at a public university. The intervention utilized a mixture of automated and personalized text messages from academic advisors and allowed for two-way communication between individual students and their major advisor. Mulitvariate analyses revealed the intervention had no impact on university persistence, but it did increase the odds of persisting in the college to the end of the semester, moving the average, overall college persistence rate from 93 to 95%. Effects were concentrated on underclass students, whose persistence rate moved from 87 to 93% at the college level. Underclass students also showed statistically significant university persistence effects, moving from 90 to 95%. Students who received texts but never engaged with the texting program were significantly less likely to request an advising appointment or to apply to be a student ambassador than were students in the control group. More research is needed to understand what motivates a student to engage with the texting software and to identify what the longer-term consequences of using text messaging to communicate with students might be. Supplementary Information: The online version contains supplementary material available at 10.1007/s11162-022-09678-8.

Time use choices and healthy body weight: a multivariate analysis of data from the American Time Use Survey.

BACKGROUND: We examine the relationship between time use choices and healthy body weight as measured by survey respondents' body mass index (BMI). Using data from the 2006 and 2007 American Time Use Surveys, we expand upon earlier research by including more detailed measures of time spent eating as well as measures of physical activity time and sedentary time. We also estimate three alternative models that relate time use to BMI. RESULTS: Our results suggest that time use and BMI are simultaneously determined. The preferred empirical model reveals evidence of an inverse relationship between time spent eating and BMI for women and men. In contrast, time spent drinking beverages while simultaneously doing other things and time spent watching television/videos are positively linked to BMI. For women only, time spent in food preparation and clean-up is inversely related to BMI while for men only, time spent sleeping is inversely related to BMI. Models that include grocery prices, opportunity costs of time, and nonwage income reveal that as these economic variables increase, BMI declines. CONCLUSIONS: In this large, nationally representative data set, our analyses that correct for time use endogeneity reveal that the Americans' time use decisions have implications for their BMI. The analyses suggest that both eating time and context (i.e., while doing other tasks simultaneously) matters as does time spent in food preparation, and time spent in sedentary activities. Reduced form models suggest that shifts in grocery prices, opportunity costs of time, and nonwage income may be contributing to alterations in time use patterns and food choices that have implications for BMI.

Effects of neighborhood walkability on healthy weight: assessing selection and causal influences.

Studies that examine the relationship between neighborhood characteristics and weight are limited because residents are not randomly distributed into neighborhoods. If associations are found between neighborhood characteristics and weight in observational studies, one cannot confidently draw conclusions about causality. We use data from the Utah Population Database (UPDB) that contain body mass index (BMI) information from all drivers holding a Utah driver license to undertake a cross-sectional analysis that compares the neighborhood determinants of BMI for youth and young adults. This analysis assumes that youth have little choice in their residential location while young adults have more choice. Our analysis makes use of data on 53,476 males and 47,069 females living in Salt Lake County in 2000. We find evidence of residential selection among both males and females when BMI is the outcome. The evidence is weaker when the outcomes are overweight or obesity. We conclude that studies that ignore the role of residential selection may be overstating the causal influence of neighborhood features in altering residents' BMI.

Trends in Americans' food-related time use: 1975-2006.

OBJECTIVE: To describe how the time spent in food-related activities by Americans has changed over the past 30 years. DESIGN: Data from four national time diary surveys, spanning 1975-2006, are used to construct estimates of trends in American adults' time spent in food-related activities. Multivariate Tobits assess how food-related activities have changed over time controlling for sociodemographic and economic covariates. RESULTS: Both bivariate and multivariate estimates reveal that between 1975 and 2006, American women's time spent in food preparation declined substantially, whereas the time spent in these activities by American men changed very little. On the contrary, grocery shopping time increased modestly for both men and women. The primary eating time (i.e. time when eating/drinking was the respondent's main focus) declined for both men and women over this historical period, and the composition of this time changed with less primary eating time being done alone. Concurrently, secondary eating time (i.e. time when something else had the respondent's primary attention, but eating/drinking simultaneously occurred) rose precipitously for both women and men between 1975 and 1998. CONCLUSIONS: The total time spent in eating (i.e. primary plus secondary eating time) has increased over the past 30 years, and the composition of this time has shifted from situations in which energy intake can be easily monitored to those in which energy intake may be more difficult to gauge. Less time is also being spent in food preparation and clean-up activities. Future research should explore possible links between these trends and Americans' growing obesity risk.

Are you what your mother weighs? Evaluating the impact of maternal weight trajectories on youth overweight.

In this study, we investigate how three alternative measures of maternal body mass index (BMI) relate to youth overweight. We contrast the typical cross-sectional measure of maternal BMI with a longitudinal mean and a standard deviation in maternal BMI. Using National Longitudinal Survey of Youth data, we estimate logistic regressions that relate maternal BMI to the risk of a youth being overweight while controlling for other familial characteristics. Participants in this study are 918 males and 841 females who were age 16-21 and either healthy weight or overweight in 2006. To be eligible for inclusion, teens were 15 years old by December 2006. After comparing several measures of maternal weight, we find that higher mean maternal BMI measured over the life of the adolescent has the strongest relationship with the odds of youth overweight for both male and female adolescents. For boys, a one unit increase in mother's mean BMI increases the odds of being overweight by 16% (OR = 1.16, 95% CI 1.11-1.20) while for girls the increase in the odds of being overweight is 13% (OR = 1.13, 95% CI 1.09-1.18). Our findings suggest that researchers should move beyond static measures of maternal weight when examining the correlates of youth BMI. Maternal weight histories offer additional insights about the youth's home environment that are associated with the risk of a youth being overweight.

Incorporation of Information-Seeking Behavior Into Food Insecurity Research.

INTRODUCTION: Limited or uncertain availability of nutritionally adequate and safe foods affects the health of individuals. Because of its association with chronic health conditions, addressing food insecurity may improve health outcomes and decrease health-related costs. This study explores whether and how information seeking as captured by calls made to United Way 2-1-1 can be used to identify food-insecure areas and information deserts-communities with low proportions of residents accessing government food resources but with high rates of 2-1-1 calls for emergency food resources. METHODS: Details regarding calls made to United Way of Salt Lake 2-1-1 for emergency food resources between 2014 and 2018 (n=63,221) were analyzed in 2019. Using GIS methods, areas with the highest number of calls for emergency food resources (hot spots) were identified; multinomial logistic regression was used to identify community-level sociodemographic predictors of food insecurity. RESULTS: Areas with a smaller proportion of the population aged <18 years, more female householders, and more African Americans are associated with higher odds of being food-insecure. CONCLUSIONS: Patterns of information seeking about emergency food resources suggest that, despite statewide access to federal means-tested food programs, significant food needs remain. This novel approach in food insecurity research can help public health officials and health systems address an important social determinant of health by identifying areas vulnerable to food insecurity. In addition, this work may be useful in benchmarking food needs, information seeking, and replicating analyses where similar data are available.

Food Insecurity and the Risk of Obesity, Depression, and Self-Rated Health in Women.

Background/Introduction/Objective: Recent studies have shown that food insecurity is associated with obesity, depression, and other adverse health outcomes although little research has been focused on these relationships in underrepresented cultural and social groups. In this study we elucidate the relationship between food insecurity, community factors, dietary patterns, race/ethnicity and health among underrepresented women. Materials and Methods: The data for this investigation come from a cross-sectional survey of women drawn from five urban Utah communities of color, including African immigrants/refugees, African Americans, Hispanics, American Indians/Alaska Natives, and Pacific Islanders, and women from four rural Utah counties. Multivariate logistic regression was used to assess the relationship between food insecurity and obesity risk, self-reported depression, and self-assessed health. Results: Urban women of color were more likely to report food insecurity than rural non-Hispanic white women. Obesity and depression scores were positively associated with food insecurity. Conclusions: Utah women of color had higher levels of food insecurity than reported in state or national data, highlight an important disparity. Nutritional education initiatives, evaluating food assistance programs, and screenings in clinical settings targeting specific racial/ethnic groups may help address the disparities observed in this study.

Mixed land use and walkability: Variations in land use measures and relationships with BMI, overweight, and obesity.

Few studies compare alternative measures of land use diversity or mix in relationship to body mass index. We compare four types of diversity measures: entropy scores (measures of equal distributions of walkable land use categories), distances to walkable destinations (parks and transit stops), proxy measures of mixed use (walk to work measures and neighborhood housing ages), and land use categories used in entropy scores. Generalized estimating equations, conducted on 5000 randomly chosen licensed drivers aged 25-64 in Salt Lake County, Utah, relate lower BMIs to older neighborhoods, components of a 6-category land use entropy score, and nearby light rail stops. Thus the presence of walkable land uses, rather than their equal mixture, relates to healthy weight.

Assessing the Likelihood of Having a Regular Health Care Provider among African American and African Immigrant Women.

Objective: Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider. Methods: Using logistic regression and data from a community-based participatory study, we estimated the relative likelihood that an African immigrant woman would have a regular health care provider compared with an African American woman. Results: Immigrant status remains a powerful predictor of whether a woman had a regular health care provider after controlling for covariates. African immigrants were 73% less likely to have a regular health care provider than were otherwise similar African American women. Conclusion: Expanding health care educational efforts for immigrants may be warranted. Future research should examine how cultural beliefs and time in residence influence health care utilization among US immigrants.

Walkability and body mass index density, design, and new diversity measures.

BACKGROUND: Rising rates of overweight and obesity in the U.S. have increased interest in community designs that encourage healthy weight. This study relates neighborhood walkability-density, pedestrian-friendly design, and two novel measures of land-use diversity-to residents' excess weight. METHODS: Walkable-environment measures include two established predictors, higher density and pedestrian-friendly design (intersections within 0.25 mile of each address), and two new census-based, land-use diversity measures: the proportion of residents walking to work and the median age of housing. In 2006, weight, height, age, and address data from 453,927 Salt Lake County driver licenses for persons aged 25-64 years were linked to 2000 Census and GIS street-network information that was analyzed in 2007-2008. Linear regressions of BMI and logistic regressions of overweight and obesity include controls for individual-level age and neighborhood-level racial/ethnic composition, median age of residents, and median family income. RESULTS: Increasing levels of walkability decrease the risks of excess weight. Approximately doubling the proportion of neighborhood residents walking to work decreases an individual's risk of obesity by almost 10%. Adding a decade to the average age of neighborhood housing decreases women's risk of obesity by about 8% and men's by 13%. Population density is unrelated to weight in four of six models, and inconsistently related to weight measures in two models. Pedestrian-friendly street networks are unrelated to BMI but related to lower risks of overweight and obesity in three of four models. CONCLUSIONS: Walkability indicators, particularly the two land-use diversity measures, are important predictors of body weight. Driver licenses should be considered as a source of data for community studies of BMI, as they provide extensive coverage at low cost.

It Takes a Village Coach: Cost-Effectiveness of an Intervention to Improve Diet and Physical Activity Among Minority Women.

BACKGROUND: This study gauged the cost-effectiveness of a community-based health coaching intervention aimed at improving diet and physical activity among women in culturally diverse communities. METHODS: The Coalition for a Healthier Community for Utah Women and Girls recruited women from 5 cultural and ethnic groups and randomized them to receive quarterly versus monthly health coaching. Coaching was performed by trained community health workers from the targeted communities. Cost-effectiveness ratios were estimated to gauge the cost-effectiveness of the intervention. RESULTS: Estimated quality-adjusted life years gained from both increased physical activity and improved diet were positive. Cost-effectiveness ratios varied by intervention arm, but all ratios fell within the favorable range described in the literature. CONCLUSIONS: This culturally adapted health coaching intervention was deemed to be cost-effective. Our findings suggest that to achieve the highest level of cost-effectiveness, programs should focus on enrolling at-risk women who do not meet recommended physical activity standards and/or dietary guidelines.

Walkable neighborhoods and obesity: Evaluating effects with a propensity score approach.

BACKGROUND: Research investigating the connection between neighborhood walkability and obesity often overlooks the issue of nonrandom residential selection. METHODS: We use propensity score methods to adjust for the nonrandom selection into residential neighborhoods in this cross-sectional, observational study. The sample includes 103,912 women residing in Salt Lake County, Utah age 20 or older. We measured percentage living in neighborhoods with more walkability, area level measures of neighborhood characteristics, and obesity (body mass index (BMI) > 30). RESULTS: Our findings confirm previous work that observes an association between living in more walkable neighborhoods and lower obesity. After adjusting for nonrandom selection, the odds of being obese when living in a less walkable neighborhood increase. Specifically, the odds ratio for being obese without the propensity score correction is 1.12. After adjusting for nonrandom selection, the odds ratio for being obese is 1.19, an increase of six percent. CONCLUSION: Results demonstrate that residential selection bias inherent in cross-sectional analysis slightly attenuates the true association between neighborhood walkability and obesity. Results lend support to the growing body of research suggesting that more walkable neighborhoods have residents with a lower prevalence of obesity. Absent propensity score controls, the causal relationship between environment and obesity would be underestimated by 6%. Our analysis suggests there is an association between neighborhood walkability and obesity.

Outcomes From a Hearing-Targeted Cytomegalovirus Screening Program.

BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) is the most common congenital infection and nongenetic cause of congenital sensorineural hearing loss in the United States. Utah was the first state to pass legislation mandating CMV screening for newborns who fail newborn hearing screening (NBHS). The study objective was to present outcomes of hearing-targeted CMV screening and determine factors predicting CMV screening. METHODS: We used Utah Department of Health HiTrack and Vital Records databases to examine CMV screening from 509 infants who failed NBHS in the 24 months after implementation of the Utah legislation. Multivariate logistic regression analyses were conducted to identify predictors of compliance with CMV screening and diagnostic hearing evaluation. RESULTS: Sixty-two percent of infants who never passed hearing screening underwent CMV screening. Fourteen of 234 infants tested within 21 days were CMV positive; 6 (42.9%) had hearing loss. Seventy-seven percent of eligible infants completed a diagnostic hearing evaluation within 90 days of birth. Compliance with CMV screening was associated with sociodemographic factors, time since the law was enacted, and NBHS protocol. Infants born after the legislation showed greater odds of achieving timely diagnostic hearing evaluation than infants born before the law. CONCLUSIONS: Incorporating CMV screening into an established NBHS program is a viable option for the identification of CMV in infants failing NBHS. The addition of CMV testing can help a NBHS program attain timely audiological diagnostics within 90 days, an important early hearing detection and intervention milestone.