Drive for thinness in adolescents predicts greater adult BMI in the Growth and Health Study cohort over 20 years.

OBJECTIVE: In youth, a preoccupation with weight and the desire to be thinner, or drive for thinness, might persist into adulthood and predict reward-based compulsive eating and greater weight status. METHODS: A total of 623 women were enrolled from a prospective cohort study starting at 10 years old and assessed up to 20 years later. Drive for thinness was measured five times during adolescence. In adulthood (mean age = 39.5), drive for thinness, reward-based eating drive, and BMI were measured. RESULTS: Structural equation modeling found cumulative adolescent drive for thinness predicted higher scores for both adult drive for thinness and reward-based eating drive. Youth drive for thinness was not directly associated with adult BMI but rather indirectly through adult drive for thinness. Reward-based eating drive was not associated with adult BMI. CONCLUSIONS: Drive for thinness during the critical developmental years may exert long-term effects on adulthood eating behaviors tied to greater weight gain, potentially reflecting an important early target of intervention.

Effect of School-Based Body Mass Index Reporting in California Public Schools: A Randomized Clinical Trial.

Importance: Annually, US schools screen millions of students' body mass index (BMI) and report the results to parents, with little experimental evidence on potential benefits and harms. Objective: To determine the impact of school-based BMI reporting on weight status and adverse outcomes (weight stigmatization and weight-related perceptions and behaviors) among a diverse student population. Design, Setting, and Participants: Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle schools. Students in grades 3 to 7 at baseline participated for up to 3 years. A modified intent-to-treat protocol was used. Data analysis was conducted from April 13, 2017, to March 26, 2020. Interventions: School staff assessed BMI each spring among students in groups 1 and 2. Parents of students in group 1 were sent a BMI report each fall for up to 2 years. Main Outcomes and Measures: Changes in BMI z score and in adverse outcomes (based on surveys conducted each fall among students in grades 4 to 8) from baseline to 1 and 2 years of follow-up. Results: A total of 28 641 students (14 645 [51.1%] male) in grades 3 to 7 at baseline participated in the study for up to 3 years. Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMI z score change (-0.003; 95% CI, -0.02 to 0.01 at 1 year and 0.01; 95% CI, -0.02 to 0.03 at 2 years). Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3). Results of the effect of BMI reporting on other adverse outcomes were mixed: compared with the control (group 3), among students weighed at school (groups 1 and 2), weight satisfaction declined more after 2 years (-0.11; 95% CI, -0.18 to -0.05), and peer weight talk increased more after 1 year (0.05; 95% CI, 0.01-0.09); however, concerning weight control behaviors declined more after 1 year (-0.06; 95% CI, -0.10 to -0.02). Conclusions and Relevance: Body mass index reports alone do not improve children's weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT02088086.

Nutrition Policies Designed to Change the Food Environment to Improve Diet and Health of the Population.

The risk of chronic disease is widespread. In the United States, nearly 60% of the population has at least 1 chronic health condition. Among the most common are cardiovascular disease, obesity, and type 2 diabetes, all of which are associated with poor diet quality. At these levels, strategies are needed that can effectively impact widespread dietary practices and population nutrition and health. Increasingly, the food environment has been recognized as a powerful influencer of the quality of diets of community members. Local nutrition policies can effectively change the food environment in ways that increase access and affordability to healthful food and beverage choices and reduce access to and affordability of less healthful food and beverage choices. While much of the effort to change dietary practices is focused on education, this paper discusses 3 strategies by which nutrition policy can improve the dietary practices of individuals: (1) promoting healthy food purchases in the retail food environment, (2) improving access to healthy foods and beverages in food assistance programs, and (3) reducing access to less healthy foods and beverages through the use of taxes. Often enhanced by educational efforts, these strategies, used by government, business, and voluntary organizations, together make it easier for the public to make healthful dietary choices and thereby reduce the risk of chronic disease.

School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study.

BACKGROUND: Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and children's weight status and obesity-related dietary outcomes. METHODS: A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates. RESULTS: Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district. CONCLUSIONS: A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues.

OBJECTIVE: To assess produce availability, quality and price in a large sample of food stores in low-income neighbourhoods in California. DESIGN: Cross-sectional statewide survey. SETTING: Between 2011 and 2015, local health departments assessed store type, WIC (Supplemental Nutrition Program for Women, Infants, and Children)/SNAP (Supplemental Nutrition Assistance Program) participation, produce availability, quality and price of selected items in stores in low-income neighbourhoods. Secondary data provided reference chain supermarket produce prices matched by county and month. t Tests and ANOVA examined differences by store type; regression models examined factors associated with price. SUBJECTS: Large grocery stores (n 231), small markets (n 621) and convenience stores (n 622) in 225 neighbourhoods. RESULTS: Produce in most large groceries was rated high quality (97 % of fruits, 98 % of vegetables), but not in convenience stores (25 % fruits, 14 % vegetables). Small markets and convenience stores participating in WIC and/or SNAP had better produce availability, variety and quality than non-participating stores. Produce prices across store types were, on average, higher than reference prices from matched chain supermarkets (27 % higher in large groceries, 37 % higher in small markets, 102 % higher in convenience stores). Price was significantly inversely associated with produce variety, adjusting for quality, store type, and SNAP and WIC participation. CONCLUSIONS: The study finds that fresh produce is more expensive in low-income neighbourhoods and that convenience stores offer more expensive, poorer-quality produce than other stores. Variety is associated with price and most limited in convenience stores, suggesting more work is needed to determine how convenience stores can provide low-income consumers with access to affordable, high-quality produce. WIC and SNAP can contribute to the solution.

Eating School Meals Daily Is Associated with Healthier Dietary Intakes: The Healthy Communities Study.

BACKGROUND: Research on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited. OBJECTIVE: This study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children's dietary intakes. DESIGN: The Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015. PARTICIPANTS AND SETTING: US children aged 4 to 15 years (n=5,106) were included. MAIN OUTCOME MEASURES: Dietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value. STATISTICAL ANALYSIS: Multivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates. RESULTS: Children who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars. CONCLUSIONS: Eating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.

Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals.

OBJECTIVES: Childhood obesity remains a significant threat to America's children. Health care leaders have increasingly called upon oral health professionals to integrate healthy weight promotion and enhanced sugar-sweetened beverage counseling into their professional practices. The aim of this scoping review is to examine recent evidence regarding the effectiveness of primary care childhood obesity interventions that have potential for adoption by oral health professionals. METHODS: Medine, and PubMed were searched from 2010 to 2016 for review articles and studies reporting patient outcomes or policy outcomes relevant to primary care childhood obesity interventions for children ages 2-11 years. Additional articles were accessed through relevant websites, journals, and references. Our screening criteria included interventions that could be adopted by oral health professionals. RESULTS: Forty-two articles met inclusion criteria. Effective interventions fell into four domains: family-based programs, motivational interviewing, office-based practice tools, and policy interventions. Despite strong evidence linking the consumption of sugar-sweetened beverages to childhood obesity, our review did not find evidence of primary care programs effectively targeting and reducing childhood sugary drinks. CONCLUSIONS: Effective primary care interventions for addressing childhood obesity have been identified, although only short-term effectiveness has been demonstrated. Dissemination of these practices as well as further research and advocacy are needed. Childhood obesity and poor oral health share many common risk factors. Additional research should focus on the benefits and feasibility of widespread interdisciplinary medical-oral health collaboration in addressing the two most prevalent diseases of childhood.

Revised WIC Food Package and Children's Diet Quality.

BACKGROUND AND OBJECTIVES: In October 2009, the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package was revised to include more fruits, vegetables, whole grains, and lower-fat milk. We examined the impact of the WIC food package revisions on the diet quality of children in households using WIC. METHODS: A total of 1197 children aged 2 to 4 years from low-income households were studied from before and after the policy implementation (using the 2003-2008 and 2011-2012 National Health and Nutrition Examination Survey). The Healthy Eating Index-2010 (HEI-2010) was calculated using two 24-hour diet recalls. Linear regression was used to examine the difference in HEI-2010 score attributable to the food package change, adjusting for baseline and secular trends among WIC participants and nonparticipants, as well as child and household characteristics. Component scores of the HEI-2010 index were analyzed with generalized linear models. RESULTS: Average HEI-2010 scores for participants and nonparticipants were 52.4 and 50.0 at baseline, and 58.3 and 52.4 after the policy change, respectively. The WIC food package revisions were associated with an adjusted average of 3.7 additional HEI-2010 points (95% confidence interval, 0.6-6.9) for WIC participants compared with nonparticipants. In particular, the revisions were associated with a 3.4-fold relative increase (95% confidence interval, 1.3-9.4) in the Greens and Beans component score for WIC participants compared with nonparticipants. CONCLUSIONS: Results from this national sample indicate that the WIC food package revisions were associated with higher diet quality for children participating in WIC.

The Healthy Communities Study: Its Rationale, Aims, and Approach.

Communities across the U.S. are implementing programs and policies designed to address the epidemic of childhood obesity. These programs vary widely in their approaches, including the intensity level, duration, funding, target population, and implementation techniques. However, no previous studies have examined these variations and determined how such aspects of community programs and policies are related to childhood obesity outcomes. The Healthy Communities Study is an observational study that is assessing the associations between characteristics of community programs and policies and BMI, nutrition, and physical activity in children. The Healthy Communities Study was funded in 2010, field data collection and medical record abstraction will be completed in 2015, and data cleaning and analyses will be completed by mid-year 2016. One-hundred and thirty communities (defined as a high school catchment area) and approximately 5,000 children in kindergarten through eighth grade and their parents have been recruited from public elementary and middle schools across the country. The study is examining quantitative and qualitative information obtained from community-based initiatives; measures of community characteristics (e.g., school environment); and child and parent measures, including children's physical activity levels and dietary practices and children's and parents' BMI. The Healthy Communities Study employs a complex study design that includes a diverse sample of communities across the country and combines current/cross-sectional and retrospective data (abstracted from children's medical records). This paper describes the rationale for the Healthy Communities Study, the study aims and logic model, and a brief overview of the study design.

Operational Implementation of the Healthy Communities Study: How Communities Shape Children's Health.

The Healthy Communities Study (HCS) is examining how characteristics of community programs and policies targeting childhood obesity are related to childhood diet, physical activity, and obesity outcomes. The study involves selected districts and public schools in 130 communities; families recruited through schools; and data collected at the community, school, household, and child levels. Data collection took place in two waves-Wave 1 in Spring 2012 and Wave 2 from 2013 to 2015-with analysis to be completed by August 2016. This paper describes operational elements of the HCS, including recruitment activities, field operations, training of data collectors, human subjects protection, and quality assurance and quality control procedures. Experienced trainers oversaw and conducted all training, including training of (1) district and school recruitment staff; (2) telephone interviewers for household screening and recruitment; (3) field data collectors for conducting household data collection; and (4) community liaisons for conducting key informant interviews, document abstraction, and community observations. The study team developed quality assurance and quality control procedures that were implemented for all aspects of the study. Planning and operationalizing a study of this complexity and magnitude, with multiple functional teams, required frequent communication and strong collaboration among all study partners to ensure timely and effective decision making.

The Healthy Communities Study Nutrition Assessments: Child Diet and the School Nutrition Environment.

Multifaceted community interventions directed at improving food environments are emerging, but their impact on dietary change and obesity prevalence has not been adequately documented. The Healthy Communities Study (HCS) is seeking to identify characteristics and combinations of programs and policies that are associated with children's diets and obesity-related outcomes in various types of communities across the U.S. The purpose of this paper is to describe the methods used in 2013-2015 in the HCS to assess dietary intake, school nutrition environments, and other nutrition-related behaviors. The conceptual framework of the HCS is based on the socioecological model and behaviors shown in previous studies to be related to obesity in children guided selection of domains. Nine domains were identified as essential measures of nutrition in the HCS: (1) intake of selected foods and beverages; (2) food patterns and behaviors; (3) social support; (4) home environment; (5) school environment; (6) community environment; (7) breastfeeding history; (8) household food insecurity; and (9) dieting behaviors and body image. Children's dietary intake was assessed using a dietary screener and up to two automated 24-hour recalls. Dietary-related behaviors were assessed by a survey administered to the parent, child, or both, depending on child age. School nutrition measures were obtained from a combination of school staff surveys and researcher observations. Information from these measures is expected to contribute to a better understanding of "what is working" to improve the dietary behaviors that are likely to prevent obesity and improve health in children.

Association between competitive food and beverage policies in elementary schools and childhood overweight/obesity trends: differences by neighborhood socioeconomic resources.

IMPORTANCE: To our knowledge, few published studies have examined the influence of competitive food and beverage (CF&B) policies on student weight outcomes; none have investigated disparities in the influence of CF&B policies on children's body weight by school neighborhood socioeconomic resources. OBJECTIVE: To investigate whether the association between CF&B policies and population-level trends in childhood overweight/obesity differed by school neighborhood income and education levels. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, from July 2013 to October 2014, compared overweight/obesity prevalence trends before (2001-2005) and after (2006-2010) implementation of CF&B policies in public elementary schools in California. The study included 2 700 880 fifth-grade students in 5362 public schools from 2001 to 2010. EXPOSURES: California CF&B policies (effective July 1, 2004, and July 1, 2007) and school neighborhood income and education levels. MAIN OUTCOMES AND MEASURES: Overweight/obesity defined as a body mass index at or greater than the 85th percentile for age and sex. RESULTS: Overall rates of overweight/obesity ranged from 43.5% in 2001 to 45.8% in 2010. Compared with the period before the introduction of CF&B policies, overweight/obesity trends changed in a favorable direction after the policies took effect (2005-2010); these changes occurred for all children across all school neighborhood socioeconomic levels. In the postpolicy period, these trends differed by school neighborhood socioeconomic advantage. From 2005-2010, trends in overweight/obesity prevalence leveled off among students at schools in socioeconomically disadvantaged neighborhoods but declined in socioeconomically advantaged neighborhoods. Students in the lowest-income neighborhoods experienced zero or near zero change in the odds of overweight/obesity over time: the annual percentage change in overweight/obesity odds was 0.1% for females (95% CI, -0.7 to 0.9) and -0.3% for males (95% CI, -1.1 to 0.5). In contrast, in the highest-income neighborhoods, the annual percentage decline in the odds of overweight was 1.2% for females (95% CI, 0.4 to 1.9) and 1.0% for males (95% CI, 0.3 to 1.8). Findings were similar for school neighborhood education. CONCLUSIONS AND RELEVANCE: Our study found population-level improvements in the prevalence of childhood overweight/obesity that coincided with the period following implementation of statewide CF&B policies (2005-2010). However, these improvements were greatest at schools in the most advantaged neighborhoods. This suggests that CF&B policies may help prevent child obesity; however, the degree of their effectiveness is likely to depend on socioeconomic and other contextual factors in school neighborhoods. To reduce disparities and prevent obesity, school policies and environmental interventions must address relevant contextual factors in school neighborhoods.

Food insecurity is inversely associated with diet quality of lower-income adults.

Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.

Energy balance for kids with play: design and implementation of a multi-component school-based obesity prevention program.

BACKGROUND: Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youth's nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data. METHODS: The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection. RESULTS: An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages. CONCLUSIONS: End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.

Does competitive food and beverage legislation hurt meal participation or revenues in high schools?

BACKGROUND: There is limited evidence to evaluate the influence of competitive food and beverage legislation on school meal program participation and revenues. METHODS: A representative sample of 56 California high schools was recruited to collect school-level data before (2006­2007) and the year after (2007­2008) policies regarding limiting competitive foods and beverages were required to be implemented. Data were obtained from school records, observations, and questionnaires. Paired t-tests assessed significance of change between the two time points. RESULTS: Average participation in lunch increased from 21.7% to 25.3% (p < 0.001), representing a 17.0% increase, while average participation in breakfast increased from 8.9% to 10.3% (p = 0.02), representing a 16.0% increase. There was a significant (23.0%) increase in average meal revenue, from $0.70 to $0.86 (per student per day) (p < 0.001). There was a nonsignificant decrease (18.0%) in average sales from à la carte foods, from $0.45 to $0.37 (per student per day). Compliance with food and beverage standards also increased significantly. At end point, compliance with beverage standards was higher (71.0%) than compliance with food standards (65.7%). CONCLUSION: Competitive food and beverage legislation can increase food service revenues when accompanied by increased rates of participation in the meal program. Future studies collecting expense data will be needed to determine impact on net revenues.

Trends in nutrition and exercise counseling among adolescents in the health care environment.

PURPOSE: Obesity is a serious health threat, particularly among racial/ethnic minorities and those who are uninsured, yet little is known about the implementation of nutrition or exercise counseling or the combination of both among these groups. Trends in counseling by race/ethnicity and types of insurance were examined. METHODS: Trend analyses were conducted with the California Health Interview Surveys among those ages 12-17 for the period 2003-2009. RESULTS: Race/Ethnicity: Receipt of both counseling methods declined from 2003-2009 for all racial/ethnic groups, except Hispanics and Whites, for whom increases in counseling began after 2007. Hispanics and African Americans generally reported higher levels of nutrition than exercise counseling, while Whites generally reported higher levels of exercise than nutrition counseling for the study period. INSURANCE TYPE: Receipt of both counseling methods appeared to decline from 2003-2009 among all insurance types, although after 2007, a slight increase was observed for the low-cost/free insurance group. Those with private health insurance generally received more exercise counseling than nutrition counseling over the study period. CONCLUSIONS: Counseling among all racial/ethnic groups and insurance types is warranted, but particularly needed for African Americans, American Indian/Alaska Natives, and the uninsured as they are at highest risk for developing obesity. Institutional and policy changes in the health care environment will be beneficial in helping to promote obesity-related counseling.

Pregnancy during adolescence has lasting adverse effects on blood lipids: a 10-year longitudinal study of black and white females.

BACKGROUND: Primiparity has been associated with 3 to 4 mg/dL lower high-density lipoprotein cholesterol concentrations in black and white adult women that persist several years after delivery. OBJECTIVE: To examine the lasting effects of adolescent pregnancy on blood lipids, an early risk factor for future cardiometabolic diseases. DESIGN: The National Heart Lung and Blood Institute's Growth and Health Study is a multicenter prospective cohort that measured fasting blood lipids for 1013 (513 black, 500 white) participants at baseline (1987-1988) ages 9-10, and again at follow-up (1996-1997) ages 18-19. METHODS: Change in fasting plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, defined as the difference between baseline and follow-up measurements, was compared among 186 (145 black, 41 white) primi- or multiparas, 106 (55 black, 51 white) nulliparous, gravidas versus 721 (313 black, 408 white) nulligravidas. Fully adjusted multiple linear regression models estimated blood lipid changes among these pregnancy groups adjusted for race, age at menarche, baseline lipids, physical inactivity, body mass index, and family sociodemographics. RESULTS: In the 10-year study period, adolescent paras compared with nulligravidas had greater decrements in high-density lipoprotein cholesterol (mg/dL; fully adjusted mean [95% confidence interval] group differences in black -4.3 [-6.7, -2.0]; P < .001 and white: -4.5 [-8.2, -0.7]; P = .016) and greater increments in fasting triglycerides (mg/dL; adjusted mean [95% confidence interval] group differences in black: 10.4 [3.9, 16.8]; P < .001, and white: 11.6 [-3.6, 26.8]; P = .167). CONCLUSION: Adolescent pregnancy contributes to pro-atherogenic lipid profiles that persist after delivery. Further research is needed to assess whether adolescent pregnancy has implications for future cardiovascular disease risk in young women.

The ethical basis for promoting nutritional health in public schools in the United States.

Schools may have an ethical obligation to act in response to the precipitous increase in the incidence of obesity among children. Using a bioethics framework, we present a rationale for school programs to improve the nutritional quality of students' diets. Because children are required to spend half their waking hours in school and because they consume a substantial portion of their daily food there, school is a logical focus for efforts to encourage healthy dietary behaviors to prevent obesity and its consequent individual and collective costs. We suggest that beyond strategic considerations, the concept of the common good justifies actions that may appear to conflict with freedom of choice of children, parents, and school staff, or with the interests of food and beverage companies.