The Association of Vaccination for Common Adult Infectious Diseases and Uptake of COVID-19 Vaccines among 5,006,851 Veterans, 20 December 2020-31 October 2021.

Disparities in vaccination coverage for coronavirus disease 2019 (COVID-19) in the United States (U.S.) are consistent barriers limiting our ability to control the spread of disease, particularly those by age and race/ethnicity. This study examines the association between previous vaccination for common adult infectious diseases and vaccination for SARS-CoV-2 among a cohort of veterans in the U.S. Sociodemographic and clinical data were utilized from three databases within the Veterans Health Administration included in the electronic health record. We examined the association of previous vaccination for common adult vaccinations through six separate multivariable logistic regression analyses, one for each previous vaccine exposure, adjusting for demographic and clinical variables. We also examined the association of receiving any one of the six common adult vaccinations and vaccination against SARS-CoV-2. Adjusted models indicate higher odds of vaccination for SARS-CoV-2 among those who received each of the previous vaccinations. Significant differences were also noted by race/ethnicity and age. Veterans who recorded receiving any one of the previous vaccinations for common adult infections had significantly greater odds of receiving any vaccination against SARS-CoV-2. Understanding veterans' previous vaccination status can assist researchers and clinicians in impacting the uptake of novel vaccines, such as vaccination against SARS-CoV-2.

Prevalence and risk factors of post-acute sequelae of COVID-19 among United States Veterans.

PURPOSE: To better understand Post-Acute Sequelae of COVID-19 (PASC) in the Veteran population, this study aims to determine the prevalence of PASC and identify risk factors associated with its development. METHODS: This retrospective cohort study included 363,825 Veterans that tested positive for COVID-19 between February 1, 2020, and September 30, 2022. The primary outcome was the development of PASC 30-180 days following an acute infection with SARS-CoV-2. Multivariate logistic regression was utilized to examine factors associated with PASC. RESULTS: Of the 363,825 Veterans included in the analysis, 164,315 (45%) displayed symptoms of PASC. The Veterans in this analysis were predominantly male, non-Hispanic White, under the age of 65 years old, and lived in an urban residence. The strongest predictors for PASC included Non-Hispanic Black or African American race compared to Non-Hispanic White race (aOR=1.14), being between the ages of 50 and 64 compared to ages 50 and below (aOR=1.80), diabetes (aOR=8.46), and severe acute infection (aOR=1.42). CONCLUSION: Results demonstrate potential health inequities for vulnerable individuals, as well as increased risk for individuals with pre-existing comorbidities. The prevalence of PASC provides estimates for future health care utilization. The risk factors identified can aid public health interventions to reduce the burden of PASC.

Impact of School Start Time Delays and Learning Modality on Sleep Timing and Duration During COVID-19.

OBJECTIVES: To assess the impact of a school start time (SST) delay on adolescent sleep health during the COVID-19 pandemic, and whether there were differences by learning modality. METHODS: Data were collected from a longitudinal study evaluating sleep, education, and health among high school students in Georgia in 2020. Paired t-tests and multivariable linear regression analyses were conducted to examine changes in sleep duration and timing among 9th grade students (n = 134) and their association with the learning modality (remote vs. in-person learner). RESULTS: Students' school day wake times were 1.5 hours later, school night sleep duration was 1.2 hours longer, and social jetlag was 0.9 hours shorter after the school start time delay (all P < .05). The learning modality was a significant predictor of changes in sleep timing but was not associated with changes in sleep duration. CONCLUSIONS: Delayed school start time was associated with positive changes in adolescent sleep health during the COVID-19 pandemic. Sleep timing was affected by the learning modality, however in-person and virtual students had similar gains in sleep duration. Learning modality may be more beneficial for adolescents with early school start times to promote healthier sleep habits.

The Association of Sleep Duration with Grade Point Averages and Absences Among 9th Graders in Georgia, USA.

This study aimed to examine the association between sleep measures (self-reported sleep duration and weekend catch-up sleep) and grade point average (GPA) and absences among 9th grade students from two racially and economically diverse high schools in a semi-rural county of north-central Georgia. Linear and Poisson regression models estimated the association between sleep measures and GPA and absences (separately), respectively. Analyses adjusted for gender, race/ethnicity, free/reduced-price school lunch status, and parental education. Sleep duration was significantly associated with both GPA and absences, such that for every one additional hour of sleep, GPA increased by 0.8 percentage points (b=0.8, 95% CI:0.1,1.5) while the number of absences was lower by 6% (b=-0.05; OR=0.94, 95% CI:0.91,0.98). Weekend catch-up sleep was also significantly and positively associated with absences (b=0.04; OR=1.04, 95% CI; 1.02, 1.07). Increasing sleep may be a strategy to improve GPA and reduce absences among teenagers. Future research should identify effective measures to lengthen sleep.

Space-time clustering of COVID-19 cases in the United States veteran population.

PURPOSE: To assess the distribution and clustering of coronavirus disease 2019 (COVID-19) testing and incidence over space and time, U.S. Department of Veteran's Affairs (VA) data were used to describe where and when veterans experienced highest proportions of test positivity. METHODS: Data for 6,342,455 veterans who utilized VA services between January 1, 2018, and September 30, 2021, were assessed for COVID-19 testing and test positivity. Testing and positivity proportions by county were mapped and focused-cluster tests identified significant clustering around VA facilities. Spatial cluster analysis also identified where and when veterans experienced highest proportions of test positivity. RESULTS: Within the veterans study population and our time window, 21.3% received at least one COVID-19 test, and 20.4% of those tested had at least one positive test. There was statistically significant clustering of testing around VA facilities, revealing regional variation in testing practices. Veterans experienced highest test positivity proportions between November 2020 and January 2021 in a cluster of states in the Midwest, compared to those who received testing outside of the identified cluster (RR: 3.45). CONCLUSIONS: Findings reflect broad regional trends in COVID-19 positivity which can inform VA policy and resource allocation. Additional analysis is needed to understand patterns during Delta and Omicron variant periods.

The Social, Demographic, and Clinical Predictors of COVID-19 Severity: a Model-based Analysis of United States Veterans.

PURPOSE: This study aims to identify the contributions of individual and community social determinants of health (SDOH), demographic, and clinical factors in COVID-19 disease severity through a model-based analysis. METHODS: This national cross-sectional study focused on hospitalization among those tested for COVID-19 and use of intensive care, analyzing data on 220,848 Veterans tested between February 20, 2020 and October 20, 2021. Multiple logistic regression models were constructed using backwards elimination. The predictive value of each model was assessed with a c-statistic. RESULTS: Those hospitalized were older, more likely to be male, of Black or Asian race, have an income less than $39,999, live in an urban residence, and have medical comorbidities. The strongest predictors for hospitalization included Gini inequality index, race, income, heart failure, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). For intensive care, Asian race, rural residence, COPD, and CKD were the strongest predictors. C-statistics were c = 0.749 for hospitalization and c = 0.582 for ICU admission. CONCLUSIONS: A combination of clinical, demographic, individual and community SDOH factors predict COVID-19 hospitalization with good predictive ability and can inform risk stratification, discharge planning, and public health interventions. Racial disparities were not explained by social or clinical factors. Intensive care models had low discriminative power and may be better explained by other characteristics.

Association between early care and education centres policies and practices and children's healthy behaviours.

OBJECTIVE: To examine the impact of nutritional and physical activity (PA) policies and practices at early care and education centres on behavioural changes among children ages 2-5. METHODS: The study population included 586 children from 25 education centres throughout the state of Georgia. Policies and practices were measured using the Georgia Nutrition and PA Assessment at the start of school year in Fall 2017. Survey data were collected at the beginning of school year September/October 2017 and at the end of school year April/May 2018 to measure changes in children's nutritional and PA behaviour over the school year. We used generalised estimating equations to estimate odds ratios and 95% confidence intervals. RESULTS: Children at centres with a high nutrition assessment score had higher odds of increasing vegetable consumption (OR = 2.1; 95% CI: 1.1, 4.0) while the odds of increasing fruit (OR = 1.4; 95% CI: 0.8, 2.4) and water (OR = 1.2; 95% CI: 0.5, 2.7) consumption increased non-significantly. The odds of improving PA were similar between children at centres with a high versus a low PA assessment score. CONCLUSION: The results, though insignificant, indicate that policies and practices could influence children's health behaviours. Further research is warranted to examine whether improvements in policies and practices could explain changes in children's health behaviours, the impact of educator's knowledge on children's health behaviours and the implementation of and adherence to policy and practice improvement plans.

Examining the Relationship Between Health Behaviors of Adults and Preschool Children.

INTRODUCTION: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. METHOD: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. RESULTS: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). DISCUSSION: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children.

Factors That Influence Sleep Behaviors of High School Students: Findings From a Semi-Rural Community in Georgia.

BACKGROUND: Inadequate sleep has been shown to have detrimental effects on academic performance, physical, mental, and emotional health among adolescents. Factors that influence sleep have been identified. However, most literature is currently limited to urban settings. This study sought to identify factors that influence sleep habits among high school students in a semi-rural community. METHODS: Twelve focus groups were conducted in-person with separate groups of students, parents, and school staff in October 2019. Discussions focused on sleep experiences, knowledge, environment, and factors influencing sleep. Data were coded using grounded theory approach. Themes were identified through summative content analysis. RESULTS: Four major themes were identified: (1) inadequate sleep adversely affects academic performance and emotional health; (2) students face a gap in knowledge regarding sleep duration; (3) academic and nonacademic activities compete with sleep needs; and (4) night-time use of technology negatively influences sleep habits. CONCLUSIONS: Our findings suggest that high school students do not get adequate sleep, largely due to the demands of academic and extracurricular activities and the use of electronics at night. These results can guide the development of targeted sleep education and intervention programs.

Adaptations to the Learning Environment for Elementary School Children in Georgia during the COVID-19 Pandemic.

In March 2020, the rapid spread of COVID-19 led to physical school closures across the United States. Schools quickly transitioned to a remote and/or virtual learning environment. This transition had implications for students at all levels of education, especially for those most vulnerable and school-dependent for ancillary resources. The goal of this qualitative exploratory research study was to examine how public elementary schools in Georgia adapted their learning environments for students in kindergarten through third grade during the early phase of the COVID-19 pandemic. Data collection activities included school demographic surveys, parent surveys, interviews with twelve school administrators, and six focus groups with twenty-six parents. The participants discussed schools' preparation capabilities, implementation of learning modalities, and resources for students and families. Most school personnel described the new virtual teaching demands as a hurdle for their teachers and identified several academic consequences stemming from inadequate technology access or training, such as student absenteeism and lower teaching performance. Schools lacked appropriate preparation as well as limited resources to transition to virtual learning. The COVID-19 pandemic aggravated pre-existing education and technology resource disparities for students and families of low socio-economic status or who live in rural areas. Findings from this study provide educators with information regarding deficiencies in the learning environment and provide recommendations for ongoing academic remedial efforts. Additionally, this study provides important context for the shortcomings of the COVID-19 learning environments and highlights the need to strengthen school community infrastructure and emergency planning.

The Impact of COVID-19 on Education Experiences of High School Students in Semi-Rural Georgia.

BACKGROUND: This study examines the consequences of COVID-19 pandemic on academic and career concerns of high school students; relationship between attendance and grades with educational concerns; and association between student perception of the pandemic and decision to attend school virtually or in-person. METHODS: Diverse students in grades 9-12 from two public high schools in semi-rural Georgia (n = 666) completed a survey shortly after school closures. Survey results were linked to academic and demographic data. Analyses were examined for differences by demographic and education measures. RESULTS: Overall, 60% expressed academic worry and reported obstacles to virtual learning. Hispanic students expressed more worry and less confidence while black students reported less worry than peers. Females indicated more worry than males. Grade 12 students reported greater academic and career worry than younger students. Students eligible for free and reduced lunch expressed more worry and obstacles than peers. Non-honors and low-attendance students reported more worry about grades and graduation than their counterparts. CONCLUSIONS: Results can inform targeted multi-level interventions to reduce the pandemic's effects on learning and ensure healthy trajectories for development across demographics. Stakeholders must take proactive measures to recover from academic loss to ensure our youth's healthy development.

Racial/Ethnic and Sex/Gender Differences in Sleep Duration Trajectories From Adolescence to Adulthood in a US National Sample.

Racial/ethnic and sex/gender disparities in sleep duration have been documented in adolescence and adulthood. Identifying racial/ethnic and sex/gender differences in sleep duration trajectories from adolescence to adulthood can inform interventions on the developmental periods individuals are most at risk for short sleep duration. We examined racial/ethnic and sex/gender differences in self-reported sleep duration trajectories from adolescence to adulthood using data from waves I, III, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018; n = 12,593). Multigroup growth mixture modeling was used to enumerate sleep duration trajectories from adolescence to adulthood. There were 3 common trajectory types across race/ethnicity and sex/gender groups: 1) consistent increasing short sleepers (i.e., increasing probability of short sleep into adulthood) (67.3%); 2) late-onset short sleepers (i.e., no probability of short sleep duration in adolescence until adulthood) (20.2%); and 3) early-onset short sleepers (i.e., declining probability of short sleep duration from adolescence into adulthood) (12.5%). The prevalence of the consistent-increasing trajectory was highest among Black male respondents, while late onset was highest among White female respondents and early onset greatest among Latinx male respondents. Findings underscore the need to intervene in early adolescence to prevent short sleep duration in adulthood.

Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents.

Objective: Racial disparities in adolescent sleep duration have been documented, but pathways driving these disparities are not well understood. This study examined whether neighborhood and household environments explained racial disparities in adolescent sleep duration. Methods: Participants came from Waves I and II of Add Health (n=13,019). Self-reported short sleep duration was defined as less than the recommended amount for age (<9 hours for 6-12 years, <8 hours for 13-18 years, and <7 hours for 18-64 years). Neighborhood factors included neighborhood socioeconomic disadvantage, perceived safety and social cohesion. Household factors included living in a single parent household and household socioeconomic status (HSES). Structural equation modeling was used to assess mediation of the neighborhood and household environment in the association between race/ethnicity and short sleep duration. Results: Only HSES mediated racial disparities, explaining non-Hispanic (NH) African American-NH White (11.6%), NH American Indian-NH White (9.9%), and Latinx-NH White (42.4%) differences. Unexpectedly, higher HSES was positively associated with short sleep duration. Conclusion: Household SES may be an important pathway explaining racial disparities in adolescent sleep duration. Future studies should examine mechanisms linking household SES to sleep and identify buffers for racial/ethnic minority adolescents against the detrimental impacts that living in a higher household SES may have on sleep.

Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey.

BACKGROUND: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities' knowledge of equity along digital health use patterns. OBJECTIVE: This study aims to identify the social determinants of digital health tool adoption in Georgia. METHODS: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. RESULTS: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. CONCLUSIONS: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions.

Historically black college and university (HBCU) COVID-19 return-to-campus policies and prevention measures-Fall 2021.

Objectives: Examine publicly accessible HBCU COVID-19 policies and associations with community COVID-19 infection and vaccination rates, and utilization of a dashboard. Participants: Excluding unaccredited or closed programs (n = 5) and those without COVID-19 information on website (n= 18), 76 HBCUs were included. Methods: Data on vaccine requirements, masking, and other policies were collected. Student enrollment and demographics and community infection and vaccination rates were obtained from websites. Results: Between August 15 and September 6, 2021, 36% of HBCU websites indicated vaccination requirements for students, with differences by private (57%) and public (17%). Masking requirements were more prevalent in HBCUs in areas with >50% community vaccination coverage vs those with <25%. Private institutions were more likely than public to require faculty/staff testing (34% vs 19%). HBCUs in areas with low/moderate COVID-19 rates were twice as likely to require vaccinations than HBCUs with higher rates. Conclusions: Easily accessible COVID-19 policies may help guide community prevention measures.

Physical activity and academic achievement: an analysis of potential student- and school-level moderators.

BACKGROUND: Many children do not engage in sufficient physical activity, and schools provide a unique venue for children to reach their recommended 60 daily minutes of moderate-to-vigorous physical activity (MVPA). Prior research examining effects of MVPA on academic achievement is inconclusive, and few studies have investigated potential moderators of this relationship. This study examined whether student-level characteristics (gender, race/ethnicity, free/reduced-price lunch status) and school-level characteristics (proportion of students qualifying for free/reduced-price lunch, physical activity environment and opportunities) moderate the relationship between MVPA and academic achievement. METHODS: In a large, diverse metropolitan public school district in Georgia, 4,936 students in Grade 4 were recruited from 40 elementary schools. Students wore accelerometers to measure school-day MVPA for a total of 15 days across three semesters (fall 2018, spring 2019, fall 2019). Academic achievement data, including course marks (grades) for math, reading, spelling, and standardized test scores in writing, math, reading, and Lexile (reading assessment), were collected at baseline (Grade 3, ages 8-9) and at follow-up in Grade 4 (ages 9-10). Standardized test scores were not measured in Grade 5 (ages 10-11) due to COVID-19-related disruptions. Multilevel modeling assessed whether student-level and/or school-level characteristics were moderators in the cross-sectional and longitudinal MVPA-academic achievement relationship. RESULTS: Cross sectional analyses indicated that the MVPA and AA relationship was moderated only by student Hispanic ethnicity for Grade 4 fall spelling marks (ß = -0.159 p < 0.001). The relationship for Grade 4 fall spelling marks was also moderated by school physical activity opportunities (ß = -0.128 (p < 0.001). Longitudinally, there was no significant moderation of the MVPA-academic achievement. A relationship by student gender, free/reduced-price lunch status, race/ethnicity; nor for school-level factors including proportion of students qualifying for free/reduced-price lunch, physical activity environment, and physical activity opportunities. CONCLUSIONS: Overall, our results did not suggest that student- or school-level characteristics moderate the MVPA-academic achievement relationship. While statistically significant results were observed for certain outcomes, practical differences were negligible. In this population, school-based MVPA does not appear to differently affect academic performance based on student gender, race/ethnicity, free/reduced-price lunch, nor school characteristics. TRIAL REGISTRATION: This study was registered with the National Institutes of Health (NIH) ClinicalTrials.gov system, with ID NCT03765047 . Registered 05 December 2018-Retrospectively registered.

The longitudinal association between objectively-measured school-day physical activity and academic achievement in US elementary school students.

BACKGROUND: It is recommended that school-aged children accrue 30 minutes of daily moderate-to-vigorous physical activity (MVPA) in school. Current literature is inconclusive about the long-term associations between school-based physical activity and academic achievement. In this study, we use a large sample and longitudinal design to rigorously evaluate whether school-day MVPA is associated with academic achievement. METHODS: In a diverse suburban public school district, 4936 Grade 4 students were recruited in 40 elementary schools. Students wore accelerometers to measure school-day MVPA for 15 days across three semesters. Academic performance data was collected across Grade 3 fall to Grade 5 spring, including teacher-assigned grades and standardized test scores. Multilevel modeling was conducted controlling for student demographics and school characteristics. RESULTS: Cross-sectional analyses found small negative associations in Grade 4. Grade 4 full-year mean daily school-day MVPA had ß = --0.066, ß = --0.063, ß = --0.066, and ß = --0.058 associations (p <  0.001) with Grade 4 math, reading, spelling, and writing grades respectively, and Grade 4 full-year mean daily school-day MVPA had ß = --0.206 and ß = --0.283 (p <  0.001) associations with Grade 4 math and English Language Arts (ELA) standardized test scores respectively out of approximately 500 points. Longitudinal analyses found no significant associations between Grade 4 full-year mean daily school-day MVPA and Grade 5 Fall course grades. Results also indicated small negative associations for students attaining 30+ minutes of daily school-day MVPA compared to those attaining less than 15 minutes, but only in Grade 4 Fall cross-sectional analyses where teacher-assigned reading, spelling, and writing grades were - 1.666, - 1.638, and - 1.993 points lower respectively (p <  0.001). CONCLUSION: The cross-sectional findings, while statistically significant in a negative direction, have a negligible association when translated practically. For example, even if students attained twice the recommended amount of school-day MVPA - which would constitute an approximately 300% increase from current levels - results suggest that grades would only decrease by 2 points on a 100-point scale. Furthermore, longitudinal analyses suggest school-day MVPA does not have a predictive association with course grades or standardized test scores. Findings suggest school-based MVPA implemented in accordance with recommendations does not meaningfully detract from academic progress. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03765047. Registered 05 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03765047.

Effects of Remote Education During the COVID-19 Pandemic on Young Children's Learning and Academic Behavior in Georgia: Perceptions of Parents and School Administrators.

BACKGROUND: In Spring 2020, Georgia public schools implemented remote learning to manage the spread of COVID-19. This study explores the effects of remote schooling on the learning of young children in Georgia during the early COVID-19 pandemic from the perspectives of school administrators and essential working parents. METHODS: A qualitative exploratory study was conducted with eight school administrators and 26 essential working parents of children in kindergarten through third grades of two rural and two urban schools in Georgia. Data collection included online surveys, virtual interviews and focus groups. Descriptive analyses of the demographics provided context to emerging themes from qualitative data. RESULTS: Most school administrators and parents reported declines in student learning and academic behavior related to remote learning. Lack of Wi-Fi, technology, and digital literacy were often cited as barriers to learning. Challenges with remote learning were amplified for students and parents of vulnerable groups. CONCLUSIONS: The findings of this study illustrate the need to institute policies, procedures, and supports to maximize schools' ability to safely offer in-person learning during the COVID-19 pandemic. Considerations should be made of the needs of essential working parents, vulnerable populations, and the digital divide.

The Relationships between Childhood Bullying, School Connectedness, and Adolescent Adiposity, the Fragile Families Child and Wellbeing Study.

BACKGROUND: School environments are important to consider for children's health. This study aims to determine if childhood peer bullying and school connectedness are associated with adolescent adiposity. METHODS: A total of 3377 children from the age 9 child interview of the Fragile Families and Child Wellbeing Study had self-reported bullying and school connectedness data at age 9, height and weight measured at ages 9 and 15, and waist circumference was measured during an age 15 home visit. Linear regression models estimated the association between bullying and school connectedness and (1) change in BMI between age 9 and 15, and (2) waist circumference at age 15. Models were stratified by sex. RESULTS: Girls had larger increases in body mass index (BMI) when experiencing low school connectedness, and students that experienced both bullying and low school connectedness had larger increases in BMI. Girls had larger waist circumferences for increased levels of bullying, low connectedness, and experiencing both. CONCLUSIONS: School environments may play a role in the development of increased adiposity and there may be gender differences in the types of factors that are important to consider, particularly for central adiposity. Positive and engaging school environments can help support students' development and healthy behaviors.

Sex and racial/ethnic differences in the prevalence of overweight and obesity among U.S. college students, 2011-2015.

OBJECTIVE: To investigate sex and racial/ethnic differences in overweight and obesity in college students. Participants: A nationally representative sample of 319,342 U.S. college students (mean age = 20.4 years; 67.7% female) from Fall 2011 to Spring 2015. Methods: A secondary data analysis of multi-year cross-sectional data was performed. Multiple logistic regression was used to examine factors (e.g. cumulative grade average, year in school, and living place) associated with overweight and obesity determined from BMI calculated by self-reported height and weight. Results: The prevalence of overweight and obesity was significantly higher for both sexes in Spring 2015 than in Fall 2011. Significant differences were found in overweight and obesity by sex and race/ethnicity. Higher adjusted odds ratios for overweight and obesity were observed for men, blacks, and Hispanics (compared to whites). Asians had the lowest adjusted odds of overweight and obesity. Conclusions: Intervention strategies for the prevention and management of overweight and obesity in U.S. college students should consider sex and racial/ethnic inequalities.