Geographic social vulnerability is associated with the alpha diversity of the human microbiome.

IMPORTANCE: As a risk factor for conditions related to the microbiome, understanding the role of SVI on microbiome diversity may assist in identifying public health implications for microbiome research. Here we found, using a sub-sample of the Human Microbiome Project phase 1 cohort, that SVI was linked to microbiome diversity across body sites and that SVI may influence race/ethnicity-based differences in diversity. Our findings, build on the current knowledge regarding the role of human geography in microbiome research, suggest that measures of geographic social vulnerability be considered as additional contextual factors when exploring microbiome alpha diversity.

Active living-oriented zoning codes and cardiometabolic conditions across the lifespan.

Environments that make it easier for people to incorporate physical activity into their daily life may help to reduce high rates of cardiometabolic conditions. Local zoning codes are a policy and planning tool to create more walkable and bikeable environments. This study evaluated relationships between active living-oriented zoning code environments and cardiometabolic conditions (body mass index, hyperlipidemia, hypertension). The study used county identifiers to link electronic health record and other administrative data for a sample of patients utilizing primary care services between 2012 and 2016 with county-aggregated zoning code data and built environment data. The analytic sample included 7,441,991 patients living in 292 counties in 44 states. Latent class analysis was used to summarize municipal- and unincorporated county-level data on seven zoning provisions (e.g., sidewalks, trails, street connectivity, mixed land use), resulting in classes that differed in strength of the zoning provisions. Based on the probability of class membership, counties were categorized as one of four classes. Linear and logistic regression models estimated cross-sectional associations with each cardiometabolic condition. Models were fit separately for youth (aged 5-19), adults (aged 20-59), and older adults (aged 60+). Little evidence was found that body mass index in youth, adults, or older adults or the odds of hyperlipidemia or hypertension in adults or older adults differed according to the strength of active living-oriented zoning. More research is needed to identify the health impacts of zoning codes and whether alterations to these codes would improve population health over the long term.

Using internet search data to understand information seeking behavior for health and conservation topics during the COVID-19 pandemic.

Emerging zoonotic diseases, such as COVID-19, exist at the intersection of human health and the environment. Public interest and support are required to maximize the effectiveness of policies to combat the current pandemic and prevent future outbreaks of zoonoses. Here, we use internet search data from the United States to investigate changes in public information seeking about topics at the intersection of health and the environment during the COVID-19 pandemic. Using breakpoint detection methods, we identify sharp increases in interest for 'wildlife trade', 'bats', and 'pangolins' in the early stages of the pandemic (on Jan. 12, Jan. 19, and Jan. 26, 2020, respectively). Network analyses also revealed increasing connectivity between terms related to human health and the environment, as well as the emergence of novel search terms pointing to a greater interest in wildlife trade and consumption. During the pandemic, the network connectivity between coronavirus keywords and conservation keywords increased, which we measured using the number of unique connections (edge connectivity, k' (G)) and the number of simple paths (Sp) between keywords. Both measures of network connectivity increased between 'coronavirus' and 'bats' or 'pangolins' (Δk' (G) = 1, ΔSp = 37), and between 'coronavirus' and 'conservation' (Δk' (G) = 1, ΔSp = 160). These findings suggest that policy and outreach efforts aimed at engaging public interest in intersectional approaches to pandemic prevention (eg: One Health, Planetary Health), may be able to take advantage of increases in public information seeking following catalyzing events during the pandemic. Further monitoring is needed to determine if these changes persist over time.

Associations between Daily Work Hassles and Energy-Balance Behaviors in Female African American Workers: An Ecological Momentary Assessment Study.

Objective: Despite their high rate of labor force participation, African American women earn less and are overrepresented in service jobs that tend to have fewer benefits, longer work hours, and less flexibility. The aim of our study was to examine associations between work-related daily hassles and energy balance behaviors among female African American workers. Design: A secondary analysis of a 7-day intensive longitudinal study using ecological momentary assessment (EMA). Setting: Metropolitan area of Chicago, Illinois, United States; July 2012 through January 2013. Participants: A convenience sample of 70 female African American workers. Methods: EMA was used to collect information over seven days on work hassles and energy balance behaviors: empty calorie food intake; moderate-to-vigorous physical activity (MVPA); sedentary behavior; sleep duration; and sleep disturbance. Within-person associations between daily work hassles and each of these daily energy balance behaviors were analyzed using person fixed-effects regression. Results: A total of 334 person-day observations from 70 female African American workers were included in the final analysis. Reporting at least one daily work hassle was associated with same-day higher empty calorie food intake (OR: 2.2, 95% CI: 1.0, 4.6) and more daily minutes of sedentary behavior (b: 35.8, 95% CI; .2, 71.3). However, no significant associations were found between prior-day work hassles and either food intake or sedentary behavior. Daily work hassles were not related to MVPA, sleep duration, or sleep disturbance. Conclusions: Our study showed that daily work hassles were associated with female African American workers' empty calorie food intake and sedentary behaviors. Strategies to eliminate daily work hassles may help to improve their energy balance behaviors.

Neighborhood Walkability and BMI Change: A National Study of Veterans in Large Urban Areas.

OBJECTIVE: Improving neighborhood walkability has been proposed as a policy intervention to reduce obesity. The objective of this study was to evaluate longitudinal relationships between neighborhood walkability and body weight among adults living in large urban areas. METHODS: In this retrospective longitudinal study of United States military veterans using Department of Veterans Affairs health care, Veterans Affairs clinical and administrative data (2007-2014) were linked to environmental measures constructed from public (2006-2014) and proprietary (2008-2014) sources, and linear regression models with person fixed effects were used to estimate associations between walkability and BMI among 758,434 men and 70,319 women aged 20 to 80 years in 2009 to 2014. RESULTS: Neighborhood walkability was associated with small reductions in BMI. Effects were most pronounced among men aged 30 to 49 and 50 to 64. For women, differences were largest in the two youngest age groups, 20 to 29 and 30 to 49, though only estimates for all women combined were statistically significant. For women aged 30 to 49, effect sizes grew when the sample was limited to those who remained in the same neighborhood during the entire follow-up period. CONCLUSIONS: Investments in the built environment to improve walkability may be a useful strategy for weight control in some segments of the adult population.

Stability of activity space footprint, size, and environmental features over six months.

As activity space measures are increasingly used to estimate exposure to environmental determinants of health, little is known about the stability of these measures over time. To test the stability of GPS-derived measures of activity-space footprint, size, and environmental features over time, we compared 14-day measures at baseline and six months later for 35 adults in a large city. Activity-space measures were based on convex hulls and 500 m route buffers, and included the geographic footprint (i.e. location of the activity space), size (i.e., area in square miles; (Cummins, 2007)), and environmental features including supermarket, fast-food restaurant, and parkland density. The proportion of the participants' smaller geographic footprint covered by the larger was, on average, 0.64 (SD 0.17) for the 500 m route buffer and 0.84 (SD 0.18) for the convex hull. Mean percent change in activity space size ranged from 36.3% (mean daily 500 m route buffer) to 221.3% (cumulative convex hull). Mean percent change in the density of environmental features ranged from 28.8 to 66.5%. Forty-one percent to 92.4% of the variance at one timepoint was predicted by environmental features measured within approximately six months. Activity-space size and environmental features were moderately to highly stable over six months, although there was considerable variation in stability between measures. Strategies for addressing measurement error in studies of activity space-health associations are discussed.

Does the built environment influence the effectiveness of behavioral weight management interventions?

Outcomes of behavioral lifestyle interventions for promoting weight loss vary widely across participants. The effectiveness of a weight management intervention may depend on a person's environmental context. This study compared short- and longer-term effects of a structured nationwide weight management program for people living in neighborhoods with different levels of walkability and different access to recreational places (parks, fitness facilities). Drawing on the health production model, we tested competing hypotheses for whether treatment effects of the program complement environmental supports or substitute for environmental constraints. We studied the US Department of Veterans Affairs (VA) MOVE! weight management program using VA electronic heath record data (2009-2014) and a difference-in-differences design with an inverse propensity score matched comparison group. A total of 114,256 program participants and 498,494 non-participants comprised the sample. Built environment features were measured within one-mile of each person's home. We estimated program effects on body mass index (BMI) for subgroups with different built environments at 6-, 12-, 18-, and 24-month follow-up using linear regressions with person and year fixed effects. At 6 months, the program reduced BMI by 0.4-0.6 kg/m2 among men and 0.3-0.5 kg/m2 among women. The effect diminished at 12, 18, and 24 months. The program effect did not vary significantly across subgroups with different walkability, park access, or fitness facility access. The MOVE! program was not sensitive to environmental context. Results did not lend support to either hypothesis that the MOVE! program complements or substitutes for a person's built environment to affect weight management outcomes.

Convergent validity of an activity-space survey for use in health research.

We explored the validity of a survey measuring activity spaces for use in health research in a racially/ethnically diverse adult sample (n = 86) living in four Chicago neighborhoods. Participants reported on the location and visit frequency of 64 activities and wore a GPS data logger. We assessed the spatial congruence of survey- and GPS-derived convex hull measures and the number of GPS points within 100 m and 1000 m of survey locations. The survey-derived convex hull measures captured a small percentage (median = 35.9%) of the GPS-derived convex hull area. However, most GPS points were located within 100 m or 1000 m of home or reported survey locations (median = 73.4% and 92.6%, respectively).

Neighborhood Environment and Asthma Exacerbation in Washington, DC.

Approximately one in eight people in the United States have been diagnosed with asthma. Asthma is associated with significant medical expenditure and has been implicated as a leading reason for chronic school absences. Environmental risk factors such as access to green space and exposure to poor air quality are patterned such that some vulnerable populations may be at higher risk. Using data from DC Health, the Washington, DC, department of public health, this study investigated associations between neighborhood social, built, and natural environments and rates of asthma-related healthcare encounters by ZIP code between 2014 and 2017. We found that significant differences in rates exist between ZIP codes and for different subpopulations. Black boys had the highest overall rate, with 58.49 visits per 1,000 population, ranging by ZIP code from 0 to 88.56 visits. We found that the ZIP code Social Vulnerability Index was consistently associated with rates of healthcare encounters, but not access to green/open space or exposure to high traffic. However, we discuss how the ZIP code level may not be an appropriate level at which to investigate such built/natural environment features because of the proportion of variability that is found within rather than between ZIP codes. We end with a short discussion of ways that nurses, in particular school nurses, could help to address neighborhood environmental risk factors.

Contextual correlates of energy-dense snack food and sweetened beverage intake across the day in African American women: An application of ecological momentary assessment.

This study examined relationships between contextual factors and within-person variations in snack food and sweetened beverage intake in African American women (n = 79), aged 25-65 years living in metropolitan Chicago. For seven days, participants wore a global positioning system (GPS) logger and were signaled five times per day to complete an ecological momentary assessment (EMA) survey assessing behaviors and environmental, social, and other contextual factors via smartphones. Within-person associations between snack food and beverage intake and contextual factors were analyzed using three-level logistic regressions. Participants reported consuming a snack food at 38.4% of signals and a sweetened beverage at 17.9% of signals. Fast food restaurant and convenience store density within the daily activity space was not associated with either snack food or sweetened beverage intake. However, perceptions of close proximity to fast food restaurants and convenience stores making it easier to eat/drink, while accounting for one's usual proximity, were associated with increased odds of snack intake (O.R. 2.1; 95% C.I. 1.4, 3.0) but not sweetened beverage. We also found engaging in activities such as watching television (O.R. 1.8; 95% C.I. 1.2, 2.7) and talking (O.R. 1.7; 95% C.I. 1.1, 2.6) while eating were associated with higher snack intake. These factors were not related to sweetened beverage intake. Public health interventions addressing fast food restaurant and convenience store accessibility and food offerings and marketing within these outlets may help reduce snack food intake. Additionally, to reduce concurrent activities while eating, real-time interventions using smart technology could be used to enhance attentive eating in this population.

Does Effectiveness of Weight Management Programs Depend on the Food Environment?

OBJECTIVE: To estimate the causal effects of a population-scale behavioral weight management program and to determine whether the program's effectiveness depends on participants' geographic access to places to purchase healthy and less healthy foods. DATA SOURCES: Secondary data from U.S. Department of Veterans Affairs clinical and administrative records (2008-2014), retail food environment measures from commercial databases (2008-2014), and the American Community Survey (2009-2014). STUDY DESIGN: We estimated the effect of the VA's MOVE! weight management program on body mass index after 6 months using difference-in-difference regressions to compare participants with a propensity score-matched control group. We estimated treatment effects overall and in subgroups with different access to supermarkets, fast-food restaurants, and convenience stores. PRINCIPAL FINDINGS: MOVE! reduced BMI by about 0.71 units among men and 0.70 units among women. The program was slightly less effective for men living near fast-food restaurants or convenience stores. We found no evidence that treatment effects varied with the food environment among women. CONCLUSIONS: The residential food environment modestly alters MOVE! effectiveness among men. A greater understanding of environmental barriers to and facilitators of intentional weight loss is needed. This study highlights important potential intersections between health care and the community.

How many days of global positioning system (GPS) monitoring do you need to measure activity space environments in health research?

This study examined the number of days of global positioning system (GPS) monitoring needed to measure attributes of an individual's routine activity space. Multiple alternative activity space representations (cumulative, mean daily), measures (kernel density, route buffer, convex hull), and attributes (area size, supermarkets, fast food restaurants, parks) were examined. Results suggested wide variability in required GPS days to obtain valid estimates of activity space attributes (1-23 days). In general, fewer days were needed for mean daily activity space representations, kernel density measures, and densities of environmental exposures (vs. counts). While kernel density measures reliably estimated between-person differences in attributes after just a few days, most variability in environmental attributes for convex hull and route buffer measures was within-person. Based on these results, a minimum of 14 days of valid GPS data is recommended to measure activity spaces.

Long-Term Weight Loss Effects of a Behavioral Weight Management Program: Does the Community Food Environment Matter?

This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and 37,192 inverse propensity-score weighted matched male and female controls. We measured the community food environment by counting the number of supermarkets, convenience stores, and fast food restaurants within a 1-mile radius around each person's home address. We used difference-in-difference regression models with person and calendar time fixed effects to estimate MOVE! effects over time in sub-populations defined by community food environment attributes. Among men, after an initial decrease in BMI at 6 months, the effect of the program decreased over time, with BMI increasing incrementally at 12 months (0.098 kg/m², p < 0.001), 18 months (0.069 kg/m², p < 0.001), and 24 months (0.067 kg/m², p < 0.001). Among women, the initial effects of the program decreased over time as well. Women had an incremental BMI change of 0.099 kg/m² at 12 months (p < 0.05) with non-significant incremental changes at 18 months and 24 months. We found little evidence that these longer-term effects of the weight management program differed depending on the community food environment. Physiological adaptations may overwhelm environmental influences on adherence to behavioral regimens in affecting longer-term weight loss outcomes.

Neighborhood Resources to Support Healthy Diets and Physical Activity Among US Military Veterans.

INTRODUCTION: Among the nearly 21 million military veterans living in the United States, 64.0% of women and 76.1% of men are overweight or obese, higher rates than in the civilian population (56.9% of women and 69.9% of men). Attributes of the residential environment are linked to obesity. The objective of this study was to characterize the residential environments of the US veteran population with respect to availability of food and recreational venues. METHODS: We used American Community Survey data to determine the concentration of veterans (the percentage of veterans among the adult population) in all continental US census tracts in 2013, and we used proprietary data to construct measures of availability of food and recreational venues per census tract. Using descriptive statistics and ordinary least-squares regression, we examined associations between the concentration of veterans per census tract and those residential environmental features. RESULTS: In census tracts with high concentrations of veterans, residents had, on average, 0.5 (interquartile range, 0-0.8) supermarkets within a 1-mile radius, while residents in census tracts with low concentrations of veterans had 3.2 (interquartile range, 0.6-3.7) supermarkets. Patterns were similar for grocery and convenience stores, fast food restaurants, parks, and commercial fitness facilities. In adjusted analyses controlling for census-tract-level covariates, veteran concentration remained strongly negatively associated with availability of those food and recreational venues. In nonmetropolitan tracts, adjusted associations were greatly attenuated and even positive. CONCLUSION: Where veterans live is strongly associated with availability of food outlets providing healthy (and unhealthy) foods and with recreational venues, raising questions about the contributions of veterans' residential environments to their high obesity rates. Additional research is needed to address those questions.

A step-by-step approach to improve data quality when using commercial business lists to characterize retail food environments.

BACKGROUND: Food environment characterization in health studies often requires data on the location of food stores and restaurants. While commercial business lists are commonly used as data sources for such studies, current literature provides little guidance on how to use validation study results to make decisions on which commercial business list to use and how to maximize the accuracy of those lists. Using data from a retrospective cohort study [Weight And Veterans' Environments Study (WAVES)], we (a) explain how validity and bias information from existing validation studies (count accuracy, classification accuracy, locational accuracy, as well as potential bias by neighborhood racial/ethnic composition, economic characteristics, and urbanicity) were used to determine which commercial business listing to purchase for retail food outlet data and (b) describe the methods used to maximize the quality of the data and results of this approach. METHODS: We developed data improvement methods based on existing validation studies. These methods included purchasing records from commercial business lists (InfoUSA and Dun and Bradstreet) based on store/restaurant names as well as standard industrial classification (SIC) codes, reclassifying records by store type, improving geographic accuracy of records, and deduplicating records. We examined the impact of these procedures on food outlet counts in US census tracts. RESULTS: After cleaning and deduplicating, our strategy resulted in a 17.5% reduction in the count of food stores that were valid from those purchased from InfoUSA and 5.6% reduction in valid counts of restaurants purchased from Dun and Bradstreet. Locational accuracy was improved for 7.5% of records by applying street addresses of subsequent years to records with post-office (PO) box addresses. In total, up to 83% of US census tracts annually experienced a change (either positive or negative) in the count of retail food outlets between the initial purchase and the final dataset. DISCUSSION: Our study provides a step-by-step approach to purchase and process business list data obtained from commercial vendors. The approach can be followed by studies of any size, including those with datasets too large to process each record by hand and will promote consistency in characterization of the retail food environment across studies.

Environmental and personal correlates of physical activity and sedentary behavior in African American women: An ecological momentary assessment study.

The authors of this study examined within-person associations of environmental factors (weather, built and social environmental barriers) and personal factors (daily hassles, affect) with moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) in African American women aged 25-64 years living in metropolitan Chicago (n = 97). In 2012-13, for seven days, women wore an accelerometer and were signaled five times per day to complete a survey covering environmental and personal factors on a study-provided smartphone. Day-level measures of each were derived, and mixed regression models were used to test associations. Poor weather was associated with a 27.3% reduction in daily MVPA. Associations between built and social environmental barriers and daily MVPA or SB were generally not statistically significant. Negative affect at the first daily signal was associated with a 38.6% decrease in subsequent daily MVPA and a 33.2-minute increase in subsequent daily SB. Each one-minute increase in MVPA during the day was associated with a 2.2% higher likelihood of positive affect at the end of the day. SB during the day was associated with lower subsequent positive affect. Real-time interventions that address overcoming poor weather and negative affect may help African American women increase MVPA and/or decrease SB.

Experiences of African-American Women with Smartphone-Based Ecological Momentary Assessment.

OBJECTIVE: Smartphone-based ecological momentary assessment (EMA), or real-time, repeated sampling of participants' states, behaviors, or experiences over time, is a promising approach to understanding obesity-related behaviors in African-American women-a population with the highest obesity prevalence. In this study, we explored participants' experiences with this methodology. DESIGN AND SAMPLE: In this secondary analysis of data, 100 African-American women participated in seven consecutive days of EMA data collection. MEASURES: Measures related to acceptability (technical challenges, daily burden, emotional responses, willingness to participate in future studies) and data quality (reporting accuracy, behavior reactivity, adherence), as well as demographics, were collected. RESULTS: While there were few demographic differences, women who were unemployed, had the lowest educational levels, or had the lowest per capita income reported the greatest enjoyment with mobile technology-based EMA, while at the same time reporting the highest levels of challenge with use of the equipment. Participants consistently indicated willingness to participate in future EMA studies and indicated that the study method was acceptable. EMA methodology produced data of sufficient quality. CONCLUSION: Findings suggest future studies using smartphone-based EMA with African-American women are feasible.