COVID-19 Information, Trust, and Risk Perception Across Diverse Communities in the United States: Initial Findings from a Multistate Community Engagement Alliance (CEAL).

Objectives. To provide initial findings from Community Engagement Alliance (CEAL), a multistate effort funded by the National Institutes of Health, to conduct urgent community-engaged research and outreach focused on COVID-19 awareness, education, and evidence-based response. Methods. We collected survey data (November 2020-November 2022) from 21 CEAL teams from 29 state and regional CEAL sites spanning 19 US states, the District of Columbia, and Puerto Rico, which covered priority populations served and trusted sources of information about COVID-19, including prevention behaviors, vaccination, and clinical trials. Results. A disproportionate number of respondents were Latino (45%) or Black (40%). There was considerable variability between CEAL sites regarding trusted sources of information, COVID-19 prevention, and COVID-19 vaccination. For example, more respondents (70%) reported health care providers as a trusted source of COVID-19 information than any other source (ranging from 6% to 87% by site). Conclusions. CEAL rapidly developed novel infrastructure to engage academic, public health, and community organizations to address COVID-19's impacts on underserved communities. CEAL provides an example of how to respond in future public health emergencies to quickly promote trustworthy, evidence-based information in ways that advance health equity. (Am J Public Health. 2024;114(S1):S112-S123. https://doi.org/10.2105/AJPH.2023.307504).

Development of a Data Visualization Tool to Evaluate the Impact of a Maternal and Child Health (MCH) Nutrition Training Program on MCH Populations.

INTRODUCTION: Maternal and Child Health (MCH) Nutrition Training Programs aim to train graduate-level registered dietitian/nutritionists (RDNs) to improve the health of MCH populations. Metrics exist to evaluate the production and success of skilled graduates; however, metrics are needed regarding the reach of MCH professionals. This study aimed to develop, validate, and administer a survey to estimate the reach of a MCH Nutrition Training Program's alumni within the MCH population. METHODS: First, content validity of the survey was established with input from an expert panel (n = 4); face validity was established using cognitive interviews (n = 5) with RDNs; a test-retest (n = 37) was conducted to establish instrument reliability. The final survey, emailed to a convenience sample of alumni, received a response rate of 57% s(n = 56 of 98). Descriptive analyses were completed to identify MCH populations that alumni served. Survey responses were used to develop a storyboard. RESULTS: Most respondents were employed (93%; n = 52) and serving MCH populations (89%; n = 50). Of those serving MCH populations, 72% indicated working with families, 70% with mothers/women, 60% with young adults, 50% with children, 44% with adolescents, 40% with infants, and 26% with children and youth with special health care needs. The storyboard was created and visually represents connections between public health nutrition employment classification, direct reach, and indirect reach of sampled alumni to MCH populations served. CONCLUSION: The survey and storyboard are important tools that allow MCH Nutrition training programs to demonstrate their reach and to justify the impact of workforce development investments on MCH populations.

Nutrition-Related Information Shared by Latine Influencers: A YouTube Content Analysis.

Latines are the fastest growing populace in the United States. Latine is a new, inclusive term for Hispanic and Latino populations regardless of gender identity. When compared with non-Latine counterparts, Latines have higher prevalence rates of obesity, diabetes, chronic liver disease, and kidney disease, which are associated with poor dietary behaviors. More research is warranted into the factors behind Latines' understanding of nutrition and potential sources of health information that influence dietary behaviors. This study describes the nutrition-related health information shared through YouTube by English-speaking Latine individuals between the ages of 18 and 49. For this content analysis, a cross-sectional study design was used. A four-step search strategy identified eligible YouTube channels and their corresponding video blogs (vlogs): discovery, screening, eligibility, and included. NVivo 1.0 was used to qualitatively code the nutrition-related information. A total of 68 vlogs were identified and reviewed. Five main themes emerged from the data (what vloggers discussed): Nutrition Philosophies, Inaccurate Information, Product Promotion, Recommendations based on the 2020-2025 Dietary Guidelines for Americans (DGA), and Recommendations not based on the 2020-2025 DGA. Although some of the nutrition-related information shared followed the 2020-2025 DGA, not all information were in line with these guidelines. Misinformation can undermine the scientific work done by health professionals and can threaten the health and lives of the citizenry by creating barriers for accessing, understanding, and utilizing evidenced-informed guidance in making health decisions. This study revealed that more research is warranted into specific aspects of social media and how they influence health behavior.

Secondhand Smoke Exposure at Home and/or in a Vehicle: Differences Between Urban and Non-Urban Adolescents in the United States, From 2015 to 2018.

INTRODUCTION: Secondhand smoke exposure during adolescence is linked to increased risk for cigarette smoking susceptibility and initiation. Non-urban youth may encounter a disproportionate number social and environmental risk factors for secondhand smoke exposure. Research is needed to explore geographic disparities in secondhand smoke exposure. AIMS AND METHODS: Four years of National Youth Tobacco Survey (2015-2018) data were pooled. Participants were 69 249 middle and high school students. Multivariable logistic regression examined the relationship between geographic region and secondhand smoke exposure (1) at home and (2) in a vehicle. A multivariable, multinomial logistic regression examined the relationship between geographic region and number of sources of secondhand smoke exposure (ie, 0, 1 source, 2 sources). Covariates included sex, race/ethnicity, grade level, past 30-day tobacco use, and living with a tobacco user. RESULTS: From 2015 to 2018, ~28.4% of middle and high school students reported secondhand smoke exposure either at home, in a vehicle, or both. Non-urban youth had greater odds of reporting secondhand smoke exposure at home (Adj OR: 1.26; 95% CI: 1.15 to 1.38) and in a vehicle (Adj OR: 1.50; 95% CI: 1.35 to 1.65), compared with urban youth. Similarly, non-urban youth had greater odds of reporting secondhand smoke exposure via one source (RRR: 1.21; 95% CI: 1.11 to 1.31) and two sources (RRR: 1.61; 95% CI: 1.42 to 1.82), relative to no exposure, than urban youth. CONCLUSION: Secondhand smoke exposure at home and/or in a vehicle varies across geographic region. Targeted interventions should be developed and implemented to reduce secondhand smoke exposure among at-risk youth. IMPLICATIONS: Findings showcase the need to address secondhand smoke exposure in non-urban areas and how it impacts adolescents. Public health interventions and regulatory policies aimed at improving social norms and expanding health infrastructure in rural communities should be designed and implemented in order to prevent and reduce secondhand smoke exposure among non-urban youth.

Using a consumer-based wearable activity tracker for physical activity goal setting and measuring steps in pregnant women with gestational diabetes mellitus: exploring acceptance and validity.

BACKGROUND: Activity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM). METHODS: Participants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding. RESULTS: Mean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m2 (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P < .05), although walking at 100 steps per minute (P = .01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P < .007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P < .001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA. CONCLUSIONS: The FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women's preferred cadence.

"It was just for us": qualitative evaluation of an exercise intervention for African-American couples.

BACKGROUND: Promoting long-term exercise adherence should be a key focus for health and fitness professionals working to reduce obesity and cardiometabolic health disparities, and all-cause mortality in inactive African-American (AA) adults. Data have suggested that romantic partners can improve long-term exercise adherence and that this dyadic approach should be examined in exercise interventions. Therefore, the purpose of this study was to conduct a qualitative evaluation of a pilot exercise intervention conducted in older AA couples. METHODS: Two semi-structured focus groups were utilized to compare participants' perceptions of and experiences during the pilot intervention across two randomly assigned treatment conditions (exercising together with partner [ET; n = 8] versus exercising separately [ES: n = 6]). Participants (mean age: 64.7 ± 6.8 years) of a previous 12-week pilot exercise intervention (walking ≥3 days/week, 30 min/day plus supervised resistance training 2 days/week) were interviewed. Verbatim transcripts were coded using an open coding approach. RESULTS: Three key themes (intervention value/benefits, intervention difficulties, and suggested improvements) emerged. Although all couples identified health and relationship benefits of the intervention, some differences surfaced within themes across the two intervention groups. CONCLUSIONS: Overall, these qualitative data suggest that couples had a positive experience while participating in the pilot study. In addition, key learning points to improve the intervention were identified including a more gradual transition to independent exercise, more flexibility training, and the incorporation of tangential education. These data will help investigators continue to develop the intervention, which is ultimately designed to promote long-term exercise adherence to reduce cardiometabolic health disparities in the AA community.

Social determinants of child trafficking addressed by government and non-government strategies in South and Southeast Asia: an integrative review.

Aims: Child trafficking in South and Southeast Asia is widespread and deeply troubling. While several agencies have initiated anti-child-trafficking interventions, it is unknown whether they address the 21 social determinants of child trafficking identified by Perry and McEwing (2013). The aim of this integrative review was to explore the anti-child-trafficking strategies employed by governments and non-governmental organizations (NGOs) that target the social determinants of child trafficking in South and Southeast Asia, and identify which levels of the socio-ecological model (SEM) they address. Methods: The authors performed a literature search for journal articles and reports by researchers, local or national governments, and international organizations on the prevention of child trafficking in eight South Asian and eight Southeast Asian nations. Identified manuscripts were analyzed to determine which social determinants and socio-ecological levels were addressed by the programs described. Results: Sixteen journal articles and 31 reports from the gray literature were identified. The government and NGO anti-child-trafficking strategies in 16 South and Southeast Asian nations addressed 15 and 12 of the 21 social determinants, respectively. Social determinants at the intrapersonal, interpersonal, community, and policy levels of SEM were addressed, but failed to address the organizational level. Conclusions: The gravity of child trafficking necessitates that interventions address all of the 21 social determinants of child trafficking at all levels of the SEM. The authors found no account on any anti-child-trafficking intervention from four South Asian and five Southeast Asian nations. Dissemination and continuous evaluation of anti-trafficking interventions are warranted.

Food security, maternal feeding practices and child weight-for-length.

BACKGROUND: Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity. METHODS: This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, child's eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats. RESULTS: Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, child's caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00). DISCUSSION: Research on food security and children's weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security. CONCLUSION: Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.

The Role of Parenting Behaviors and Their Influence on Adolescent Drunk and Drugged Driving: 2016-2019, USA.

Drugged driving, the act of driving a vehicle under the influence of illicit drugs, by adolescents is a serious public health concern. Many factors contribute to this risk behavior, but much less is known regarding the role of parenting behaviors in this phenomenon. The purpose of this study was to examine specific parenting behaviors and their influence among a nationally representative sample of adolescents. Pooled data from the 2016-2019 National Survey on Drug Use and Health (NSDUH) among 17,520 adolescents ages 16-17 years old were analyzed. Differences were found in specific parenting behaviors and adolescent drugged/drunk driving, with parents not checking homework and not telling their children they are proud of them being the most influential. Findings from the present study may inform drugged driving prevention programs for parents and adolescents and enhance road safety interventions.

Perceptions of access to care after a rural hospital closure in an economically distressed county of Appalachian Tennessee.

PURPOSE: The rise in rural hospital closures has sparked concern about the potential loss of essential health care services for rural communities. It is crucial to incorporate the perspectives of community residents, which have been largely missing from the literature, when devising strategies to improve health care for this population. The purpose of this study was to describe community residents' perceptions of access to care following a rural hospital closure in an economically distressed Appalachian county of Tennessee. METHODS: This study used a qualitative descriptive approach to illustrate how community residents perceive accessing care post hospital closure. We conducted semi-structured interviews with 24 community residents via telephone in May through August of 2020. Interviews were analyzed using conventional content analysis. FINDINGS: Five themes were identified based on Penchansky and Thomas' framework of health care: accessibility, availability, affordability, accommodation, and acceptability. Accessibility was identified as the most common concern among participants. Specifically, participants perceived longer travel times to receive care, reduced availability of emergency and specialty care, increased costs associated with ambulance services, and extended wait times to see providers. CONCLUSIONS: Our findings provide a critical perspective to inform local leaders and policymakers on the impacts of a hospital closure in a rural community. As rural hospitals continue to close, it is crucial to develop multi-level, community-driven solutions to ensure access to care for rural communities.

Drugged driving among U.S. adolescents, 2016-2019, USA.

INTRODUCTION: Drugged driving, the operation of a vehicle under the influence of any illegal drugs and alcohol, is a growing problem, but remains understudied among adolescents. The purpose of this article is to estimate past-year driving under the influence of alcohol, marijuana, and other drugs among a large sample of U.S. adolescents and potential associations (e.g., age, race, metropolitan status, sex). DESIGN: A cross-sectional secondary data analysis of the 2016-2019 National Survey on Drug Use and Health among 17,520 adolescents ages 16-17-years old was conducted. Weighted logistic regression models were built to determine potential associations to drugged driving. RESULTS: An estimated 2.00% of adolescents drove under the influence of alcohol in the past year, 5.65% drove under the influence of marijuana in the past year, and an estimated 0.48% drove under the influence of other drugs other than marijuana in the past year. Differences were based on race, past-year drug use, and county status. CONCLUSIONS: Drugged driving is a growing problem among adolescents and interventions are greatly needed to mitigate these behaviors among youth.

Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children and Dietary Intake in Children: Associations With Race and Ethnicity.

INTRODUCTION: Establishing healthy dietary intake in pediatric populations is important for prevention of chronic disease across the lifespan. Federal nutrition assistance programs can support the dietary intake of U.S. children. The objective of this study was to assess the relationship between Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation status and dietary intake within racial and ethnic groups. METHODS: Dietary intake of children aged 2-4 years in the cross-sectional National Health and Nutrition Examination Survey 2011-2016 was analyzed in 2021. Multivariable linear regression was used to compare stratum-specific mean estimates for nutrient and food group intake of children participating in Special Supplemental Nutrition Program for Women, Infants, and Children (reference group) with those of nonparticipants who were income eligible and income ineligible (i.e., above income limits) for the WIC program. Significance was set to Bonferroni-corrected p-values. RESULTS: Hispanic WIC participants consumed less added sugar (8.9 [SE=0.5] teaspoons) than their higher-income counterparts (14.6 [SE=1.5] teaspoons, p<0.001). Hispanic WIC participants also consumed more fiber (13.0 [SE=0.6] grams) than income-eligible (11.4 [SE=0.7] grams, p=0.032) and income-ineligible (i.e., higher-income, 9.4 [SE=1.3] grams, p=0.019) nonparticipants, but this was not significant at the Bonferroni-adjusted p-value of 0.01. No differences in dietary intake were observed by WIC participation status for non-Hispanic White and non-Hispanic Black children. CONCLUSIONS: Participation in WIC was associated with healthier dietary outcomes among Hispanic children; however, dietary intake of White and Black children was comparable by WIC participation status. Federal nutrition assistance programs should support sound nutrition, an important factor in reducing the risk of chronic disease, in all groups.

African American Couples' Experiences during an Exercise Intervention Interrupted by the COVID-19 Pandemic: A Qualitative Case Study.

Exercise intervention researchers often struggle to transition participants from supervised/laboratory-based exercise to independent exercise. Research to inform this critical juncture remains underdeveloped. This qualitative case study investigated the transition from laboratory-based to home-based training in a subset of middle-aged and older African American couples whose exercise intervention experience was interrupted by the COVID-19 pandemic. All four couples (N = 8) whose study participation was interrupted participated in dyadic interviews by videoconference. Two investigators independently reviewed verbatim transcripts, and then used an iterative open coding approach to identify themes from the qualitative data. Three main themes were identified: (1) resistance training program modifications, (2) partner interactions, and (3) external pandemic-related factors. Each theme included both positive and negative feedback related to participants' experiences. Overall, virtual, home-based training appeared acceptable and feasible in this group. Further research is needed to investigate the utility of virtual training to effectively transition participants from laboratory-based to independent exercise.

Implementing Prevention Plus with Underserved Families in an Integrated Primary Care Setting.

Background: This proof-of-concept trial examined a 6-month Prevention Plus (PP) intervention implemented in a federally qualified health center on child standardized BMI (ZBMI), using a planned clinical effect threshold of -0.16 ZBMI. The relationship between food security status and PP delivered with caregiver goals (PP+) and without caregiver goals (PP-) on energy balance behaviors (i.e., fruits and vegetables, physical activity) and child ZBMI was explored. Methods: Seventy-three, underserved children, 4-10 years of age with a BMI ≥85th percentile, were randomized to one of two interventions, PP+ and PP-, both providing 2.5 hours of contact time, implemented in five clinics by behavioral health consultants (BHCs). Outcomes were child anthropometrics (included 9-month follow-up), implementation data collected from electronic health records, and caregiver and BHC evaluations. Results: Children were 57.5% female and 78.1% Hispanic, with 32.9% from food-insecure households and 58.9% from households with an annual income of less than $20,000. Child ZBMI significantly (p < 0.05) decreased at 6 and 9 months (-0.08 ± 0.24 and -0.12 ± 0.43), with only PP+ reaching the clinical threshold at 9 months (PP+: -0.20 ± 0.42 vs. PP-: -0.05 ± 0.42). Sixty-four percent of families attended ≥50% of the sessions, and BHCs delivered 78.5% ± 23.5% of components at attended sessions. Caregivers were satisfied with the intervention and BHCs found the intervention helpful/useful. No relationship with food insecurity status and outcomes was found. Conclusions: PP+ when delivered by a primary care provider to underserved families showed promise for producing a clinically meaningful effect. Families and providers felt the intervention was a viable treatment option.

Efficacious lifestyle interventions for appropriate gestational weight gain in women with overweight or obesity set in the health care system: a scoping review.

Purpose: Health care systems offer opportunities to scale up interventions for appropriate gestational weight gain (GWG); however, GWG interventions in the health care setting remain largely unavailable to women with overweight or obesity. To inform the translation of efficacious lifestyle interventions to health care delivery systems, this scoping review aimed to systematically identify randomized controlled trials for appropriate GWG in women with overweight or obesity that were set in a health care system.Methods: A scoping review allows for the systematic synthesis of knowledge on an exploratory research question aimed at mapping key concepts (e.g. time, location, source, and evidence) and gaps in a specific area of study. The Colquhoun et al. (2014) framework to conducting scoping reviews was used to develop the research question, identify relevant studies, select studies, extract data, and synthesize data. Specifically, two reviewers searched publication databases for English-language articles published from January 2009 to May 2020 using specific keywords/MeSH terms.Results: Eight peer-reviewed journal articles were identified; six trials were based in Europe and two in the U.S. Only four included lifestyle interventions that were efficacious in reducing GWG. Three trials with efficacious interventions were among women with obesity only and encouraged them to gain at or below the lower limit for total GWG (i.e. ≤5 kg) of the Institute of Medicine (IOM) guidelines. The fourth was among women with overweight or obesity and encouraged women to gain within the IOM guidelines with a telehealth behavioral intervention. Efficacious interventions were initiated in the first half of pregnancy and included frequent contact delivered through multiple modalities (i.e. in-person visits, telephone calls, text messages, email) by trained intervention staff (i.e. dietitian, lifestyle coach, and/or physiotherapist). Only one efficacious intervention trial briefly mentioned theoretical components for health promotion (e.g. self-monitoring); likewise, only one included cost-effectiveness analyses.Conclusions: This review systematically identified randomized controlled trials of efficacious lifestyle interventions (i.e. consisting of diet and physical activity components) for appropriate GWG in women with overweight or obesity that were set in the health care system and delivered by non-clinicians. Translation efforts could draw upon aspects of the efficacious lifestyle interventions described in this review. Future studies should examine theory-based telehealth interventions and cost-effectiveness.

Physical activity, watching television, and the risk of obesity in students, Texas, 2004-2005.

INTRODUCTION: The epidemic of childhood obesity has been well-documented. Prevalence of obesity among students in Texas is higher than the US prevalence. Our objective was to understand the combined influence of physical activity and television viewing on weight status of students in Texas. METHODS: Students in grades 4, 8, and 11 participated in the School Physical Activity and Nutrition survey during the 2004-2005 academic year. Multinomial logistic regression tested the associations between both being overweight and obese (vs underweight/normal weight) and the combined influence of physical activity and watching television, adjusting for age, grade, race/ethnicity, language spoken at home, and percentage of economically disadvantaged students in the school. We used 5 physical activity indicators to describe students' physical activity. RESULTS: Girls who participated in less than 3 days of exercise per week to strengthen or tone muscles and watched 2 hours or less per day of television had increased odds of being obese (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0) compared with girls who participated in 3 or more days per week of exercise to strengthen or tone muscles and watched 2 hours or less per day of television. Boys in our study who watched 3 or more hours per day of television and did not meet physical activity recommendations had increased odds of being obese in all of our 5 physical activity indicators. CONCLUSION: Although results varied by physical activity indicator and sex, our findings provide further evidence for the combined effect of high television watching and low physical activity engagement on the risk for obesity in children and adolescents.

Adiposity, biological markers of disease, and insulin resistance in Mexican American adolescents, 2004-2005.

INTRODUCTION: Rates of obesity and overweight, which frequently lead to type 2 diabetes, have increased dramatically among US children during the past 30 years. We analyzed associations between insulin resistance and other markers of disease in a sample of Mexican American adolescents from a severely disadvantaged community on the Texas-Mexico border. METHODS: We analyzed results from 325 students from 1 high school in this descriptive study. We measured height, weight, waist circumference, blood pressure, blood glucose, and lipids; calculated body mass index; and estimated insulin resistance. RESULTS: Approximately 50% of our sample (mean age, 16 y) were overweight or obese, and more participants were obese than overweight. More than 40% had high waist circumference, and 66% had elevated high-density lipoprotein cholesterol. These characteristics were already present in the youngest participants (aged 12 y). Although only 1% of participants had elevated fasting blood glucose, 27% exhibited insulin resistance and most of these were also obese. Similarly, participants with high waist circumference were more likely to exhibit insulin resistance than those with normal waist circumference. CONCLUSION: Participants in this sample had insulin resistance, a potent predictor of diabetes. Two markers, low high-density lipoprotein cholesterol and high waist circumference, were strongly linked to insulin resistance; the surrogate for central adiposity, waist circumference, exhibited strong association. We identified high levels of obesity and markers for future disease in our sample. These findings emphasize the need to address insulin resistance at least as early as adolescence to prevent adverse economic, social, and health consequences.

Role of Sex on the Relationship Between Sexual Minority Status and Misperceptions of Body Weight Among High School Students.

PURPOSE: Misperception of body weight during adolescence is a risk factor for negative self-image, harmful eating/dietary habits (e.g., binge eating and purging), and body dysmorphia. Sexual minority youth, particularly males, may be at increased risk for misperceptions of body weight, relative to youth who do not identify as a sexual minority. This study examines the risk for misperception of body weight among sexual minority youth and explores biological sex as an effect modifier in this relationship. METHODS: We pooled data from the 2015 and 2017 Youth Risk Behavior Surveillance Surveys. Participants were 18,634 high school students who were not overweight/obese. Multivariable logistic regression examined the association between sexual minority status (i.e., gay, lesbian, bisexual, and unsure) and misperceptions of body weight (i.e., self-perceived as overweight/severely overweight). Weighted multivariable logistic regression analyses, stratified by biological sex, were used to compare this relationship across males and females. Covariates included race/ethnicity, grade, bullying victimization, television/electronic screen time, and tobacco use. RESULTS: Overall, 16.6% of the sample self-reported misperceptions of body weight. Sexual minority youth had 1.49 (95% confidence interval [CI]: 1.28-1.73) greater odds of misperception of body weight, adjusting for covariates; this relationship was found across biological sex, but that the main effect was significantly greater among sexual minority males (adjusted odds ratio: 2.24, 95% CI: 1.65-3.03) relative to sexual minority females (adjusted odds ratio: 1.33, 95% CI: 1.11-1.59). CONCLUSIONS: Sexual minority youth had greater odds of overestimating their weight status. Biological sex appears to modify this relationship with sexual minority males being at particularly high risk for overestimating their weight status.

Role of sex on the relationship between sexual minority status and past 30-day marijuana use among high school students (YRBS, 2015-2019).

BACKGROUND: Sexual minority status (SMS) is a known risk factor for marijuana use among youth in the United States (US). Limited research has examined the differing relationship between SMS and marijuana use across males and females. This study examined the modifying effect of sex on the relationship between sexual minority status (SMS) and past 30-day marijuana use among youth. METHODS: Data were pooled from the 2015, 2017, and 2019 Youth Risk Behavior Surveillance survey. Participants were 9th through 12th grade students in the US (n = 37,870). An interaction model (SMS*sex) and models stratified by sex tested effect modification. Covariates included race/ethnicity, grade, tobacco use, illicit drug use, and survey year. RESULTS: The association between SMS and past 30-day marijuana use differed statistically by sex assigned at birth. Among females, SMS was associated with 1.33 greater odds of past 30-day marijuana use. Conversely, among males, SMS was associated with 0.70 lower odds of past 30-day marijuana. Interaction model was statistically significant. CONCLUSION: SMS is associated with greater odds of being a past 30-day marijuana user among females but lower odds among males. Prevention and education programs aimed at youth should consider these factors during development and implementation. Longitudinal research is needed to further examine the nuances of the relationship observed in this analysis.

Cat and/or Dog Ownership, Cardiovascular Disease, and Obesity: A Systematic Review.

Pet ownership, the most common human-animal interaction, is believed to bestow positive health benefits onto pet owners. However, there is limited research on substantiating these assertions. The aim of this review was to systematically identify, evaluate, and summarize primary research on the relationship between cat and/or dog ownership and cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity to inform future research on pet ownership and chronic disease. How pet ownership was defined/measured, and identification of the chronic disease variables and health behaviors most often measured were emphasized. Two researchers independently searched PubMed and Web of Science, where One Health literature are mostly likely to be indexed, for peer-reviewed literature on pet ownership and CVD, T2D, and obesity. A review of 4541 titles and abstracts for relevance resulted in 34 manuscripts eligible for full-text review. Two researchers assessed each eligible manuscript and extracted data only from those that met the inclusion criteria (n = 14). Ten studies on CVD, four studies on obesity, and zero studies on T2D met the study criteria. The CVD and obesity variables varied and were not well described. The relationship between pet ownership and CVD and obesity varied (positive, negative, mixed effects, and no effect). Generalizability lacked across all studies: most studies were with Non-Hispanic White populations. Other areas of weakness were quality of study outcomes and instrument validity. Operationalization of pet ownership varied (from no verification to confirmed pet registration). Integration of the evidence-based influence of the human-animal connection through pet ownership on CVD and obesity may make prevention, mitigation, and treatment strategies more robust.