Search

Changes in food choice often accompany globalization and economic growth. These changes have not been well documented in rural settings and among young people. To advance research on food choice, we demonstrate adolescents’ selection of local vs.non-local foods in a rural area of India where globalization is just reaching. A representative sample of 237 school-going adolescents in a village in Southern India completed a survey in 2019 to understand how adolescents decide among foods traditional to the area and foods arriving from other parts of the country and the world. Adolescents most frequently consumed local foods but also occasionally consumed non-local items. In hypothetical scenarios, 81% of the adolescents reported being most interested in substituting local foods with non-local foods if they were to have more money. Among the few who currently consumed non-local snacks and drinks, very few would be willing to replace them with local alternatives, particularly if they were to have more money (snacks: 10% and drinks: 5% respectively). Overall, adolescents were most interested in switching to non-local items when considering fruits, vegetables and snacks. As India faces the dual burden of undernutrition and overnutrition, understanding the changing food environment may help inform efforts to improve nutrition.

People living in poor rural communities, particularly in the South, live shorter and less healthy lives than those residing elsewhere in the United States. The basis of this very high rural burden of heart, lung, and blood disease, which does not spare any race, is unclear. We hypothesized that a potential contribution to this phenomenon is differential selection of healthy individuals to migrate out of rural communities. We examined how county-level migration patterns relate to county-level mortality with a specific focus on rural counties. We compiled nationally representative county-level data migration data from Internal Revenue Services for years 2011-2019 and mortality data from National Center for Health Statistics at the Centers for Disease Control and Prevention for years 2018-2019. We standardized characteristics to a mean=0 and standard deviation=1 and modeled county-level age-adjusted death rate in 2019 using 2-level hierarchical linear regression. Out- and in-migration in 2019 was not significantly associated with age-adjusted death rate in 2019 after adjustment for social, economic and population factors at the county-level. However, when stratified by 6 categories of urban/rural, greater out-migration in the smallest rural counties (non-core) was associated with higher age-adjusted death rate after adjustment for other county factors [Beta (95% CI); 7.2 (0.11,14.28)] (Table 1). When including lagged out-migration rates for years prior to 2019, previous out-migration was associated with age-adjusted death rate in the second smallest rural county categorization (micropolitan). These findings help to ascertain another component potentially contributing to differentially poorer health in rural communities. Future work at the conference will further evaluate decade trends in migration across the US by county.

The multiracial population is considered the fasted growing population in the United States. In 2020, the percentage of people who reported multiples races changed more than all of the single race groups, increasing from 2.9% of the population (9 million people) in 2010 to 10.2% of the population (33.8 million) in 2020. Each multiracial subgroup has unique social and political histories that may lead to distinct social perceptions, economic situations, and health outcomes. We hypothesized that there is a multiracial distinction in the prevalence of obesity. On average multiracial respondents will have better or worse than both single-race component groups. We assessed whether the patterns of obesity of adults who identify as multiracial are distinctive from that of adults who identify a single-race identity, by using a three-year (2010-2012) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We further investigate whether the prevalence of obesity in multiracial versus single-race individuals differ among Hispanic and non-Hispanic subgroups. Results show that categorizing all multiracial individuals into one group masks the different patterns of obesity within multiracial individuals. White-Black, White-Asian, White-Native Hawaiian/Pacific Islander (NHPI), and White-American Indian adults have a prevalence of obesity in between their single-race counterparts (Figure 1, Panel A). Among Hispanics, the prevalence of obesity in White-Black and Black-America Indian adults is lower than the same categories among non-Hispanics (Figure 1, Panel B). Whereas the prevalence of obesity in White-NHPII and Asian NHPI is higher than the same categories among non-Hispanics. This study helps us address aspects of the social construction of race and the complexity in evaluation of obesity prevalence. Findings raise further questions about the usage of a homogenous multiple race categorization in national surveys.

COVID-19 is associated with one of the largest disturbances to life in the 21st century. To quell disease spread, governments implemented lockdowns that likely created hardships for house-holds. To improve knowledge of consequences, we examine how the pandemic period was associ-ated with household hardships and assess factors associated with these hardships. We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with house-hold hardships. Data were collected between August and September of 2021 from a random sam-ple of 880 households living in a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Ethiopia. Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19 including lockdowns and travel restrictions were inde-pendently associated with experiencing household hardships. Our results identify characteristics of groups at-risk for food insecurity during the pan-demic; households that were already strug-gling prior to the onset of the pandemic were at greatest risk of adverse consequences during the pandemic period. These findings may inform future efforts to mitigate the consequences of COVID-19 and future disease out-breaks.

Objective: We examined multimorbidity among foreign-born adults in the United States. This population may be particularly affected by chronic conditions and limited health care access.Design: Longitudinal cohort.Setting: United States.Participants: Foreign-born adults at the point of legal permanent residency.Methods: We estimated the prevalence of multimorbidity and patterns over time. Data are from the New Immigrant Survey (NIS), a nationally representative study of adult immigrants at green card status in 2003 (N=8,174) and reinterview in 2008.Main Outcome Measures: Multimorbid­ity defined as two or more of eight chronic conditions (hypertension, diabetes, obesity, arthritis, stroke, cancer, chronic lung dis­ease, and heart problems).Results: The prevalence of multimorbid­ity was 6% in 2003, and 12% in 2008. The most common condition dyad at both time points was hypertension-obesity; the largest increase over time was in combinations that included hypertension, diabetes, and obesity. The odds of having multimorbidity compared to no chronic conditions were higher among older immigrants and those who had seen a doctor in the past year. The odds of gaining one chronic condition over a 5-year period increased with age; 45-65 years: OR 2.8[CI 2.3,3.5]; aged ≥65 years: OR 3.2 CI[2.2,4.7].Conclusions: The prevalence of multimor­bidity among immigrants was lower than the prevalence in the overall US population of the same age, consistent with studies show­ing an immigrant health advantage. Ethn Dis. 2022;32(3):213-222; doi:10.18865/ed.32.3.213

In developed countries, low disparity in lifespan contributed by the reduction in the burden of noncommunicable diseases (NCDs) is the key to advances in epidemiological transition. Contrarily, India passing through a phase of the dual burden of CDs and NCDs shows a heavy burden of NCDs responsible for the high disparity in lifespan. The Gini coefficient was decomposed for examining the contribution of 22 causes of death and their repercussions for inequality in age at death for 30 years between 1990–1994 and 2015–2019, using Global Burden of Disease data. The outcomes of the study reveal that India’s epidemiological transition has been just modest on account of high inequality in mortality by NCDs emplaced in the middle through old age despite a consistent mortality decline at infant through old age for communicable diseases (CDs). The structural changes in causes of death structure is shaped by CDs rather than NCDs, but overall bolstered by the adult mortality decline, especially in women. However, the process is restrained by the small contribution of the middle age group and a benign contribution of old mortality decline owing to the low threshold age. India needs to target health interventions in seeking significant mortality decline in the middle age group of 50–69 years that is warranted for epidemiological transition apace as evident in the developed nations.

Purpose: Globally, 300,000-400,000 cases of childhood cancers are estimated to occur yearly. In low- and middle-income countries, where most children with cancer live, malignancies remain underreported due to lack of quality cancer registries and data. They also tend to be under-diagnosed due to limited access to facilities and insufficient infrastructure to support diagnosis and treatment. Patients and Methods: This study provides epidemiologic data on the histopathological pattern and demographic characteristics of pediatric solid malignancies in children 0-15yrs at Tikur Anbessa Hospital in Addis Ababa, Ethiopia between January 2016, and August 2020. Results: Within the study period, 432 solid malignancies were evaluated. Among the 401 cases that we were able to classify, the most common solid malignancies were Lymphoma (21.8%), Retinoblastoma (19.4%), and Wilms tumor (13.9%). Burkitt lymphoma accounted for 2.1% of cases, despite being the most reported pediatric malignancy in sub-Saharan Africa. Brain tumors (5.6%) and Neuroblastoma (0.5%) were reported less frequently. Possibly due to detection biases, males were diagnosed more frequently than females (M: F=1.7), with the largest difference being in Lymphomas (M: F=3.5, p=0.001). Conclusion: In this report of pediatric cancer in Ethiopia, we saw similarities with other studies from Africa in terms of tumor types, age, and gender distribution, except for Burkitt lymphoma and neuroblastoma. This study highlights the need for improvements in diagnostic capabilities in low- and middle-income countries as many tumors may be under- or misdiagnosed. Research and diagnosis of malignancies need to be expanded in Ethiopia to improve the wellbeing of children with cancer.

We evaluated the relationship of urinary sodium excretion with a conditional mean, 10th and 90th percentiles of body mass index (BMI), and waist circumference among 10,034 person-visits of Bangladeshi population. We fitted linear mixed models with participant-level random intercept and restricted maximum likelihood estimation for conditional mean models; and quantile mixed-effect models with participant-level random intercept and Laplace estimation for 10th and 90th percentiles models. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.10 kg/m2 (95% CI: 0.00, 0.10) increase in the mean; a 0.39 kg/m2 (95% CI: 0.23, 0.54) increase in the 10th percentile; and a 0.59 kg/m2 (95% CI: 0.39, 0.78) increase in the 90th percentile of BMI. For each 100 mmol/24 h increase in urinary sodium excretion, participants had a 0.20 cm (95% CI: 0.10, 0.30) increase in mean; a 0.18 cm (95% CI: −0.03, 0.40) change in the 10th percentile; and a 0.23 cm (95% CI: 0.03, 0.43) increase in the 90th percentile of waist circumference. We found a modest association between urine sodium and conditional mean of BMI and waist circumference. The magnitude of associations between urine sodium and the 10th and 90th percentile BMI distributions were higher compared to the conditional mean models, suggesting high sodium intake could be more detrimental to underweight and obese participants.

INTRODUCTION: Obesity prevalence among children and adolescents has risen sharply, yet there is a limited understanding of the age-specific dynamics of obesity as there is no single nationally representative cohort following children into young adulthood. Investigators constructed a pooled data set of 5 nationally representative panels and modeled age-specific obesity incidence from childhood into young adulthood. METHODS: This longitudinal prospective follow-up used 718,560 person-years of observation in a pooled data set of 5 high-quality nationally representative panels— National Longitudinal Survey of Youth 1979 and 1997, National Longitudinal Study of Adolescent Health, and Early Childhood Longitudinal Study-Kindergarten cohorts of 1998 and 2011—constructed by the authors covering 1980–2016. Differences in obesity incidence across birth cohorts and disparities in obesity incidence by sex and race/ethnicity (non-Hispanic Black, Hispanic, and non-Hispanic White) were tested in multivariate models. Data were analyzed from September 2018 to October 2021. RESULTS: Obesity incidence increased by approximately 6% for each 1 year of age (hazard ratio=1.06, 95% CI=1.05, 1.07); however, incidence was non-linear, exhibiting an inverted U-shaped pattern before age 15 years and then rising from adolescence through age 30 years. Obesity incidence more than doubled between the cohorts born in 1957–1965 and those born in 1974–1985 during adolescence. There was no significant change among those born in 1991–1994 and 2003–2006 up to age 15 years. Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children had higher obesity incidence in all study cohorts. The magnitude of these disparities on the relative scale remained stable throughout the study period. CONCLUSIONS: Although many children become obese prior to age 10 years, obesity incidence rises from about age 15 years into early adulthood, suggesting that interventions are required at multiple developmental stages.

This study examines the association of changes in weight status from teen to young adult ages with the number of ideal cardiovascular health (CVH) and clinical CVH metrics by adulthood. We hypothesized that increases in weight status from teen to young adult ages are associated with less ideal CVH metrics in adulthood. Data from a subset of participants (n=4252) of the National Longitudinal Study of Adolescent Health (AddHealth) with Life Simple 7 (LS7) metrics (diet, physical activity, BMI, smoking, cholesterol, blood pressure, and glucose) collected at mean age 38±0.05 were used. LS7 metrics and criteria were used to estimate the number of ideal CVH (range 0-7) and clinical CVH metrics (range 0-3). Height and weight measured at mean ages 16±0.03 and 28±0.04 were used to determine three categories of change in weight status from teen to young adult ages: increased, no change, or decreased. Linear regression models were used to test the association of changes in weight status from teen to young adult ages with the number of ideal CVH and clinical CVH metrics in adulthood. Tests adjusted for age, sex, single parent status, parent’s education, and baseline weight status were conducted overall and stratified by race/ethnicity. Mean number of ideal CVH metrics was 2.8±0.02. When compared with no changes in weight status from teen to young adult ages, increases associated with less ideal CVH (β= -0.90; 95% CI -0.99, -0.82) and clinical CVH (-0.39; -0.44, -0.33) metrics, while decreases associated with more ideal CVH (0.26; 0.01,0.51), and clinical CVH (0.19; 0.03,0.35) metrics. Stratified tests showed that decreases in weight status associated with more ideal CVH and clinical CVH metrics among Latinx (0.78; 0.21, 1.35; and 0.57; 0.16, 0.97) and Asian (1.66; 0.45, 2.88; 1.12; 0.39, 1.85), but not among White or Black (p>0.05) participants. Findings underscore the importance of supporting weight loss and maintenance of normal weight among emerging adults for optimal CVH in adulthood. Racial/ethnic differences merit further investigation.

Background India holds the world's largest burden of chronic and acute child undernutrition. Poverty and systemic inequities are basic causes of undernutrition that also drive households to engage in circular migration for livelihood. Short-term, temporary movement of the whole family, including young children, is common; yet, the nutritional implications of recurrent movements beginning in early life has not been studied. We sought to estimate the association of repeat and early life migration with stunting and wasting outcomes among circular migrant children under three. Methods Using a stratified cluster design, we conducted two waves of primary data collection among 2564 randomly selected circular migrant children under three years of age temporarily residing across 1156 brick kilns in Bihar, India. We conducted multilevel modeling to estimate the association of the number of migration episodes and age at first migration with stunting (

We aim to evaluate weight status in mother-child household pairs and patterns specific to over-nutrition households and double burden households.We used nationally representative data from the most recent Demographic and Health Survey (2001-2014) in the Middle EastNorth African (MENA) Region (n = 45,104) to examine weight status of mother-child dyads. Under-nutrition households were defined as mothers with underweight and children with wasting; over-nutrition households as mothers with overweight/obesity and children with overweight; and double burden households as mothers with underweight and children with overweight or mothers with overweight/obesity mother and children with wasting. Survey-adjusted multinomial logistic regression were used to quantify predictors of weight patterns.Across the MENA region, 8.6% of households were experiencing double burden malnutrition, 11% were experiencing over-nutrition and 0.2% were experiencing under-nutrition. Wealthier households with older mothers, higher birth-order children, more educated parents and private water access were more likely to be over-nutrition or double burden households. Compared to over-nutrition households, double burden households were poorer and more likely to have a child with low birthweight.Over-nutrition is the most common unhealthy weight pattern, followed by double-burden; socioeconomic status and birth weight are consistent predictors of unhealthy mother-child pairs.

ObjectivesAssess differences in movement behaviours within the 24-hour cycle, including light intensity physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time and sleep, before and during the COVID-19 pandemic and assess these differences stratified by several relevant factors in a subcohort of the Cancer Prevention Study-3.Design and settingUS-based longitudinal cohort study (2018–August 2020).ParticipantsN=1992 participants, of which 1304 (65.5%) are women, and 1512 (75.9%) are non-Latino white, with a mean age 57.0 (9.8) years.MeasuresAge, sex, race/ethnicity, education; self-reported LPA, MVPA, sedentary time and sleep duration collected before and during the pandemic; pandemic-related changes in work, childcare and living arrangement; COVID-19 health history.ResultsCompared to 2018, participants spent an additional 104 min/day sedentary, 61 fewer min/day in LPA and 43 fewer min/day in MVPA during the pandemic. Time spent sleeping was similar at the two time points. Differences in movement behaviours were more pronounced among men, those with a higher level of education, and those who were more active before the pandemic.ConclusionsFrom 2018 to Summer 2020, during the COVID-19 pandemic, US adults have made significant shifts in daily time spent in LPA, MVPA and sedentary. There is an urgent need to promote more physical activity and less sedentary time during this public health crisis to avoid sustaining these patterns long-term.