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This study aims to (1) assess the associations between sugar-sweetened beverages (SSB) consumption and C-reactive protein (CRP) levels, and (2) evaluate the modifying effect of body mass index (BMI) on the association between SSB consumption and CRP levels. A total of 6856 eligible adults were selected from the 2007–2010 National Health and Nutrition Examination Survey (NHANES). Average quantity of SSB consumption was calculated from 2-day 24-h dietary recalls. All data analyses were performed with appropriate sampling weights. Compared with non-SSB drinkers, a 0.26 mg/l higher CRP was observed in heavy SSB drinkers after adjusting for demographic characteristics, lifestyle patterns, and BMI. An effect modification of BMI on SSB intake and CRP levels was detected (P

Summary Introduction Significant health disparities exist in asthma and obesity for African American youths. Successful interventions present an opportunity to address these disparities but require detailed study in order to ensure generalizability. This study investigated the intersection of obesity, neighbourhood disadvantage, and asthma. Methods Data were extracted from 129 African American females ages 13 to 19 years (mean = 15.6 years [SD = 1.9]). Obesity was measured via body mass index (BMI). Asthma status was based on clinical diagnosis and/or results of the International Study of Asthma and Allergies during Childhood (ISAAC) questionnaire. The concentrated disadvantage index (CDI) assessed neighbourhood disadvantage. Results Findings showed that 21.5% (n = 28) of participants were clinically defined as having asthma, 76.2% (n = 99) had obesity, and 24.9% (n = 31) were classified without obesity. The mean BMI was 35.1 (SD = 9.1) and the mean CDI was 1.0 (SD = 0.9). CDI and obesity were significantly associated in participants without asthma, but not in those with asthma. Multivariable linear regression results showed a significant interaction between CDI and asthma (t value = 2.2, P = .03). Conclusion In sum, results from this study found that asthma moderated the relationship between neighbourhood disadvantage and obesity.

Objective This study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes.

Introduction Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. Methods Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. Results Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). Conclusions Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.

BackgroundHuman breastmilk contains pro- and anti-inflammatory compounds and hormones that can influence infant growth. However, little is known about the specific interrelationships between these compounds and whether their effects on infant growth may be influenced by pre-pregnancy weight status.ObjectiveThe purpose of this novel, prospective cohort study was to assess the interrelationships between pro-inflammatory cytokines (TNF-α, IL-6), hormones (insulin, leptin) and PUFAs (n-6, n-3) in blood and breastmilk in early postpartum between women with normal BMI (Group 1, n = 18; 18.5MethodsParticipants were robustly phenotyped along with their infants at 4-8 weeks postpartum. TNF-α, IL-6, insulin, leptin, and n-3 and n-6 PUFAs measured in blood and breastmilk and compared between pre-pregnancy BMI groups and with infant weight, length, head circumference and % fat mass.ResultsGroup 1 women had higher serum leptin (pConclusionsPro-inflammatory qualities of breastmilk were associated with infant growth measures regardless of maternal pre-pregnancy BMI. However, infants born to women with overweight or obesity demonstrated less responsive growth to breastmilk contents. More studies are needed to assess longitudinal effects of this impact.

Background: It has been estimated that there are approximately 14.5 million cancer survivors in the United States. One out of every six people over 65 is a cancer survivor. Recently growing evidence suggests a link between sugar-sweetened beverage (SSB) consumption and risk of pancreatic and endometrial cancer, and risk of colon cancer recurrence and mortality among cancer survivors. The objective of this study is to closely evaluate the impact of cancer status and other risk factors on sugar intake from SSBs. Methods: A total of 22,182 adults aged ≥20 years old were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2003–2012 data. The primary outcome is high sugar intake (≥80 g) from SSBs per day. The association between sugar intake from SSB consumption and cancer status was evaluated using weighted logistic regression. Results: Approximately 17% of non-cancer participants and 8% of cancer survivors had high sugar intake from SSBs. However, this cancer group difference was not significant after adjusting for other factors, especially age and gender. Individuals who had high sugar intake from SSB were younger, male (21.7%), Black (23.3%), had education level at high school (20.9%), low income (poverty income ratio ≤1, 23.4%), obese (17.1%), current smokers (26.9%) and non-cancer individuals (16.7%) or cervix cancer survivors (17.1%). After adjusting for demographic factors, a significant association between sugar intake from SSBs and cancer status was not observed except that prostate cancer survivors were less likely to intake sugar from SSBs compared to non-cancer individuals (OR =0.41, 95% CI: 0.22–0.77). Conclusions: In general, cancer survivors consumed less sugars from SSBs compared to non-cancer individuals. However, this difference was primarily due to the differences in age distribution of the cancer and non-cancer groups (mean age, 62 and 45 years old, respectively). Individuals who were younger, male, Black, with lower education, with lower income, obese, and current smokers tended to have high sugar intake from SSBs. Custom intervention of decreasing sugar consumption from SSBs should be conducted for both non-cancer individuals and cancer survivors.

The aim of this review was to highlight research that has focused on examining expressions of peak oxygen uptake (VO2peak) in children and youth, with special reference to allometric scaling. VO2peak is considered the highest VO2 during an increasing workload treadmill or bicycle ergometer test until volitional termination. We have reviewed scholarly works identified from PubMed, One Search, EBSCOhost and Google Scholar that examined VO2peak in absolute units (L·min(-1)), relative units [body mass, fat-free mass (FFM)], and allometric expressions [mass, height, lean body mass (LBM) or LBM of the legs raised to a power function] through July 2015. Often, the objective of measuring VO2peak is to evaluate cardiorespiratory function and fitness level. Since body size (body mass and height) frequently vary greatly in children and youth, expressing VO2peak in dimensionless units is often inappropriate for comparative or explanatory purposes. Consequently, expressing VO2peak in allometric units has gained increased research attention over the past 2 decades. In our review, scaling mass was the most frequent variable employed, with coefficients ranging from approximately 0.30 to over 1.0. The wide variance is probably due to several factors, including mass, height, LBM, sex, age, physical training, and small sample size. In summary, we recommend that since skeletal muscle is paramount for human locomotion, an allometric expression of VO2peak relative to LBM is the best expression of VO2peak in children and youth.

Objective It is unclear whether physiologic and metabolic biomarkers are associated with chronic stressors evidenced during early childhood. Methods Cross-sectional data were obtained from a cohort of healthy, prepubertal (Tanner stage

Objective: Farmers’ markets are increas­ingly being promoted as a means to provide fresh produce to poor and underserved communities. However, farmers’ market (FM) use remains low among low-income patrons. The purpose of our study was to examine FM awareness and use, grocery shopping behaviors, and internet use among Supplemental Nutrition Assistance Program (SNAP) recipients.Design: A descriptive analysis of preliminary data was performed to evaluate quantita­tive baseline data among SNAP recipients between June and August 2016 in New Or­leans, Louisiana (N=51). Data were collected via a 42-item online survey that included demographics, internet use, FM awareness and use, health information seeking behaviors and fruit and vegetable purchasing behaviors.Results: Less than half of the survey respondents (n=24) had ever been to a FM. Local grocery stores and Wal-Mart were most used for purchasing fruits and vegetables (88% and 84%, respectively). The most common sources of healthy eat­ing information were Women, Infants and Children (WIC) and the internet, frequently accessed via smartphones. More than 80% of participants were not aware that local FMs accepted electronic benefit transfer payments as a form of payment.Conclusion: These results support the incorporation of promotional methodol­ogy that combines internet-based mobile technology and existing services (eg, WIC) as a viable strategy to improve farmers’ market use among low-income populations. As most participants were not aware that participating FMs accept electronic ben­efit transfer payments, this fact should be emphasized in promotional material.Ethn Dis. 2017;27(Suppl 1):295-302; doi:10.18865/ed.27.S1.295.

The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide. Significance for public health This brief report establishes the need for local farmers’ markets (FM) in New Orleans, Louisiana to distribute information to increase the awareness of the markets, especially among low-income individuals. A variety of the FMs in New Orleans offer discounts to increase access to fresh produce among underserved individuals. However, there is a lack of knowledge of these markets, the ability to utilize Supplemental Nutrition Assistance Program benefits to purchase food, and of the discounts offered. Furthermore, this assessment demonstrates that low-income individuals have adequate access to the internet and a variety of social media channels. Based on these results, our research establishes that cost-effective and efficient, web-based marketing could be used as means help increase FM participation among low-income individuals. Increasing awareness of FMs and discounts offered to low-income individuals is one step in creating better access to affordable produce, which could lead to increased fruit and vegetable consumption and better health outcomes among at-risk populations.

To examine for the first time the associations between pro-inflammatory cytokines and obesity-related metabolic biomarkers in, exclusively prepubertal, otherwise healthy obese and non-obese Black and White children, 7-9 years of age.Body mass index (BMI), homeostasis model assessment-estimated insulin resistance, visceral adipose tissue and subcutaneous adipose tissue (SAT (magnetic resonance imaging)); total body fat (dual-energy X-ray absorptiometry), ectopic, intrahepatic lipid (IHL) and intramyocellular lipid (IMCL) fat (proton magnetic resonance spectroscopy) and serum levels of interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor alpha (TNF-α) and monocyte chemoattractant protein-1 were measured in 40 obese and non-obese children. Relationships between inflammatory cytokines and obesity were assessed by analysis of variance and Spearman's rank correlation.Significant inverse correlations were found between BMI z-score, SAT, total BF, and IHL and levels of TNF-α (Spearman's ρ=-0.36, -0.39, -0.43 and -0.39, respectively; P0.05). Levels of IL-8 were significantly and inversely correlated with IMCL (-0.39; P=0.03) and remained significant after adjusting for race. IMCL was inversely associated with TNF-α only after adjusting for race (-0.37; P=0.04).Relationships between pro-inflammatory and metabolic markers commonly observed in adults are reversed in healthy, Black and White children before puberty. Prospective studies are warranted to determine how these inverse relationships modify chronic disease risk later in life.

Background: The current study examined relationships between the neighborhood social environment (parental perceived collective efficacy (PCE)), constrained behaviors (e.g., avoidance or defensive behaviors) and adolescent offspring neighborhood physical activity in low- versus high-incivility neighborhoods. Methods: Adolescents (n = 71; 11–18 years (14.2, SD ± 1.6); male = 37 (52%); non-white = 24 (33.8%); low-income = 20 (29%); overweight/obese = 40 (56%)) and their parents/guardians enrolled in the Molecular and Social Determinants of Obesity in Developing Youth study were included in the current study. Questionnaires measured parents’/guardians’ PCE, constrained outdoor play practices and offspring neighborhood physical activity. Systematic social observation performed at the parcel-level using Google Street View assessed neighborhood incivilities. t-tests and chi-square tests determined differences by incivilities. Multilevel regression models examined relationships between PCE and: (1) constrained behaviors; and (2) neighborhood physical activity. The Hayes (2013) macro determined the mediating role of constrained behaviors. Results: Parents who had higher PCE reported lower levels of avoidance (p = 0.04) and defensive (p = 0.05) behaviors. However, demographic variables (i.e., gender, race and annual household income) limited these results. The direct relationship between PCE and parent-reported neighborhood physical activity was statistically significant in high-incivility neighborhoods only. Neither avoidance nor defensive behavior mediated the relationship between PCE and neighborhood physical activity. Conclusions: PCE influences parenting behaviors related to youth physical activity. Community-based programs that seek to facilitate social cohesion and control may be needed to increase adolescents’ physical activity.

Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches.

Background:To determine if there are differences in time spent in physical activity and sedentary behavior between rural African American and Caucasian children.Methods:Children wore accelerometers for 3 weekdays. The students were randomly selected from a larger sample of children participating in a weight gain prevention intervention. Usable data were obtained from 272 of the 310 students who agreed to participate. The outcome data included counts per minute (CPM), time spent in moderate to vigorous (MVPA), light (LPA), and sedentary (SED) activity. The equation and cutoff used to analyze national accelerometry data were used for the current study.Results:The sample had an average age of 10.4 (1.1) years and 76% were African American. Lower SES African Americans had more CPM (P = .012) and spent more time in MVPA (P = .008) compared with middle SES African American and lower SES Caucasian children. Lower SES African American children also spent fewer minutes in SED activity (P = .044) compared with middle SES African American children.Conclusions:These findings support recent results that also used objective activity measures. Children appeared less active and more sedentary than a national sample, warranting interventions in minority and rural populations.

We hypothesised that ectopic fat deposition is present in liver and skeletal muscle before puberty and that both are potentially important factors in the early pathogenesis of insulin resistance.Proton magnetic resonance spectroscopy was used to evaluate intramyocellular and intrahepatic lipids in 50 male and 42 female multi-ethnic, prepubertal (Tanner2) children (8.1 ± 0.8 years; 35.4 ± 10.7 kg; 27.9 ± 8.3% body fat; means ± SD). Intramyocellular lipid was measured in soleus muscle and intrahepatic lipid in the middle right lobe. Abdominal fat was measured by magnetic resonance imaging, body fat by dual energy X-ray absorptiometry, and insulin resistance using homeostatic model assessment.Intrahepatic lipid ranged from 0.11% to 4.6% relative to the liver water signal (mean 0.79 ± 0.79%) whereas intramyocellular lipid ranged from 0.13% to 1.86% relative to the muscle water signal (mean 0.51 ± 0.28%). Intramyocellular and intrahepatic lipids were significantly correlated with total adiposity (r = 0.49 and 0.59), abdominal adiposity (r = 0.44 and 0.54), and each other (r = 0.39, p0.05, Spearman). Both intramyocellular and intrahepatic lipid were positively correlated with fasting insulin (r = 0.37 and 0.38 respectively) and insulin resistance (r = 0.37 and 0.37; p0.01). After adjustment for race and sex, the relations between ectopic fat and insulin resistance remained, whereas both disappeared when further adjusted for body fat or BMI z scores.These results suggest that typical relations between body composition, ectopic fat and insulin resistance are present in children before puberty. Thus, interventions aimed at reducing adiposity have the potential to decrease ectopic fat accumulation, delay the onset of insulin resistance and decrease the risk for development of type 2 diabetes in children.

Neighbourhood parks may serve as a coping resource in post-disaster communities, yet little is known about the impact of large-scale disasters on park use. The objective of this study is to explore the impact of Hurricane Katrina (August 2005) on park use by visitors from flooded areas of New Orleans, Louisiana, compared to visitors from non-flooded areas. In 2006 and 2007, following Hurricane Katrina, 201 adults who visited 27 New Orleans parks were interviewed. Visitors from flooded neighbourhoods used their parks less often and were less likely to engage in animal interaction than visitors from non-flooded neighbourhoods. They placed more importance on escape and physically-active motivations than visitors from non-flooded areas. Social reasons were also more important to visitors from flooded areas, but these differences disappeared after adjusting for race. Neighbourhood parks are a community asset that may play a role in the post-disaster recovery process by providing opportunities for escape and physical activity.

Intramyocellular and intrahepatic (IHL) lipids are significantly associated with insulin resistance in adults and adolescents and may represent an early marker for developing the metabolic syndrome or type 2 diabetes.During the pilot phase of a larger cross-sectional study, we used proton magnetic resonance spectroscopy ((1)H-MRS) to determine the feasibility of noninvasively evaluating IHL in 11 male (n = 4) and female (n = 7) prepubertal children using a standard clinical system and to determine whether IHL is correlated with adiposity, fasting insulin and glucose, and liver enzymes.Body mass index (BMI) (range, 13.4-32.4 kg/m(2)) and IHL stores (range, 0.07-3.2% relative to an oil phantom) were variable. IHL was correlated with body mass (r = 0.66, P = 0.037), BMI (r = 0.73, P = 0.016), percentage body fat (r = 0.73, P = 0.01, n = 10), waist circumference (r = 0.85, P = 0.016), and serum lactate dehydrogenase concentration (r = 0.77, P = 0.03) but was not significantly correlated with other markers of liver damage, including aspartate aminotransferase activity (r = 0.59, P = 0.09, n = 9) and alkaline phosphatase concentrations (r = 0.60, P = 0.087). IHL was also (P0.01) correlated with fasting insulin concentration (r = 0.85, P = 0.03, n = 6) and insulin resistance (r = 0.94, P = 0.006, n = 6), but these correlations were driven by the results for one child.These preliminary data suggest that (1)H-MRS obtained in a standard pediatric clinical environment may be used to determine IHL in healthy normal and overweight prepubertal youth. This noninvasive technique may prove useful in identifying early markers of the metabolic syndrome in at-risk youth.

Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance insulin sensitivity, and may reduce the risk for type 2 diabetes. An important adjunct to aerobic-based physical activity for diabetes prevention is resistance training. The American Academy of Pediatrics supports properly supervised strength/resistance training as a safe method for strength development in preadolescent children. Resistance training may increase skeletal muscle mass, therefore increasing whole-body glucose disposal capacity. In addition to immediate health benefits during childhood, increased physical activity in children and adolescents is likely to contribute to the establishment of healthy leisure habits over a lifetime and improved adult...

Rates of obesity among children have been rising in recent years. Information on the prevalence of obesity in children living in rural communities is needed. We report the prevalence of overweight and obesity in children enrolled in grades 4 to 6 who live in rural areas of Louisiana, USA.These data were collected as baseline assessment for the Louisiana (LA) Health project. Height, weight, and estimates of body fat (using body impedance analysis) were collected on 2 709 children. Average age was 10.5 years and the sample composition was 57.3% girls, 61.7% African-American, 36.0% Caucasian, and 2.3% other minority. A majority of children (77%) met the criterion for poverty status.The distribution of body mass index (BMI) percentile was highly skewed toward obesity. The most frequent BMI percentile scores were 98(th) and 99(th) percentile. Using Centers for Disease Control and Prevention (CDC) norms, the overall prevalence of obesity was 27.4%, and for overweight was 45.1%, of which 17.7% were between the 85(th) and 95(th) percentile. The prevalence of childhood overweight and obesity were much higher than the national norm and this increased prevalence was observed in both genders and in Caucasian and African-American children.The prevalence of childhood overweight and obesity was found to be much higher in rural and primarily poor (77%) children living in Louisiana when compared with national norms. This observation suggests that rural children from Louisiana may be experiencing an epidemic of obesity that exceeds national prevalence estimates.

1) Report the feasibility of completing the 180-minute Frequently Sampled Intravenous Glucose Tolerance Test (FSIVGTT) in healthy weight, overweight and obese pre-pubertal children and, 2) describe the finalized FSIVGTT protocol after addendums were implemented to decrease the frequency of mild adverse events and improve test completion rates.Insulin sensitivity was determined by FSIVGTT.FSIVGTT was attempted in a total of 22 study participants. Insulin sensitivity was successfully assessed in 15 study participants (8 males, 7 females, 10 Caucasian, 4 African American, 1 Pacific Islander, age range 7-9 years). Mean insulin sensitivity was 15.1+/-9.8 (mmicro/l)(-1) min(-1) range 4.4-43.2 (mmicro/l)(-1) min(-1). However, seven study participants experienced mild adverse events of hypoglycemia. Several addendums were made to the FSIVGTT protocol to ensure study participants' comfort and safety, and to decrease the frequency of mild adverse events and increase test completion rates.Addendums made to FSIVGTT protocol allowed successful completion of FSIVGTT in 15 (68%) of the 22 children. These results demonstrate that FSIVGTT is challenging, yet feasible in healthy lean and obese pre-pubertal children.

This study tested the reliability and validity of measuring children's food intake with the digital photography method and the effects of second servings upon food intake. Food intake was measured in a school cafeteria for 5 days. Adiposity was assessed with body impedance analysis and body mass index, expressed as percentile rank. Mood and self-esteem were assessed with questionnaires. Estimates of food intake were highly reliable between two registered dietitians who independently estimated food intake. Boys ate more food than girls. A significant association between food intake and adiposity supported convergent validity. Non-significant correlations between food intake and depressed mood and self-esteem supported discriminant validity. When second servings were available, more food was selected and discarded, but mean food intake did not increase. Children who returned for second servings, however, ate more food when second servings were available, and a trend suggested that they also ate more food when second servings were not available. These findings support the reliability and validity of measuring children's food intake using digital photography and demonstrate its utility for studies of food intake and body weight.

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

From conception, to gestation, birth, and throughout the life course maternal behaviors (e.g. nutrition, exercise, social interactions), and exposure to pathogens, define how the body responds to stimuli and the susceptibility to complex diseases like asthma, obesity, cardiovascular disease, and cancer. This chapter summarizes the relationship between the environment, epigenetics and disease. In the last 20 years, this relationship has been the focus of intense research. Epigenetic alterations due to environmental insult may be reversible through novel treatment options. By changing the epigenetic “landscape” through simple lifestyle modification, disease risk may be ameliorated, thus improving healthspan. As we advance our understanding of the “epigenome”, the portion of human genome that is either expressed or repressed in disease based on epigenetic status, we may be able to modify this profile to reduce potential sequelae. New technologies have become available allowing scientists to study epigenetic processes targeting specific genes, genomic regions, and even entire genomes. Further advances in this field are crucial to understanding the role of epigenetic modifications in normal biological functions and disease states. Because epigenetics is implicated in growth and development, cell differentiation, tumorigenesis, and many other important cellular processes involved in both normal function and disease states, the need to understand and measure epigenetic changes is becoming increasingly important.

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

The purpose of this study was to compare heart rate peak in obese (n=43) and normal weight (n=45) female youth. Heart rate (HR) peak was significantly lower (p2 (L min-) peak similar between groups (1.77±20.53, 1.97±0.60). Bivariate correlations for heart rate peak with body weight, percent fat, and body mass index yielded the following: -0.53, -0.54, and -0.57. These findings agree with the adult data indicating low HR peak in obese individuals. Further research is needed to explore physiologic factors that may lead to reduced HR peak in obese female youth.

The integrated, 4-level approach of Committed to Kids is successful because of several factors: The sessions are designed to entertain the adolescents and promote initial success; The program features parent-training methods in short, interactive, educational sessions; In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical activity; and The program team provides consistent feedback-patients and their families receive results and updates every 3 months. Most importantly, the program is conducted in groups of families. The adolescent group dynamics and peer modeling are primary components of the successful management of obesity in youth.

Background:The National Physical Activity Plan Alliance partnered with physical activity experts to develop a report card that provides a comprehensive assessment of physical activity among United States children and youth.Methods:The 2014 U.S. Report Card on Physical Activity for Children and Youth includes 10 indicators: overall physical activity levels, sedentary behaviors, active transportation, organized sport participation, active play, health-related fitness, family and peers, school, community and the built environment, and government strategies and investments. Data from nationally representative surveys were used to provide a comprehensive evaluation of the physical activity indicators. The Committee used the best available data source to grade the indicators using a standard rubric.Results:Approximately one-quarter of children and youth 6 to 15 years of age were at least moderately active for 60 min/day on at least 5 days per week. The prevalence was lower among youth compared with younger children, resulting in a grade of D- for overall physical activity levels. Five of the remaining 9 indicators received grades ranging from B- to F, whereas there was insufficient data to grade 4 indicators, highlighting the need for more research in some areas.Conclusions:Physical activity levels among U.S. children and youth are low and sedentary behavior is high, suggesting that current infrastructure, policies, programs, and investments in support of children’s physical activity are not sufficient.

Obesity has reached epidemic proportions worldwide with disproportionate prevalence in different communities and ethnic groups. Recently, the American Medical Association recognized obesity as a disease, which is a significant milestone that opens the possibilities of treating obesity under standardized health plans. Obesity is an inflammatory disease characterized by elevated levels of biomarkers associated with abnormal lipid profiles, glucose levels, and blood pressure that lead to the onset of metabolic syndrome. Interestingly, inflammatory biomarkers, in particular, have been implicated in the risk of developing several types of cancer. Likewise, obesity has been linked to esophageal, breast, gallbladder, kidney, pancreatic, and colorectal cancers. Thus, there exists a link between obesity status and tumor appearance, which may be associated to the differential levels and the circulating profiles of several inflammatory molecules. For example, mediators of the inflammatory responses in both obesity and gastric cancer risk are the same: pro-inflammatory molecules produced by the activated cells infiltrating the inflamed tissues. These molecules trigger pathways of activation shared by obesity and cancer. Therefore, understanding how these different pathways are modulated would help reduce the impact that both diseases, and their concomitant existence, have on society.

Obesity has reached epidemic proportions worldwide with disproportionate prevalence in different communities and ethnic groups. Recently, the American Medical Association recognized obesity as a disease, which is a significant milestone that opens the possibilities of treating obesity under standardized health plans. Obesity is an inflammatory disease characterized by elevated levels of biomarkers associated with abnormal lipid profiles, glucose levels, and blood pressure that lead to the onset of metabolic syndrome. Interestingly, inflammatory biomarkers, in particular, have been implicated in the risk of developing several types of cancer. Likewise, obesity has been linked to esophageal, breast, gallbladder, kidney, pancreatic, and colorectal cancers. Thus, there exists a link between obesity status and tumor appearance, which may be associated to the differential levels and the circulating profiles of several inflammatory molecules. For example, mediators of the inflammatory responses in both obesity and gastric cancer risk are the same: pro-inflammatory molecules produced by the activated cells infiltrating the inflamed tissues. These molecules trigger pathways of activation shared by obesity and cancer. Therefore, understanding how these different pathways are modulated would help reduce the impact that both diseases, and their concomitant existence, have on society.

The aim of the study was to objectively determine whether the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program improved physical activity levels during the school day.The study compared the physical activity levels of subjects from 26 daycare centers, randomized into treatment (N=13) and control (N=13) groups. The subjects were 3 to 5 year olds (N=209, 104 males and 105 females; age [years]=3.85±0.8 [mean±standard deviation]), and accelerometry was used to determine the subjects' physical activity levels. Accelerometers were attached to each subject for 2 days before and immediately after a 6-month intervention. Height, mass, and waist were also measured.Regression analyses indicated that the treatment group demonstrated significant increases in moderate and vigorous physical activity, as compared to the control group (F(1, 207)=6.3, p0.05, Cohen's d=0.30; F(1, 207)=4.7, p0.05, Cohen's d=0.25, respectively). The treatment group also showed significant increases in total physical activity (F(1, 218)=12.4; p0.05) from pre- to post-test with significant increases in moderate and vigorous intensity physical activity (F(1, 218)=18.6, p0.05; F(1, 218)=23.3, p0.05, respectively). Regression analyses revealed significant increases in height for both groups from pre- to post-tests, but no differences were noted between groups.Implementation of the NAP SACC program in treatment daycare facilities resulted in significant increases in objectively measured physical activity levels, compared to the control group, demonstrating physical activity improvement in the treatment daycare centers.

Several variations in the nicotinic receptor genes have been identified to be associated with both lung cancer risk and smoking in the genome-wide association (GWA) studies. However, the relationships among these three factors (genetic variants, nicotine dependence, and lung cancer) remain unclear. In an attempt to elucidate these relationships, we applied mediation analysis to quantify the impact of nicotine dependence on the association between the nicotinic receptor genetic variants and lung adenocarcinoma risk. We evaluated 23 single nucleotide polymorphisms (SNPs) in the five nicotinic receptor related genes (CHRNB3, CHRNA6, and CHRNA5/A3/B4) previously reported to be associated with lung cancer risk and smoking behavior and 14 SNPs in the four 'control' genes (TERT, CLPTM1L, CYP1A1, and TP53), which were not reported in the smoking GWA studies. A total of 661 lung adenocarcinoma cases and 1,347 controls with a smoking history, obtained from the Environment and Genetics in Lung Cancer Etiology case-control study, were included in the study. Results show that nicotine dependence is a mediator of the association between lung adenocarcinoma and gene variations in the regions of CHRNA5/A3/B4 and accounts for approximately 15% of this relationship. The top two CHRNA3 SNPs associated with the risk for lung adenocarcinoma were rs1051730 and rs12914385 (p-value = 1.9×10(-10) and 1.1×10(-10), respectively). Also, these two SNPs had significant indirect effects on lung adenocarcinoma risk through nicotine dependence (p = 0.003 and 0.007). Gene variations rs2736100 and rs2853676 in TERT and rs401681 and rs31489 in CLPTM1L had significant direct associations on lung adenocarcinoma without indirect effects through nicotine dependence. Our findings suggest that nicotine dependence plays an important role between genetic variants in the CHRNA5/A3/B4 region, especially CHRNA3, and lung adenocarcinoma. This may provide valuable information for understanding the pathogenesis of lung adenocarcinoma and for conducting personalized smoking cessation interventions.

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial–ethnic, age, and sex groups. 32,38,54 Evidence continues to support reduced physical activity and sedentary behaviors, such as television viewing, as primary causes of the current worldwide obesity epidemic. 15,28,30 Several researchers have published results of programs that target decreases in sedentary behaviors as methods to increase physical activity and reduce obesity in children. 12,30,36,55 It is possible that, for many children, increasing physical activity may be adequate to prevent the onset of childhood obesity. 28,35,47,55 Because young animals, including humans, are inherently active, young children will be active if given encouragement and opportunity. 21,62 Childhood activity is often intermittent and sporadic 4 ; thus, children likely will not participate in prolonged exercise without rest periods; however, if given the opportunity, young children will perform relatively large volumes of intermittent, nonstructured physical activity. 4,21,62 Generous periods of free play are recommended highly, together with frequent periods of adult-initiated moderate to vigorous activities, including the participation of parents and teachers. 35,42,62 Encouraging active play as a means for increasing overall energy expenditure has been shown to be effective in reducing obesity in 5- to 8-year-old girls. 21 Providing safe environments for young children to play actively outdoors is essential to increasing the physical activity patterns of overweight children and those at risk for obesity. 35 This provision may be accomplished only through policy changes, environmental planning, and school and community educational efforts. Motivating young, nonobese, physically active children to maintain activity patterns may be less challenging than increasing patterns in already obese older children. Javernick 42 suggests that just monitoring children during free play does not encourage the participation of heavier children. Heavier children often are ignored and ridiculed 1 and often choose indoor, sedentary activities to escape negative activity situations. 42 Therefore, encouraging sedentary, obese children to participate in physical activity is difficult. In addition, even mildly overweight children have a decreased exercise tolerance; movement may be uncomfortable and, in some cases, painful. 64,66,69 Structured and vigorous, aerobic-type activities when prescribed to overweight children, regardless of the individual's cognitive, physical, and emotional stage of development, may result in noncompliance or physical injury. Prior failure to motivate and maintain increased physical activity in overweight or obese children may be attributed to inappropriate exercise recommendations 64,65,71 and a lack of physical opportunities for overweight children in the traditional school environment. 42 In addition, emotional problems further may inhibit successful motivation of sedentary children. 1,38,64

OBJECTIVE The conventional ratio method (milliliters O(2) per mass) typically is used to express VO(2) peak. The goal of the current study was to compare VO(2) peak of obese girls with normal-weight girls by ratio and allometric scaling methods. RESEARCH METHODS AND PROCEDURES We compared VO(2) peak by ratio and allometric methods in 46 obese and 47 normal-weight girls. Indirect calorimetry was used to measure VO(2) peak during either treadmill running or walking. Regression analysis was used to determine coefficients for mass and stature for each group with ANOVA used to compare data between groups. RESULTS The obese girls were taller and had higher values of body fatness (p < or = 0.05). Absolute VO(2) peak (liters per minute) was similar between groups; however VO(2) peak relative to mass was 50% lower (p < or = 0.05) in the obese girls. When VO(2) peak (milliliters per minute per kilogram) and mass were correlated, r = -0.48 was found in the obese group. Allometric scaling of logarithmic transformed stature and mass reduced this to r = -0.002, thus eliminating the bias associated with the ratio method. Adjusting VO(2) peak allometrically scaled for mass, stature, and the combination of mass and stature reduced the difference between groups from 50% (ratio method) to 10% to 11% (p < or = 0.05) with higher values found in the normal-weight girls. DISCUSSION These results demonstrate the bias associated with the ratio method when comparing VO(2) peak in obese girls with VO(2) peak in normal-weight girls. Allometric scaling eliminated the bias and thus may reflect a truer comparative response.