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BackgroundA positive association of socioeconomic position and health is well established in high-income countries. In poorer nations, however, higher income individuals often have more cardiovascular risk factors (including obesity) than do those with less income. Our study goal was to estimate the effects of receiving a living wage (340% higher income) on short-term changes in consumption and cardiovascular risk factors among low-wage workers in a middle-income country.MethodsThis cross-sectional study matched workers at an apparel factory (n=105) in the Dominican Republic with those at a similar factory (n=99) nearby, 15 months after the intervention factory introduced a substantially higher living wage. Statistical matching on non-time varying individual characteristics (childhood health, childhood living conditions, work experience, demographic factors) strengthened causal inference. Primary outcomes were blood pressure (systolic and diastolic), pulse rate, body mass index and waist circumference. Secondary outcomes were dietary consumption and spending on services, consumables and durable goods.ResultsReceiving the living wage was associated with increased consumption of protein, dairy, soda and juice and sugars, but not with cardiovascular risk factors. Intervention factory workers spent more on grocery items and household durable goods.ConclusionsWhile having a higher income in a middle-income country might be expected to increase obesity and its associated health risks, the current study found no short-term negative associations. There may be possible longer-term negative health consequences of increases in consumption of soda, juice and sugars, however. It is important to consider complementary interventions to support healthy dietary intake in areas with increasing wages.

BackgroundA small number of studies have used a natural experiment approach to examine the health impacts of increased economic resources stemming from Native American-owned casinos. We build on this work by examining whether casinos are associated with obesity-related health in utero.MethodsWe examined whether casino openings or expansion (as proxy for increased economic resources) are associated with a decreased likelihood of infants being born large-for-gestational-age (LGA), an important risk factor for childhood overweight/obesity. We used repeated cross-sectional data from California birth records (1987-2011) to assess the prevalence of LGA births among Native Americans (n = 21 011). Using zip code fixed-effect regression models, we compared how prevalence of LGA births changed in association with casino openings or expansions, while controlling for secular trends through the inclusion of a comparison group of Native American newborns in zip codes that were eligible to open or expand casinos, but did not do so. In sensitivity analyses, we evaluated whether there was any change in small-for-gestational-age births (SGA).ResultsAverage prevalence of LGA births over the period was 11%. Every one slot machine per capita increase was associated with a 0.13 percentage point decrease (95% confidence interval: -0.25, -0.01) in the prevalence of LGA births but was not associated with SGA prevalence.ConclusionsCasino expansion in California is associated with a lower prevalence of LGA births. Interpreted in combination with previous work showing that California casino expansions were associated with a lower body mass index (BMI) among schoolchildren, these results suggest that casinos are associated with improvement in a surrogate marker of excess adiposity. Further studies are needed to elucidate the mechanisms by which casinos might be associated with obesity-related health outcomes among Native Americans.

IntroductionFood security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.MethodsWe surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.ResultsRespondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β(busyness) = -0.40; 95% confidence interval [CI], -0.52 to -0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β(taste) = -0.38; 95% CI, -0.60 to -0.15) and cost (β(cost) = -0.29; 95% CI, -0.44 to -0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.ConclusionPerceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.

ObjectivesTo describe the food environments experienced by American Indians living on tribal lands in California.MethodsGeocoded statewide food business data were used to define and categorize existing food vendors into healthy, unhealthy, and intermediate composite categories. Distance to and density of each of the composite food vendor categories for tribal lands and nontribal lands were compared using multivariate linear regression. Quantitative results were concurrently triangulated with qualitative data from in-depth interviews with tribal members (n = 24).ResultsAfter adjusting for census tract-level urbanicity and per capita income, results indicate there were significantly fewer healthy food outlets per square mile for tribal areas compared to non-tribal areas. Density of unhealthy outlets was not significantly different for tribal versus non-tribal areas. Tribal members perceived their food environment negatively and reported barriers to the acquisition of healthy food.ConclusionsUrbanicity and per capita income do not completely account for disparities in food environments among American Indians tribal lands compared to nontribal lands. This disparity in access to healthy food may present a barrier to acting on the intention to consume healthy food.

Background/Objectives Previous studies about obesity and its associated factors in low- and middle-income countries have been based mostly on women of reproductive age. Furthermore, disproportionally changing BMI distributions have been a challenge for its appropriate modeling. In this context, we assessed the magnitude and rate of change in BMI distribution by socioeconomic and geographic factors in both sexes in Latin American countries, modeling the shape of BMI distributions. Subjects/Methods We used data from national surveys conducted in Mexico, Colombia, and Peru at two time points between 2005 and 2013 (N = 57,414, 13,5403, and 30,811, respectively). We estimated shapes of BMI distributions for 2005 and 2010, and assessed their changes, using the generalized additive model for location, scale, and shape (GAMLSS), in which BMI was assumed to follow a Box-Cox Power Exponential (BCPE) distribution. Results In all the three countries, higher education was negatively associated with BMI in women but somewhat positive in men; and household wealth was positively associated in men but not in women. Lower household wealth was associated with higher rates of change in BMI distributions in women. Conclusion Education and household wealth were associated with BMI distributions and their change over time. Observed sex differences in these associations have implications for designing relevant policies and programs to approach target populations effectively. The BCPE-GAMLSS method can provide a useful visual assessment of time-varying measures., Author(s): Goro Yamada [sup.1] [sup.2] , Jessica C. Jones-Smith [sup.1] [sup.3] , Carlos Castillo-Salgado [sup.2] , Lawrence H. Moulton [sup.1] Author Affiliations: (1) Department of International Health, Johns Hopkins Bloomberg [...]

ImportanceEconomic resources have been inversely associated with risk of childhood overweight/obesity. Few studies have evaluated whether this association is a direct effect of economic resources or is attributable to unmeasured confounding or reverse causation. American Indian-owned casinos have resulted in increased economic resources for some tribes and provide an opportunity to test whether these resources are associated with overweight/obesity.ObjectiveTo assess whether openings or expansions of American Indian-owned casinos were associated with childhood overweight/obesity risk.Design, setting, and participantsWe used repeated cross-sectional anthropometric measurements from fitness testing of American Indian children (aged 7-18 years) from 117 school districts that encompassed tribal lands in California between 2001 and 2012. Children in school districts encompassing American Indian tribal lands that either gained or expanded a casino were compared with children in districts with tribal lands that did not gain or expand a casino.Main outcomes and measuresPer capita annual income, median annual household income, percentage of population in poverty, total population, child overweight/obesity (body mass index [BMI] ≥85th age- and sex-specific percentile) and BMI z score.ResultsOf the 117 school districts, 57 gained or expanded a casino, 24 had a preexisting casino but did not expand, and 36 never had a casino. The mean slots per capita was 7 (SD, 12) and the median was 3 (interquartile range [IQR], 0.3-8). Among districts where a casino opened or expanded, the mean change in slots per capita was 13 (SD, 19) and the median was 3 (IQR, 1-11). Forty-eight percent of the anthropometric measurements were classified as overweight/obese (11,048/22,863). Every casino slot machine per capita gained was associated with an increase in per capita annual income (β = $541; 95% CI, $245-$836) and a decrease in percentage in poverty (β = -0.6%; 95% CI, -1.1% to -0.20%) among American Indians living on tribal lands. Among American Indian children, every slot machine per capita gained was associated with a decreased probability of overweight/obesity by 0.19 percentage points (95% CI, -0.26 to -0.11 percentage points) and a decrease in BMI z score (β = -0.003; 95% CI, -0.005 to -0.0002).Conclusions and relevanceIn this study, opening or expanding a casino was associated with increased economic resources and decreased risk of childhood overweight/obesity. Given the limitations of an ecological study, further research is needed to better understand the mechanisms behind this association.

ObjectiveOur objective was to use longitudinal data from a US birth cohort to test whether the probability of overweight or obesity during the first 6 years of life varied according to socioeconomic status.Design and methodsUsing six waves of longitudinal data from full-term children in the Early Childhood Longitudinal Study-Birth Cohort (2001-2007; n≈4,950), we examined the prevalence of overweight or obesity (Body Mass Index (BMI)>2 standard deviations above age- and sex- specific WHO Childhood Growth Standard reference mean; henceforth, "overweight/obesity") according to age, socioeconomic status, and race/ethnicity using generalized estimating equation models.ResultsThe association between socioeconomic status and overweight/obesity varied significantly by race/ethnicity, but not by sex. Overweight/obesity was significantly associated with socioeconomic status among whites, Hispanics and Asians; the adjusted odds of overweight/obesity began to diverge according to SES after the first 9 months of life. By approximately 4 years, children with the highest SES had a significantly lower odds of overweight/obesity. SES was not significantly related to overweight/obesity among African Americans and American Indians during early childhood.ConclusionsFew studies have assessed the associations between SES and overweight/obesity within racial/ethnic groups in the US. We find that in contemporary, US-born children, SES was inversely associated with overweight/obesity among more racial/ethnic groups (whites, Hispanics, and Asians) than previously reported.

ObjectiveIt is unknown whether any association between neighborhood food environment and obesity varies according to individual income and/or race/ethnicity. The objectives of this study were to test whether there was an association between food environments and obesity among adults with diabetes and whether this relationship differed according to individual income or race/ethnicity.Research design and methodsSubjects (n = 16,057) were participants in the Diabetes Study of Northern California survey. Kernel density estimation was used to create a food environment score for each individual's residence address that reflected the mix of healthful and unhealthful food vendors nearby. Logistic regression models estimated the association between the modeled food environment and obesity, controlling for confounders, and testing for interactions between food environment and race/ethnicity and income.ResultsThe authors found that more healthful food environments were associated with lower obesity in the highest income groups (incomes 301-600% and >600% of U.S. poverty line) among whites, Latinos, and Asians. The association was negative, but smaller and not statistically significant, among high-income blacks. On the contrary, a more healthful food environment was associated with higher obesity among participants in the lowest-income group (

Objective: Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity. Design: Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey. Setting: Washington State, USA. Participants: Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more. Results: The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not. Conclusions: Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity. [ABSTRACT FROM AUTHOR]

Objective: There is growing recognition that precarious employment is an important determinant of health, which may increase BMI through multiple mechanisms, including stress. It was investigated whether increases in precarious employment were associated with changes in BMI in the United States. Methods: Data were from the National Longitudinal Survey of Youth adult cohort (1996–2016) (N = 7280). Thirteen indicators were identified to operationalize seven dimensions of precarious employment (range: 0–7, 7 indicating most precarious): material rewards, working‐time arrangements, stability, workers' rights, collective organization, interpersonal relationships, and training. The precarious employment–BMI association was estimated using linear regression models and an instrumental variables approach; state‐ and individual‐level firm sizes were the instruments for precarious employment. Models also included individual and year fixed effects and controlled for age, marital status, education, region, and industry. Results: The average precarious employment score (PES) was 3.49 (95% CI: 3.46–3.52). The PES was the highest among Hispanic (4.04; 95% CI: 3.92–4.15) and non‐Hispanic Black (4.02; 95% CI: 3.92–4.12) women with lower education. A 1‐point increase in the PES was associated with a 2.18‐point increase in BMI (95% CI: 0.30–4.01). Conclusions: Given that even small changes in weight affect chronic disease risk, policies to improve employment quality warrant consideration. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to understand youths' perceptions of the food environment in one "healthy food priority area" in Seattle, WA. With a convenience sample of 13 youth, we conducted semi-structured interviews and analyzed the data using content analysis. We found five themes: 1) cost drove family food-purchasing decisions, 2) access to cars mitigated the lack of food retailers, 3) families used limited resources to travel farther to obtain cultural food, 4) youth disliked school lunch, and 5) youth recognized issues facing their communities. Youth want to share their unique perspective of the food environment and help improve food access. [ABSTRACT FROM AUTHOR]

Objective The associations of birth size, rate of growth during infancy, and odds of childhood overweight have not yet been thoroughly investigated in contemporary cohorts in low- and middle-income countries. The primary aim of this study was to evaluate the influence of birth size (using body mass index at birth) and accelerated growth during infancy (defined as upward growth curve percentile crossing between birth and age 1 year) on the odds of childhood overweight. A secondary goal was to characterize the sociodemographic correlates of accelerated growth during infancy. Design Observational prospective cohort. Subjects/setting Participants were 163 children and their mothers living in semiurban Mexico who were originally recruited between 1997 and 2000 and followed until 2005. Main outcome measures Primary outcome was childhood overweight (as assessed by body mass index). Secondary outcome was accelerated growth during infancy. Statistical analyses performed Multivariate linear regression and logistic regression were used to determine the associations among birth size, accelerated growth, and childhood overweight. Results Increased size at birth and accelerated growth during the first year of life increased the odds of childhood overweight (odds ratio [OR] 7.62, P<0.0005 and OR 2.23, P<0.05, respectively). The effect of accelerated growth on odds of childhood overweight varied by size at birth (OR for interaction term 0.63, P<0.05). Living in a "dual burden" household, where the child was underweight at birth and the mother was overweight 4 to 6 years after birth, was associated with accelerated growth during the first year of life. Conclusions In a sample of Mexican children living in poverty, accelerated growth during infancy was associated with increased odds of childhood overweight among small and normal-sized babies. Among large babies, accelerated growth did not appear to pose an additional risk for overweight beyond that of high birth weight. Upward growth curve percentile crossing in infancy may be predictive of future childhood overweight status, particularly among smaller infants.