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The recommendations for the age and frequency that women at average risk for breast cancer should undergo breast cancer mammography screening have been a matter of emotional, political, and scientific debate over the past decades. Multiple national organizations provide recommendations for breast cancer screening age and frequency. US Centers for Disease Control and Prevention (CDC) funding for state comprehensive cancer control (CCC) planning requires compliance with stated objectives for attaining goals. US Preventive Services Task Force (USPSTF) recommendations on cancer prevention and control are currently used to require coverage of prevention services.To evaluate the consistency of state CCC plan objectives compared with the most current (2016) USPSTF recommendations for the age and frequency that individuals should undergo mammography screening and to make recommendations for improvement of state CCC plans.This cross-sectional study used a descriptive, point-in-time evaluation and was conducted from November 1, 2019, to June 30, 2021. In November 2019, the most recent CCC plans from 50 US states and the District of Columbia were downloaded from the CDC website. The recommended ages at which to begin and end mammography examinations and the frequency of mammography examinations were extracted from plan objectives.The recommendations found in CCC plan objectives regarding the ages at which to begin and end mammography examinations and the frequency of mammography examinations for women with average risk for breast cancer were compared with USPSTF recommendations.Of the 51 CCC plans, 16 (31%) were consistent with all USPSTF recommendations for age and frequency that women at average risk should undergo mammography. Twenty-six plans (51%) were partially consistent with recommendations, and 9 plans (18%) were not consistent with any of the 3 guideline components.Compared with the USPSTF recommendation, state CCC plans are not homogenous regarding the age and frequency that women at average risk for breast cancer should undergo mammography. This variation is partially due to differences in state-specific planning considerations and discretion, variations in recommendations among national organizations, and publication of plans prior to the most current USPSTF recommendation (2016). Specifying the concept that high-risk populations need different age and frequency of screening recommendations than the general population may reduce heterogeneity among plans.

This study explores the association between neighborhood social and economic change from 2009 to 2013 and changes in the retail food environment from 2013 to 2017 in Madrid (Spain). We classified neighborhoods into four types: decreasing SES, new housing/gentrifying, increasing SES, and aging (population and housing). Food store data was obtained from a retail spaces census and classified as supermarket, specialized small store, or fruit and vegetable store. Compared to aging areas, new housing/gentrifying and areas with increasing SES had a higher baseline presence and proportion of supermarkets and a lower proportion of specialized stores and fruit and vegetable stores. Areas with decreasing SES had an initially higher presence and proportion of fruit and vegetable stores but showed a declining trend in both presence and proportion of fruit and vegetable stores.

Background Exposure to Bisphenol A (BPA) is ubiquitous and includes dietary and environmental pathways. BPA is rapidly glucuronidated in the body, and both BPA and its conjugates can be readily measured in urine. Objectives To investigate the contribution of canned food and beverages, known sources of BPA contamination, to BPA biomarkers of exposure using dietary and urinary BPA concentration information in a representative sample of the U.S. population. Methods We evaluated 7669 NHANES 2003–2008 participants 6 years and older with 24-h dietary recall information and urinary BPA concentrations available. Using linear regression models, we evaluated the associations between recent canned food and beverage consumption and urinary BPA concentrations, adjusting for potential confounders. Results We found 9% of our participants consumed one canned food in the past 24 h and 2% consumed two or more canned foods. The consumption of one canned food vs. none was associated with 24% (95% CI 1.11, 1.38) higher urinary BPA concentrations. The consumption of two or more canned foods vs. none was associated with 54% (95% CI 1.27, 1.88) higher urinary BPA concentrations. The consumption of one or more of some specific types of canned foods vs. none were associated with higher urinary BPA concentrations: 41% (95% CI 1.23, 1.63) higher BPA for vegetable and fruit, 70% (95% CI 1.18, 2.44) higher for canned pasta, and 229% (95% CI 1.22, 4.30) higher for canned soup. Canned beverages were not associated with urinary BPA concentrations. Conclusions Canned food, including some specific types such as canned vegetable and fruit, canned pasta, and canned soup were associated with higher levels of urinary BPA concentrations.

Places where we buy food influence dietary patterns, making local food environments a good example of a mass influence on population diets. Cross-cultural studies, using reliable methods, may help understanding the relationship between food environments and diet-related health outcomes. We aimed to understand cross-national differences in the local food environment between Madrid and Baltimore by comparing an average neighborhood in each city in terms of food store types, healthy food availability, and residents' pedestrian access. During 2012-2013, we assessed one neighborhood (~15,000 residents) in each city selecting median areas in terms of socio-demographic characteristics (segregation, education, aging, and population density). We collected on-field data on (a) number and types of all food stores, (b) overall healthy food availability and (c) specific availability of fruits & vegetables. Throughout a street network analysis (200m, 400m and 800m) of food stores with high healthy food availability, we estimated residents' pedestrian accessibility. We found 40 stores in Madrid and 14 in Baltimore. Small food stores carrying fresh foods in Madrid contrasted with the high presence of corner and chain convenience stores in Baltimore. In Madrid, 77% of the residents lived within less than 200m from a food store with high healthy food availability. In contrast, 95% of Baltimore's residents lived further than 400m from these stores. Our results may help promoting interventions from local city agencies to allocate resources to existing small-sized food stores, and to improve walkable urban environments. These actions may influence food choices, especially for those residents lacking access to private vehicles.

A pilot multiphase environmental intervention (February to September 2011) was conducted in 4 intervention and 4 comparison carry-outs in low-income urban areas of Baltimore, Maryland, to examine the association between exposure to a point-of-purchase intervention and purchasing behavior among customers (n = 186). Intervention exposure score (IES; range: 0–24) combined the number of intervention materials seen. Multivariate linear regression calculated an adjusted beta-coefficient (β) and 95% confidence intervals for a diversity of healthy items (DHI) purchased, adjusting for sociodemographic and eating out behavioral factors. Intervention customers purchased 4.5 DHI, whereas comparison customers purchased less than 1 (P < .001). Those who reported high intervention exposure purchased more DHI (β = 5.0, 95% confidence interval, 2.3–7.7) than those with low exposure. An environmental intervention at carry-outs increased healthy item purchasing among low-income consumers.

The US food system functions within a complex nexus of social, political, economic, cultural, and ecological factors. Among them are many dynamic pressures such as population growth, urbanization, socioeconomic inequities, climate disruption, and the increasing demand for resource-intensive foods that place immense strains on public health and the environment. This review focuses on the role that policy plays in defining the food system, particularly with regard to agriculture. It further examines the challenges of making the food supply safe, nutritious, and sustainable, while respecting the rights of all people to have access to adequate food and to attain the highest standard of health. We conclude that the present US food system is largely unhealthy, inequitable, environmentally damaging, and insufficiently resilient to endure the impacts of climate change, resource depletion, and population increases, and is therefore unsustainable. Thus, it is imperative that the US embraces policy reforms to transform the food system into one that supports public health and reflects the principles of human rights and agroecology for the benefit of current and future generations.

Evolving global demographic trends have changed the face of “conventional” refugee and internally displaced populations. Such populations were encountered on a large scale in the 1990s with Serbian...

Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all.

Meats are key dietary sources for many important nutrients including protein and many other essential micronutrients such as minerals and vitamins to maintain good health(1). During recent years, the Atkins diet, which consists of high meat consumption (MC), has been advocated for weight loss(2,3). On the other hand, MC has been linked to higher intakes of saturated fat, total energy and reduced consumption of vegetables(4,5), leading some researchers to propose vegetarian diets as a means to prevent many diet-related chronic diseases including obesity, despite the many associated controversies(4,6–10). MC has been related to increased chronic morbidity, while higher intake of vegetables, fruits, cereals, nuts and legumes has been independently associated with a lower risk for several chronic diseases, such as IHD, diabetes, obesity and many cancers(6,7). Earlier studies indicate that diets largely based on plant foods, including well-balanced vegetarian diets, offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol and animal protein, as well as higher levels of fibre, magnesium, potassium, folate and antioxidants. Compared to their non-vegetarian counterparts, vegetarians are found to have lower BMI, blood pressure and blood cholesterol levels; lower rates of hypertension, type 2 diabetes, prostate and colon cancer; and reduced death rates from heart disease(4,6,7). Therefore, it would be of interest to examine MC patterns over time and determine whether they have been affected by the recent related research findings and advocacy campaigns, although many remain controversial(1,7,11,12). Using US nationally representative data collected over the past two decades, we examined the trends in US adults’ MC and compared the differences among gender, ethnic, and socio-economic status (SES) groups. We also tested whether psychosocial–behavioural factors such as nutrition-related knowledge and perceptions, and food label use might affect MC. Our findings will help shed light on the recent shifts in food consumption patterns and the variation in these shifts across population groups in the United States.

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

Annual global aquaculture production has more than tripled within the past 15 years, and by 2015, aquaculture is predicted to account for 39% of total global seafood production by weight. Given that lack of adequate nutrition is a leading contributor to the global burden of disease, increased food production through aquaculture is a seemingly welcome sign. However, as production surges, aquaculture facilities increasingly rely on the heavy input of formulated feeds, antibiotics, antifungals, and agrochemicals. This review summarizes our current knowledge concerning major chemical, biological and emerging agents that are employed in modern aquaculture facilities and their potential impacts on public health. Findings from this review indicate that current aquaculture practices can lead to elevated levels of antibiotic residues, antibiotic-resistant bacteria, persistent organic pollutants, metals, parasites, and viruses in aquacultured finfish and shellfish. Specific populations at risk of exposure to these contaminants include individuals working in aquaculture facilities, populations living around these facilities, and consumers of aquacultured food products. Additional research is necessary not only to fully understand the human health risks associated with aquacultured fish versus wild-caught fish but also to develop appropriate interventions that could reduce or prevent these risks. In order to adequately understand, address and prevent these impacts at local, national and global scales, researchers, policy makers, governments, and aquaculture industries must collaborate and cooperate in exchanging critical information and developing targeted policies that are practical, effective and enforceable. Keywords: Aquaculture, Human health, Fish, Shellfish, Antibiotics, Antibiotic residues, Antibiotic-resistant bacteria, Wastewater, Metals, Agrochemicals, Organohalogens

Half of the seafood consumed globally now comes from aquaculture, or farmed seafood. Aquaculture therefore plays an increasingly important role in the global food system, the environment, and human health. Traditionally, aquaculture feed has contained high levels of wild fish, which is unsustainable for ocean ecosystems as demand grows. The aquaculture industry is shifting to crop-based feed ingredients, such as soy, to replace wild fish as a feed source and allow for continued industry growth. This shift fundamentally links seafood production to terrestrial agriculture, and multidisciplinary research is needed to understand the ecological and environmental health implications. We provide basic estimates of the agricultural resource use associated with producing the top five crops used in commercial aquaculture feed. Aquaculture's environmental footprint may now include nutrient and pesticide runoff from industrial crop production, and depending on where and how feed crops are produced, could be indirectly linked to associated negative health outcomes. We summarize key environmental health research on health effects associated with exposure to air, water, and soil contaminated by industrial crop production. Our review also finds that changes in the nutritional content of farmed seafood products due to altered feed composition could impact human nutrition. Based on our literature reviews and estimates of resource use, we present a conceptual framework describing the potential links between increasing use of crop-based ingredients in aquaculture and human health. Additional data and geographic sourcing information for crop-based ingredients are needed to fully assess the environmental health implications of this trend. This is especially critical in the context of a food system that is using both aquatic and terrestrial resources at unsustainable rates. Keywords: Agriculture, Aquaculture, Environmental health, Nutrition, Seafood, Sustainability

There is a substantial need among clinicians for health-related, evidence-based recommendations. Evidence-based recommendations help distill research findings and aid health care providers in making clinical decisions. However, it is infeasible for providers to sort through thousands of available guidelines, and heterogeneity among recommendation developers (e.g., composition, processes, outputs) can make it difficult for clinicians to identify which recommendations are trustworthy, feasible, and applicable to their patient population. Even when there is broad consensus about the quality and utility of recommendations, a range of contextual factors (e.g., the health care system, patient characteristics, enabling resources) can impede implementation. This study examined the diffusion of evidence-based recommendations through professional societies to clinically-trained members, and explored knowledge, attitudes, beliefs, and behaviors regarding evidence-based recommendations and practice. The study had three aims: 1.) Describe the role primary care professional societies play in developing and/or disseminating evidence-based reports and recommendations; 2.) Determine if the needs of primary care providers and their professional societies for evidence-based reports and recommendations are being met; 3.) Describe the value that the federal government contributes to evidence-based practice.

Dioxins and related compounds are undesirable and unintended contaminants in the food supply, and dietary intake is the major route of exposure. Reducing dietary exposure to dioxins among the most vulnerable segments of the population (i.e., pregnant women, infants, and young girls) is an effective strategy for reducing body burdens in future generations. Exposure to dioxins through foods can be minimized by selecting lower-fat versions of meats, poultry, and dairy products. Consuming all foods, including fatty fish, in recommended amounts is congruent with the goal of reducing dioxin intake exposure and maintaining good health.

Although a rich source of n-3 polyunsaturated fatty acids (PUFAs) that may confer multiple health benefits, some fish contain methyl mercury (MeHg), which may harm the developing fetus. U.S. government recommendations for women of childbearing age are to modify consumption of high-MeHg fish to reduce MeHg exposure, while recommendations encourage fish consumption among the general population because of the nutritional benefits. The Harvard Center for Risk Analysis convened an expert panel (see acknowledgements) to quantify the net impact of resulting hypothetical changes in fish consumption across the population. This paper estimates the impact of fish consumption on stroke risk. Other papers quantify coronary heart disease mortality risk and the impacts of both prenatal MeHg exposure and maternal intake of n-3 PUFAs on cognitive development. This analysis identified articles in a recent qualitative literature review that are appropriate for the development of a dose-response relationship between fish consumption and stroke risk. Studies had to satisfy quality criteria, quantify fish intake, and report the precision of the relative risk estimates. The analysis combined the relative risk results, weighting each proportionately to its precision. Six studies were identified as appropriate for inclusion in this analysis, including five prospective cohort studies and one case-control study (total of 24 exposure groups). Our analysis indicates that any fish consumption confers substantial relative risk reduction compared to no fish consumption (12% for the linear model), with the possibility that additional consumption confers incremental benefits (central estimate of 2.0% per serving per week).

The high level of meat and saturated fat consumption in the USA and other high-income countries exceeds nutritional needs and contributes to high rates of chronic diseases such as cardiovascular disease, diabetes mellitus and some cancers. Affluent citizens in middle- and low-income countries are adopting similar high-meat diets and experiencing increased rates of these same chronic diseases. The industrial agricultural system, now the predominant form of agriculture in the USA and increasingly world-wide, has consequences for public health owing to its extensive use of fertilisers and pesticides, unsustainable use of resources and environmental pollution. In industrial animal production there are public health concerns surrounding feed formulations that include animal tissues, arsenic and antibiotics as well as occupational health risks and risks for nearby communities. It is of paramount importance for public health professionals to become aware of and involved in how our food is produced.

Health care providers are increasingly relying on collection agencies to recoup charges associated with medical care. Little is known about the prevalence of this practice in low-income communities and what effect it has on health-seeking behavior.Cross-sectional survey at 10 "safety net" provider sites in Baltimore, Md. Specific queries were made to underlying comorbidities, whether they had a current medical debt, actions taken against that debt, and any effect this has had on health-seeking behavior.Overall, 274 adults were interviewed. The average age was 43.9 years, 77.3% were African American, 54.6% were male, 47.2% were homeless, and 34.4% had less than a 12th grade education. Of these, 46.2% reported they currently had a medical debt (average, 3,409 dollars) and 39.4% reported ever having been referred to a collection agency for a medical debt. Overall, 67.4% of individuals reported that either having a current medical debt or having been referred to a collection agency for a medical debt affected their seeking subsequent care: 24.5% no longer went to that site for care; 18.6% delayed seeking care when needed; and 10.4% reported only going to emergency departments now. In the multiple logistic regression model, having less than a 12th grade education (odds ration [OR], 2.5; 95% confidence interval [CI], 1.0 to 6.0) and being homeless (OR, 4.1; 95% CI, 1.4 to 12.3) were associated with a change in health-seeking behavior while having a chronic medical condition (OR, 0.2; 95% CI, 0.1 to 0.5) and going to a community clinic for usual care (OR, 0.2; 95% CI, 0.1 to 1.0) were protective.Aggressive debt retrieval for medical care appears to be indiscriminately applied with a negative effect on subsequent health-seeking behavior among those least capable of navigating the health system.

The industrial agriculture system consumes fossil fuel, water, and topsoil at unsustainable rates. It contributes to numerous forms of environmental degradation, including air and water pollution, soil depletion, diminishing biodiversity, and fish die-offs. Meat production contributes disproportionately to these problems, in part because feeding grain to livestock to produce meat—instead of feeding it directly to humans—involves a large energy loss, making animal agriculture more resource intensive than other forms of food production. The proliferation of factory-style animal agriculture creates environmental and public health concerns, including pollution from the high concentration of animal wastes and the extensive use of antibiotics, which may compromise their effectiveness in medical use. At the consumption end, animal fat is implicated in many of the chronic degenerative diseases that afflict industrial and newly industrializing societies, particularly cardiovascular disease and some cancers. In terms of human health, both affluent and poor countries could benefit from policies that more equitably distribute high-protein foods. The pesticides used heavily in industrial agriculture are associated with elevated cancer risks for workers and consumers and are coming under greater scrutiny for their links to endocrine disruption and reproductive dysfunction. In this article we outline the environmental and human health problems associated with current food production practices and discuss how these systems could be made more sustainable. Key words: diet, environment, health, industrial agriculture, sustainability, sustainable agriculture. Environ Health Perspect 110:445‐456 (2002). [Online 20 March 2002] http://ehpnet1.niehs.nih.gov/docs/2002/110p445-456horrigan/abstract.html

Many endocrine-disrupting chemicals (EDCs), including bisphenol A (BPA), are approved for use in food packaging, with unbound BPA migrating into the foods it contacts. Children, with their developing organ systems, are especially susceptible to hormone disruption, prompting this research to model the potential dose of BPA from school-provided meals. Probabilistic exposure models for school meals were informed by mixed methods. Exposure scenarios were based on United States school nutrition guidelines and included meals with varying levels of exposure potential from canned and packaged food. BPA exposure potentials were modeled with a range of 0.00049 μg/kg-BW/day for a middle school student with a low exposure breakfast and plate waste to 1.19 μg/kg-BW/day for an elementary school student eating lunch with high exposure potential. The modeled BPA doses from school meals are below the current US EPA Oral Reference Dose (RfD) of 50 μg/kg-BW/day. Recent research shows BPA animal toxicity thresholds at 2 μg/kg-BW/day. The single meal doses modeled in this research are at the same order of magnitude as the low-dose toxicity thresholds, illustrating the potential for school meals to expose children to chronic toxic levels of BPA.