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

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

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

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

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

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

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

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

Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA domains and whether associations with gender differ by school type. We randomly selected an equal number of girls and boys (ages 13-16 years) from public and private schools in Southern India ( n = 395). Cross-sectional 24-hour time-use surveys measured PA, which was categorized into three domains: chores, errands, and work; play; and transportation. Negative binomial and logistic regression modeled relative differences in domain-specific PA minutes and the probability of engaging in ≥60 minutes of moderate-to-vigorous PA (MVPA), respectively, in the prior 24 hours. Girls and boys were equally likely to meet MVPA recommendations. However, girls spent twice as much active time completing chores, errands, and work (rate ratio = 1.98, 95% confidence interval = [1.32, 2.98]), while boys spent twice as much active time playing (rate ratio = 2.11, 95% confidence interval = [1.23, 3.62]). Public and private school girls spent more active time in chores, errands, and work than boys; however, gender differences were greater among public school students ( p value for interaction

Background In low-resource settings, urbanization may contribute to the individual-level double burden of malnutrition (DBM), whereby under- and overnutrition co-occur within the same individuals. Objective We described DBM prevalence among Malawian women by urban-rural residence, examined whether urban residence was associated with DBM, and assessed whether DBM prevalence was greater than the prevalence expected by chance given population levels of under- and overnutrition, which would suggest DBM is a distinct phenomenon associated with specific factors. Methods We analyzed nationally representative data of 723 nonpregnant women aged 15-49 y from the 2015-2016 Malawi Micronutrient Survey. DBM was defined as co-occurring overweight or obesity (OWOB) and ≥1 micronutrient deficiency or anemia. We used Poisson regression models to examine the association between urban residence and DBM and its components. The Rao-Scott modified chi-square test compared the observed and expected DBM prevalence. Results Nationally, 10.8% (95% CI: 7.0, 14.5) of women had co-occurring OWOB and any micronutrient deficiency and 3.4% (95% CI: 1.3, 5.5) had co-occurring OWOB and anemia. The prevalence of co-occurring OWOB and any micronutrient deficiency was 2 times higher among urban women than rural women [urban 32.6 (24.1, 41.2) compared with rural 8.6 (5.2, 11.9), adjusted prevalence ratio: 2.0 (1.1, 3.5)]. Co-occurring OWOB and anemia prevalence did not significantly differ by residence [urban 6.9 (0.6, 13.2) compared with rural 3.0 (0.8, 5.3)]. There were no statistically significant differences in observed and expected prevalence estimates of DBM. Conclusions This analysis shows that co-occurring OWOB and any micronutrient deficiency was higher among women in urban Malawi compared with rural areas. However, our finding that co-occurring OWOB and any micronutrient deficiency or anemia may be due to chance suggests that there may not be common causes driving DBM in Malawian women. Thus, there may not be a need to design and target interventions specifically for women with DBM.

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

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

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

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

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

Background Diabetes poses a heavy burden on patients due to its progressive and chronic nature; it requires continuous management to promote a high-quality and long life. Disease management is especially challenging in emergency settings. We examined how displaced people with diabetes experienced managing their illness before and throughout the process of fleeing their home communities and seeking resettlement in Europe. Design We designed an interview instrument with closed- and open-ended questions about diabetes diagnosis and management before fleeing the home country, during migration, stays in transit countries, and reception in the European Union. We interviewed 20 asylum seekers living in Belgian reception centres with diagnosed diabetes mellitus. Results Primary topics emerging from interviews were availability, accessibility, and quality. Belgium was described as a setting with high availability, accessibility, and quality of diabetes management components (medication, tools, care) compared to other settings before and during migration. Even in Belgium, maintaining a healthy diet as an asylum seeker was difficult. Other concerns such as safety, other health issues, and the asylum request itself often outweighed diabetes management. Conclusions Displaced people in non-western countries need attention for nutrition and diabetes medicine, so aid agencies should consider providing for those needs. For people seeking asylum in the West and living in temporary facilities, care should be paid to the dietary options available for those with diabetes. For irregular migrants, diabetes can be deadly, and resources should be made available for their basic diabetes needs, even if they are not eligible for regular health services.

Low socioeconomic position (SEP) across the lifecourse is associated with Type 2 diabetes (T2DM). We examined whether these economic disparities differ by race and sex. We included 5448 African American (AA) and white participants aged ≥45 years from the national (United States) REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort without T2DM at baseline (2003–07). Incident T2DM was defined by fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, or using T2DM medications at follow-up (2013–16). Derived SEP scores in childhood (CSEP) and adulthood (ASEP) were used to calculate a cumulative (CumSEP) score. Social mobility was defined as change in SEP. We fitted race-stratified logistic regression models to estimate the association between each lifecourse SEP indicator and T2DM, adjusting for covariates; additionally, we tested SEP-sex interactions. Over a median of 9.0 (range 7–14) years of follow-up, T2DM incidence was 167.1 per 1000 persons among AA and 89.9 per 1000 persons among white participants. Low CSEP was associated with T2DM incidence among AA (OR = 1.61; 95%CI 1.05–2.46) but not white (1.06; 0.74–2.33) participants; this was attenuated after adjustment for ASEP. In contrast, low CumSEP was associated with T2DM incidence for both racial groups. T2DM risk was similar for stable low SEP and increased for downward mobility when compared with stable high SEP in both groups, whereas upward mobility increased T2DM risk among AAs only. No differences by sex were observed. Among AAs, low CSEP was not independently associated with T2DM, but CSEP may shape later-life experiences and health risks.

ObjectivesTo describe temporal trends in child marriage between 1990 and 2019 in a rural sub-district of Bangladesh and characterize relationships between age, time to pregnancy, complications during delivery, and perinatal mortality.DesignHealth and demographic surveillance system.SettingBaliakandi sub-district, Bangladesh.Participants56,155 female residents.Main outcome measuresAnnual proportion of marriages to female residents under 18 years of age, time between first marriage and pregnancy, proportion of births with complications during delivery, and odds of perinatal mortality.ResultsBetween 1990 and 2010, the proportion of marriages to female residents under 18 years of age decreased from 71% to 57%. Most notably, marriages to females aged 10 to 12 years dropped from 22% of all marriages to 3%. In 2019, 53% of all marriages were to females under 18 years. The estimated time between first marriage and pregnancy did not differ by female age at marriage. By 365 days after marriage, the cumulative incidence of pregnancy was approximately 50% for each age group. Adolescent girls were more likely to experience complications during delivery with at least one complication reported for 36% of mothers aged 13 to 15 years, 32% of mothers aged 16 to 17 years, and 23% of mothers aged 18 to 34 years (χ2 test, PConclusionsChild marriage persists in Baliakandi. Over half of all marriages were to child brides and only minor reductions were seen over the past decade. Pregnancies were common among adolescent girls with no evidence of delayed pregnancy after marriage. Compared to adults, adolescents were more likely to experience complications during delivery and perinatal death. Preventing child marriage has substantial social and health benefits for girls and, by doing so, will also contribute to Bangladesh’s commitment to reduce child mortality.

Background: Pregnancy identification and follow-up surveillance can enhance the reporting of pregnancy outcomes, including stillbirths and perinatal and early postnatal mortality. This paper reviews pregnancy surveillance methods used in Health and Demographic Surveillance Systems (HDSSs) in low- and middle-income countries. Methods: We searched articles containing information about pregnancy identification methods used in HDSSs published between January 2002 and October 2019 using PubMed and Google Scholar. A total of 37 articles were included through literature review and 22 additional articles were identified via manual search of references. We reviewed the gray literature, including websites, online reports, data collection instruments, and HDSS protocols from the Child Health and Mortality Prevention Study (CHAMPS) Network and the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH). In total, we reviewed information from 52 HDSSs described in 67 sources. Results: Substantial variability exists in pregnancy surveillance approaches across the 52 HDSSs, and surveillance methods are not always clearly documented. 42% of HDSSs applied restrictions based on residency duration to identify who should be included in surveillance. Most commonly, eligible individuals resided in the demographic surveillance area (DSA) for at least three months. 44% of the HDSSs restricted eligibility for pregnancy surveillance based on a woman’s age, with most only monitoring women 15-49 years. 10% had eligibility criteria based on marital status, while 11% explicitly included unmarried women in pregnancy surveillance. 38% allowed proxy respondents to answer questions about a woman’s pregnancy status in her absence. 20% of HDSSs supplemented pregnancy surveillance with investigations by community health workers or key informants and by linking HDSS data with data from antenatal clinics. Conclusions: Methodological guidelines for conducting pregnancy surveillance should be clearly documented and meticulously implemented, as they can have implications for data quality and accurately informing maternal and child health programs.

Purpose: This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US. Design: Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children’s Health. Setting: US, national. Subjects: Children ages 10-17 years (n = 34,640) Measures: Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts. Analysis: Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics. Results: An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time. Conclusion: Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime.

Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.

We investigated the influence of parents’ weight status on their children’s growth trajectories and its association with age at onset of overweight and obesity. We used 16,396 height and weight records from 3,284 youths from the Panel Study of Income Dynamics, followed across childhood into adulthood (United States, 1997–2017). Across age groups, we modeled body mass index trajectories (ages 5–32 years) according to parents’ weight status, using mixed-effect models to estimate age at onset of overweight and obesity and proportion with obesity from childhood to adulthood. There were large differences in growth patterns according to parents’ weight status: Children of parents with obesity had, on average, overweight at age 6 (95% confidence interval (CI): 5, 7) and steep growth trajectories until age 12; children of normal-weight parents had slower increases in body mass index, reaching overweight on average at age 25 (95% CI: 24, 27). By age 30, 30% (95% CI: 28, 31) of youths had obesity. Differences in early-life growth persisted into adulthood: 48% (95% CI: 45, 52) of adult children of parents with obesity had obesity versus 16% (95% CI: 14, 19) of those of normal-weight parents. Trajectories to unhealthy weight were heavily influenced by parents’ weight status, especially before age 12, children of parents with obesity having overweight 19 earlier in life than children of normal-weight parents.

OBJECTIVES: Little is known about the association of family eating behaviors with young children's cognitive development, particularly among non-White populations. The objective of this study is to determine if healthier family eating behaviors are associated with young Mexican children's cognitive functioning. METHODS: We used cross-sectional data from a convenience sample of low-income child-mother dyads recruited from a public preschool in San Luis Potosi, S.L.P., Mexico. Using the Family Nutrition and Physical Activity (FNPA) questionnaire, mothers were asked to report the frequency of ten family eating behaviors (e.g., frequency of breakfast intake, family mealtimes, etc.). Children completed two cognitive tests: a working memory test of their ability to recall four words after a timed distraction (i.e., delayed recall); and a verbal fluency test, examined with a 60-second trial of word retrieval in response to “things people eat”. The associations of family eating behaviors with children's working memory and verbal fluency were examined using multiple linear regression models adjusting for child sex, age, mother's age, education, and subjective socioeconomic status. RESULTS: Study included 85 child-mother dyads; children's ages ranged from 3 to 6 years (4.58 ± 0.58) and mothers from 19 to 55 years (30.92 ± 8.49). Children had a mean working memory score of 2.24 ± 0.99 words recalled and retrieved a mean of 20.06 ± 5.26 words in the verbal fluency tests. Higher frequency of breakfast intake was associated with higher working memory scores (β = 0.56, P = 0.013). No other family eating practices were significantly associated with children's working memory. Children's verbal fluency scores were not significantly associated with family eating practices. CONCLUSIONS: Frequent breakfast intake was associated with young children's memory maintenance. Future research is needed to examine the mechanisms through which breakfast intake could benefit children's neurodevelopmental health. FUNDING SOURCES: This study was supported by the training grant “Illinois Transdisciplinary Obesity Prevention Program (I-TOPP)” funded by the National Institute of Food and Agriculture, United States Department of Agriculture (USDA) and support from the NIDDK.

OBJECTIVES: On average, U.S. immigrants experience increases in body mass during their time in the country. These changes are related to important shifts in diet post immigration but could also continue to be influenced by sending-area environments. We assess the level of variance in dietary change that is attributable to country of origin and U.S. state of residence-level factors. METHODS: Using longitudinal data on three measures of dietary change from the nationally-representative New Immigrant Survey (n = 7930), we use cross-classified multilevel models to test what proportion of the variance in dietary change is attributable to country of origin vs. U.S. state of residence. The three measures of dietary change are degree of change (1–10); whether any foods from the home country were abandoned; whether any new foods were adopted in the U.S. RESULTS: When foreign-born individuals received legal permanent resident status (+/− 8 years after arriving in the U.S.), country of origin explained 6% of individual variation in diet (a moderate but nontrivial amount), with state of residence explaining a much smaller amount of variance at 1.6%. Interesting, the interaction of country of origin and state of residence explained an additional 1.4%, suggesting that the context in which immigrants are “received” varies in some important ways across people of different national origins to shape dietary changes. When adding covariates at country or U.S. state level to explain the variance at these scales, higher availability of sweets in the country of origin and U.S. state levels of obesity were particularly important variables predicting dietary change. CONCLUSIONS: While “new” obesogenic and broader nutritional environments the foreign-born are exposed to after immigration may indeed have an impact on nutritional outcomes, “old” environments may continue to leave a mark on people's dietary choices, and further shape the way in which new environments affect people's dietary change. FUNDING SOURCES: Research reported in this presentation was supported in part by the NIDDK of the NIH under Award Number R01DK115937. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Introduction: The persistence of obesity from adolescent to adult ages is associated with risk of cardiovascular disease later in life. Data from cohorts that passed through childhood before 1980 show that when obesity is first observed in youth it often persists into adulthood. However, less is known about current weight trajectories of adolescents transitioning to adulthood. We examined the changes in weight status from adolescence to adulthood and baseline predictors of normal weight in adulthood. Methods: Study used data from the National Longitudinal Study of Adolescent Health (AddHealth) (n=14,135), a nationally representative sample of adolescents recruited in 1994 and followed up in 1996, 2001, and 2008. Weight and height measurements collected at each visit were used to classify weight status; we identified 4 trajectories between mean ages 16 and 30: 1) maintained normal weight, 2) achieved normal weight, 3) gained weight to enter the obesity category, and 4)maintained overweight or obesity. Logistic regression models included individual and family characteristics. Results: Among adolescents with normal weight, 56% gained weight to enter overweight or obesity categories 14 years later. Of those with overweight at baseline, 68% gained weight to enter obesity and 8% achieved normal weight; among adolescents with obesity, 89% maintained obesity, and only 2% achieved normal weight. After controlling for sex, age, race-ethnicity, and baseline weight status, adolescents who were trying to lose weight, skipped breakfast, ate dinner with their parents, had a mother with diabetes or obesity, a father with obesity, parents with less than high-school education, or married in high-school were less likely to have normal weight as adults. Independent of baseline weight status, adolescents who reported feeling loved were more likely to have normal weight in adulthood. Conclusion: Findings shed light on individual and family factors associated with normal weight outcomes after the transition from adolescence to adulthood.

Background Asset-based indices are widely-used proxy measures of wealth in low and middle-income countries (LMIC). The stability of these indices within households over time is not known. Methods We develop a harmonized household asset index using Principal Component Analysis for the participants (n = 2392) of INCAP Longitudinal Study, Guatemala using data from six waves of follow-up over the period of 1965–2018. We estimate its cross-sectional association with parental schooling (in 1967–75) and attained schooling (in 2015–18) of cohort members. We study how patterns of cross-sectional loadings change over time and between urban-rural settings. We assess its robustness to omission of assets or study waves and alternate specifications of factor extraction procedure (exploratory factor analysis, multiple correspondence analysis). Results The harmonized index constructed using 8 assets and 11 housing characteristics explained 32.4% of the variance. Most households increased in absolute wealth over time with median wealth (25th percentile, 75th percentile; households) increasing from − 3.74 (− 4.42, − 3.07; 547) in 1967 to 2.08 (1.41, 2.67; 1145) in 2017–18. Ownership of television, electricity, quality of flooring and sanitary installation explained the largest proportion of variance. The index is positively associated with measures of schooling (maternal: r = 0.16; paternal: r = 0.10; attained: r = 0.35, all p Conclusion A temporally harmonized asset index constructed from consistently administered surveys in a cohort setting over time may allow study of associations of life-course social mobility with human capital outcomes in LMIC contexts. The approach permits exploration of trends in household wealth of the sample over a follow-up period against repeated cross-sectional surveys which permit the estimation of only the mean trajectory.

OBJECTIVE We investigated the risk of depression and anxiety in people whose spouse did or did not have diabetes. We also examined associations between depression and anxiety and severity of spouse’s diabetes. RESEARCH DESIGN AND METHODS We analyzed prospective self-reported data about diagnosed depression/anxiety and diabetes in cohabiting couples in the national Panel Study of Income Dynamics (PSID) during 1999–2017 (n = 13,500, 128,833 person-years of follow-up, median follow-up 8.1 years). We used Poisson models to estimate incidence and incidence rate ratios (IRRs) of depression/anxiety, according to spouse’s diabetes status overall and by severity of diabetes. RESULTS Age-, sex-, and race-adjusted incidence of depression/anxiety was 8.0/1,000 person-years (95% CI 6.5, 9.6) among those whose spouse had diabetes and 6.5/1,000 person-years (95% CI 6.0, 6.9) among those whose spouse did not have diabetes. Those whose spouse had diabetes had higher risk of depression/anxiety (IRR 1.24 [95% CI 1.01, 1.53]). Those whose spouse had diabetes-related limitations in daily activities (IRR 1.89 [95% CI 1.35, 2.67]) and diabetes combined with other chronic conditions (IRR 2.34 [95% CI 1.78, 3.09]) were more likely to develop depression/anxiety, while those whose spouse had diabetes with no limitations or additional chronic conditions had incidence of depression/anxiety similar to that of subjects whose spouses did not have diabetes. CONCLUSIONS People living with a spouse with diabetes are at higher risk of developing depression/anxiety than people whose spouse does not have diabetes; this risk is driven by the severity of the spouse’s diabetes. Strategies to address the impacts of diabetes on families need to be devised and tested.

Recent studies in the U.S. have shown that incidence of diagnosed diabetes decreased and prevalence plateaued after 2010 despite a modest increase in obesity prevalence. If the reduction in diabetes incidence is driven by changing obesity levels, prevalence may be an inadequate metric. Therefore, we investigated changes in prevalence and incidence of obesity and diabetes in adults in the United States during a 17 year period, 2001-2017. We analyzed adult (≥20years) anthropometric records and diabetes status (prediabetes and diabetes combined) from the U.S. national representative Panel Study of Income Dynamics, 2001-2017. We used Poisson models to estimate the prevalence biannually from 2001-2017 and incidence of obesity (cases/1000 person years, PY) over 4 periods (2001-2005; 2005-2009; 2009-2013; 2013-2017). All rates were age- and sex-adjusted; survey weights were applied. Prevalence of obesity increased from 20.9% (95% CI, 19.4-22.5) in 2001 to 26.4 (95% CI, 25.0-27.8) in 2009 to 29.5% (95% CI, 28.1-31.0) in 2017 (p The incidence of obesity changed over time: Compared to an obesity incidence of 29.3/1000 PY (95% CI, 26.0-35.5) in 2001-2005, the incidence increased to 31.7/1000 PY (95% CI,29.7-33.7) in 2005-2009, decreased to 28.8/1000 PY (26.3-31.4) in 2009-2013, and increased to 34.0/1000 PY (95% CI, 31.1-36.7) in 2013-2017 (p In contrast to other U.S. studies of diabetes incidence, our results show no decline during the 2010s. This may be explained by our findings of an increasing incidence of obesity in the same population. Disclosure J. NIelsen: None. E. Gregg: None. K. Narayan: None. S.A. Cunningham: None. Funding Independent Research Fund Denmark (DFF-7025-00053B); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024, 1R01DK115937)

Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke. Hypothesis: Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequality at the Census Tract level were obtained from the 2000 decennial census. Both variables were standardized to have a mean of 0 and a standard deviation of 1; z-score of median household income was multiplied by -1 (representing neighborhood income deprivation) to allow for comparability. Using Cox Proportional Hazards analysis we examined the risk of stroke associated with these exposures in separate models. Model 1 was unadjusted, Model 2 was adjusted for demographic characteristics (age, race, sex, marital status), and Model 3 was adjusted for individual socioeconomic characteristics (household income and education). Results: Within Model 1, neighborhood income deprivation (HR: 1.18; 95% CI 1.11-1.24) and neighborhood income inequality (HR: 1.10; 95% CI: 1.05-1.16) were both significantly associated with risk of stroke. The association persisted in Model 2: neighborhood income deprivation (HR: 1.13; 95% CI 1.07-1.20) and neighborhood income inequality (HR: 1.06; 95% CI: 1.00-1.11). Within Model 3, neighborhood income deprivation maintained its positive association (HR: 1.06; 95% CI 1.00-1.13), while neighborhood income inequality was no longer predictive of stroke risk (HR:1.04; 95% CI 0.99-1.10). Conclusions: Neighborhood income deprivation and neighborhood income inequality were similar predictors of incident stroke. The effect of absolute economic resources in a Census Tract was slightly larger than the relative economic standards within a Census Tract. There is a need to investigate other characterizations of neighborhood economic conditions, such as residential income segregation. The findings from this project suggest that there are multiple policy levels that can be used to decrease incident stroke, through decreasing income inequality and improving the absolute economic conditions of deprived neighborhoods.

Background In India, the prevalence of overweight and obesity has increased rapidly in recent decades. Given the association between overweight and obesity with many non-communicable diseases, forecasts of the future prevalence of overweight and obesity can help inform policy in a country where around one sixth of the world's population resides. Methods We used a system of multi-state life tables to forecast overweight and obesity prevalence among Indians aged 20-69 years by age, sex and urban/rural residence to 2040. We estimated the incidence and initial prevalence of overweight using nationally representative data from the National Family Health Surveys 3 and 4, and the Study on global AGEing and adult health, waves 0 and 1. We forecasted future mortality, using the Lee-Carter model fitted life tables reported by the Sample Registration System, and adjusted the mortality rates for Body Mass Index using relative risks from the literature. Results The prevalence of overweight will more than double among Indian adults aged 20-69 years between 2010 and 2040, while the prevalence of obesity will triple. Specifically, the prevalence of overweight and obesity will reach 30.5% (27.4%-34.4%) and 9.5% (5.4%-13.3%) among men, and 27.4% (24.5%-30.6%) and 13.9% (10.1%-16.9%) among women, respectively, by 2040. The largest increases in the prevalence of overweight and obesity between 2010 and 2040 is expected to be in older ages, and we found a larger relative increase in overweight and obesity in rural areas compared to urban areas. The largest relative increase in overweight and obesity prevalence was forecast to occur at older age groups. Conclusion The overall prevalence of overweight and obesity is expected to increase considerably in India by 2040, with substantial increases particularly among rural residents and older Indians. Detailed predictions of excess weight are crucial in estimating future non-communicable disease burdens and their economic impact.

Objectives The Child Health and Mortality Prevention Surveillance (CHAMPS) Network is designed to elucidate and track causes of under-5 child mortality and stillbirth in multiple sites in sub-Saharan Africa and South Asia using advanced surveillance, laboratory and pathology methods. Expert panels provide an arguable gold standard determination of underlying cause of death (CoD) on a subset of child deaths, in part through examining tissue obtained via minimally invasive tissue sampling (MITS) procedures. We consider estimating a population-level distribution of CoDs based on this sparse but precise data, in conjunction with data on subgrouping characteristics that are measured on the broader population of cases and are potentially associated with selection for MITS and with cause-specific mortality. Methods We illustrate how estimation of each underlying CoD proportion using all available data can be addressed equivalently in terms of a Horvitz-Thompson adjustment or a direct standardization, uncovering insights relevant to the designation of appropriate subgroups to adjust for non-representative sampling. Taking advantage of the functional form of the result when expressed as a multinomial distribution-based maximum likelihood estimator, we propose small-sample adjustments to Bayesian credible intervals based on Jeffreys or related weakly informative Dirichlet prior distributions. Results Our analyses of early data from CHAMPS sites in Kenya and Mozambique and accompanying simulation studies demonstrate the validity of the adjustment approach under attendant assumptions, together with marked performance improvements associated with the proposed adjusted Bayesian credible intervals. Conclusions Adjustment for non-representative sampling of those validated via gold standard diagnostic methods is a critical endeavor for epidemiologic studies like CHAMPS that seek extrapolation of CoD proportion estimates.

Objective Unhealthy weight is a major global health concern. This study examines unhealthy weight among children in Spain and the role of the home environment therein. Data are from a 2010 national survey of families with children. We examined unhealthy weight among children ages 5–10 years using the WHO Child Growth Standards and used multivariate logistic regression to assess associations with family characteristics. Results There was a high prevalence of unhealthy weight, with only 46% of children at normal weight. Both underweight and obesity were higher among boys (14%; 22%) than girls (13%; 12%). Underweight and obesity were higher among children of mothers with obesity and those with unemployed parents. Obesity was higher among children of mothers who were less educated (35%) and among children of immigrants (19%). We find high levels of unhealthy weight in children, with both underweight and obesity being predicted by the same family environment characteristics. Electronic supplementary material The online version of this article (10.1186/s13104-018-3665-2) contains supplementary material, which is available to authorized users.

Purpose: To examine associations of adolescent sugar-sweetened beverage (SSB) intake with parent SSB intake and parent and adolescent knowledge of SSB-related health risks. Design: Quantitative, cross-sectional. Setting: 2014 SummerStyles survey. Subjects: Nine hundred and ninety parent and adolescent (12-17 years) pairs. Measures: The outcome was self-reported adolescent intake (0, >0 to 0 to Analysis: Separate multinomial logistic regression models were used to estimate adjusted odds ratios (aORs) for adolescent SSB intake ≥1 time/day (ref: 0 times/day), according to (1) parent SSB intake and (2) parent and (3) adolescent knowledge. Results: About 31% of adolescents consumed SSBs ≥1 time/day, and 43.2% of parents consumed SSBs ≥2 times/day. Adolescent and parent knowledge that SSB intake is related to health conditions ranged from 60.7% to 80.4%: weight gain (75.0% and 80.4%, respectively), diabetes (60.7% and 71.4%, respectively), and dental caries (77.5% and 72.9%, respectively). In adjusted models, adolescent SSB intake ≥1 time/day was associated with parent intake ≥2 times/day (aOR = 3.30; 95% confidence interval = 1.62-6.74) but not with parent or adolescent knowledge of health risks. Conclusion: Parental SSB intake may be an important factor in understanding adolescent behavior; knowledge of SSB-related health conditions alone may not influence adolescent SSB behavior.

People socially connected with each other often share health risks, possibly due to shared environments and behaviors. In a retrospective cohort study, we examined whether incidence of diabetes was different for individuals with recently diagnosed partners compared to individuals similar on other characteristics but whose partners were never diagnosed with diabetes. We analyzed 2007–11 data from Kaiser Permanente Northern California (KNPC), an integrated health system with >3.5 million members. We estimated annual diabetes incidence controlling for demographic, socio-economic, behavioral, and health characteristics. Using propensity score matching and multivariate logistic regression, we compared odds of incident diabetes among co-residing partners ages 18–89 years of people who had been diagnosed with diabetes during the previous year (in robustness checks up to the previous three years) and people who had never been diagnosed but were similar on observed characteristics. Partners of newly-diagnosed people had annual diabetes incidence of 16.4/1,000, equivalent to10.8 times higher (95%CI: 9.2–12.6) than people whose spouses had never been diagnosed (1.5/1,000). Odds remained higher three years after a spouses’ diagnosis (45.4 vs. 11.7/1,000). Adjusting for other characteristics, odds of diabetes for those with a partner diagnosed in the previous year were 8.7 times higher CI: 7.4–10.2) than among those whose partner had never been diagnosed. Partners of persons with recently-diagnosed diabetes developed diabetes at much higher rates than partners of persons with similar characteristics who were never diagnosed with diabetes. Individuals with a recently diagnosed partner could be considered a high-risk population for screening and prevention.

The gut microbiome is a critical component of an individual’s metabolism and overall health. The prenatal period is marked by unique inflammatory and immune changes that alter maternal gut function and bacterial composition as the pregnancy advances. The composition of the maternal gut microbiome contributes to obstetric outcomes with long-term health sequelae for mother and child. Estrogen and progesterone also impact gut function, especially during the prenatal period. These physiologic changes in pregnancy allow for adjustments in maternal metabolism and weight necessary to support the pregnancy. This article will review the normal hormonal, metabolic and immunologic changes to the maternal gut microbiome throughout the prenatal period, in addition to relevant implications for nurses providing care for pregnant women.

This study uses freelists to document perceptions of healthfulness, modernity, and availability of foods and beverages among adolescents ages 13-18 years (n = 26) in urbanizing India. Among the 10 foods and beverages adolescents perceived as "new," half were also seen as modern and unhealthy, 4 as traditional and unhealthy, and 3 as modern and healthy. Of those 10 "new" foods, 4 were reported as available only in supermarkets, 4 only in kiraana (local) stores, and 6 in both. Adolescents ascribed healthfulness and modernity to food and beverage items and were aware of their availability across stores.