April 2021

New Resources Added to the Catalogue of Surveillance Systems

NCCOR recently added eight new entries to the Catalogue of Surveillance Systems. The Catalogue offers one-stop access to more than 100 publicly available datasets relevant to childhood obesity research. NCCOR recently added eight new entries to the Catalogue:

• American Housing Survey
• Pregnancy Risk Assessment Monitoring System
• WIC Participants and Characteristics Report
• WIC Infant and Toddler Feeding Practices Study
• School Nutrition and Meal Cost Study
• SNAP Policy Database
• Linked HUD Administrative Data for the National Health and Nutrition Examination Survey and the National Health Interview Survey

These additions build on the Catalogue’s history of compiling national, state, and local data in one easy-to-access resource for researchers and program developers. For example, researchers studying food assistance may select data from the WIC Participants and Characteristics Report, the WIC Infant and Toddler Feeding Practices Study, and the SNAP Policy Database. A study investigating the links between housing, health, and obesity could use the American Housing Survey and the HUD linked surveys to examine the health of people who live in HUD-assisted housing. The Catalogue’s diverse content provides a unique window on obesity-related environmental factors and policies, as well as trends in relevant determinants, health behaviors, and outcomes.

Learn how to make the most of the Catalogue’s new and existing content. NCCOR offers a factsheet, a case study, and a demonstration video to help guide users. We also welcome feedback about the Catalogue and regularly update it based on user recommendations. Visit the NCCOR website to submit a surveillance system for inclusion in the Catalogue, suggest an update to an existing profile, or provide general feedback.

Have you used the Catalogue before? Tell us how, and you could be featured in our next case study!

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NCCOR Toolbox

NCCOR toolbox: Learn more about A Guide to Methods for Assessing Childhood Obesity with this new, short video! The video provides an overview of the resource—developed in 2020—to help researchers, public health practitioners, clinicians, or any professional or student with an interest in researching or evaluating weight-related outcomes in selecting the most appropriate method of measuring adiposity in children.

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Children’s Access to Healthy Food Suffers When Child Care Programs Close Their Doors

Child care is a critical part of the fabric of our society—it supports children’s healthy development and supports their parents and caregivers by enabling them to engage fully in the workforce. Children in child care arrangements receive a range of essential services. Access to nutritious food and the opportunity to establish healthy eating habits at a young age are some of the most fundamental supports provided by child care programs.

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Is Obesity a Manifestation of Systemic Racism? A Ten‐Point Strategy for Study and Intervention

March 6, 2021, Journal of Internal Medicine

Abstract:

In the recent past, there has been rising attention to systemic racism. The ensuing discussions have largely focused on COVID‐19 and policing. Despite long‐standing disparities in obesity across racial and ethnic groups and obesity’s important role in COVID‐19 disparities, there has been minimal attention to whether obesity itself could be a manifestation of systemic racism. Nor has there been serious policy attention dedicated to alleviating obesity and its disproportionate burden on BIPOC (Black, Indigenous, and People of Color). We discuss whether obesity’s disproportionate harms to BIPOC may be attributed to systemic racism, and we provide a ten‐point strategy for studying and solving the core public health issues at the intersection of obesity and systemic racism.

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The Amount of Time Children Spend Watching Screens Influences Their Eating Habits

April 13, 2021, EurekAlert!

The time children and adolescents spend on screen time entertainment -computers, mobile phones, television and video games- adversely affects their eating habits. This is the main conclusion drawn from a research carried out by EpiPHAAN (Epidemiology, Physical Activity, Accelerometry and Nutrition) research group of the University of Malaga, which further establishes that parents’ education level is also associated with the adherence to the Mediterranean diet.

This research was conducted within the PASOS Study -Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth- of Gasol Foundation, which analyzed more than 3800 children and adolescents, aged 8 to 16, from 245 schools from all over Spain, in order to assess the level of physical activity, sedentarism, lifestyles and obesity in Spanish youth and their families.

“The Mediterranean diet is one of the most complete, balanced and healthy diets, as it prevents obesity and represents a life assurance against cardiovascular diseases”, explains Julia Wärnberg, researcher of the University of Malaga, Nutrition expert, and main author of this study, which has been published in Journal of Clinical Medicine.

This study evidences that in children and adolescents a greater amount of screen time is associated with a lower consumption of fruit, vegetables, legumes, fish and nuts -the foundations of the Mediterranean diet- and a greater consumption of sweets, candies and fast food.

According to the experts, it is important for children and adolescents to follow the Mediterranean diet to maintain good eating habits, reduce the probability of childhood and adolescent obesity and enhance their health in adulthood. “It is essential to promote this dietary pattern, as well as its related lifestyle habits, such as physical activity and reduced sedentary behavior”, remarks the researcher of the UMA.

Likewise, the scientists evidenced that low parent education level influences the adoption of worse lifestyles among children and adolescents, including poor diets, as well as little knowledge of nutrition and awareness about nutritional aspects.

‘Screen Time and Parents’ Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study’ was conducted by 28 researchers of PASOS from more than ten R&D&I groups. The scientists of the UMA Javier Barón, Juan Carlos Benavente and Napoleón Pérez Farinós are other members of EpiPHAAN who authored this study.

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Prevalence of Self-Reported Intake of Sugar-Sweetened Beverages Among US Adults in 50 States and the District of Columbia, 2010 and 2015

April 15, 2021, Preventing Chronic Disease

Abstract:

Frequent intake of sugar-sweetened beverages (SSBs) is associated with adverse health outcomes, including obesity, type 2 diabetes, and cardiovascular disease. We used combined data from the 2010 and 2015 National Health Interview Survey to examine the prevalence of SSB intake among US adults in all 50 states and the District of Columbia. Approximately two-thirds of adults reported consuming SSBs at least daily, including more than 7 in 10 adults in Hawaii, Arkansas, Wyoming, South Dakota, Connecticut, and South Carolina, with significant differences in sociodemographic characteristics. Efforts to decrease SSB consumption could consider the sociodemographic and geographic differences in SSB intake when designing equitable interventions.

Objective:

Sugar-sweetened beverages (SSBs) are a leading source of added sugars in the US diet and are associated with obesity, type 2 diabetes, heart disease, kidney disease, nonalcoholic fatty liver disease, and tooth decay (1–4). SSBs, which are sweetened with various forms of added sugars, include regular soda, sweetened fruit drinks, sports/energy drinks, and sweetened coffee/tea drinks (5). Previous studies reported geographic differences in SSB intake (6–8). However, no study has reported SSB intake for every state. We assessed the prevalence of SSB intake among US adults by sociodemographic characteristics for all 50 states and the District of Columbia by using National Health Interview Survey (NHIS) data.

Methods:

NHIS is a nationally representative, cross-sectional household survey conducted by the National Center for Health Statistics (NCHS) that uses in-person interviews. The Cancer Control Supplement (CCS), which contains dietary intake information, was administered both in 2010 and in 2015 and was approved by the NCHS Research Ethics Review Board. We used nationally weighted data from combined 2010 and 2015 NHIS CCS to examine the prevalence of consuming SSBs 1 or more times daily among 56,260 US adults aged 18 or older. Data were combined to increase the sample size and reduce the variability associated with state estimates. This study required the use of restricted NHIS files for state estimates and categorizing metropolitan status available through the NCHS Research Data Center. SSB intake was based on survey respondents’ answers to 4 questions asking about intake frequency over the past month of regular soda, sweetened fruit drinks, sports/energy drinks, and sweetened coffee/tea drinks (9,10). Sweetened fruit drinks and sweetened coffee/tea drinks included drinks that were presweetened in addition to drinks that were sweetened at home by adding sugar. Adults responded with intake frequency per day, week, or month for each beverage type. Weekly and monthly intake frequency for each type of beverage was converted to daily intake frequency by dividing by 7 or 30, respectively. To calculate frequency of total daily SSB intake, we summed responses from intake of regular soda, sweetened fruit drinks, sports/energy drinks, and sweetened coffee/tea drinks. SSB categories and frequency cutoff of once per day were used, consistent with previous studies (6,7). Differences in respondent characteristics were assessed by χ² tests (P < .05). Prevalence estimates were calculated for SSB categories and by state for all 50 states and the District of Columbia. Analyses were conducted with SAS-callable SUDAAN, version 9.0 (RTI) to account for a complex survey design and sampling weights.

Results:

Overall, 63.0% of US adults reported consuming SSBs 1 or more times daily in combined 2010 and 2015 NHIS CCS data (Table 1). US adults reported consuming the following 1 or more times daily, by beverage type: sweetened coffee/tea drinks, 39.5%; regular soda, 19.5%; fruit drinks, 5.7%; and sports/energy drinks, 5.5%. Among sociodemographic categories with significant differences overall, the prevalence of SSB intake was highest among adults aged 18 to 24 (65.0%) and 25 to 39 (65.4%), men (66.1%), Hispanic respondents (70.1%), people with less than a high school education (69.8%), people with an annual household income less than $35,000 (66.0%), people residing in nonmetropolitan areas (65.0%), and people residing in the Northeast census region (67.0%). The prevalence of SSB intake did not significantly differ by marital status.

By state, SSB intake of 1 or more times daily ranged from 44.5% in Alaska to 76.4% in Hawaii. These 6 states had a prevalence of daily SSB intake of 70.0% or more: Hawaii (76.4%), Arkansas (74.2%), Wyoming (73.2%), South Dakota (72.5%), Connecticut (72.2%), and South Carolina (70.2%). Only 1 state, Alaska (44.5%), had a daily intake prevalence below 50.0% (Table 2). Most states had a daily intake prevalence between 50.0% and 70.0% (Figure).

Discussion:

Daily SSB intake is common among US adults and is particularly high in some states and among some populations. The prevalence in our study was higher than in the 2017 Behavioral Risk Factor Surveillance System (BRFSS) survey (8). This discrepancy may be explained by differences in the types of SSBs assessed, modes of survey administration, methods of collecting dietary intake data, and representativeness. Previous NHIS, NHANES (National Health and Nutrition Examination Survey), and BRFSS data also showed that SSB consumption is higher among young adults, men, adult in nonmetropolitan counties, and people with low levels of education (6–8,11).

The prevalence of SSB consumption in previous studies was high in the Northeast (7) and in southern states (6), consistent with our study’s findings. The high northeastern prevalence may be due to high consumption of sweetened coffee or tea drinks (7). Data from the 2017 BRFSS survey (8) for 12 states, and data from the 2013 BRFSS survey (6) for 23 states also revealed state-specific differences in SSB intake. Reasons for state differences may reflect demographic differences. States and communities may also differ in SSB marketing (12), pricing, and access to alternatives.

Our study has several limitations, including self-reported information, assessment of intake frequency without volume or amount of SSBs, age of the data, and combination of data. Declines in SSB intake have occurred over time (13). Combining data may mask changes in prevalence in the study period. Regardless, ours is the first study to our knowledge to examine SSB intake frequency for all 50 states and the District of Columbia by using a nationally representative sample of US adults. Our findings highlight that prevalence of daily SSB intake remains high among US adults, with sociodemographic and geographic differences. Efforts to decrease SSB intake could consider the higher intake prevalence in sociodemographic and geographic subpopulations to aid design and targeting of equitable interventions.

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Contribution of Prepregnancy Obesity to Racial and Ethnic Disparities in Severe Maternal Morbidity

May 2021, Obstetrics and Gynecology

Objective: 

To evaluate the role of prepregnancy obesity as a mediator in the association between race–ethnicity and severe maternal morbidity.

Methods: 

We conducted an analysis on a population-based retrospective cohort study using 2010–2014 birth records linked with hospital discharge data in New York City. A multivariable logistic regression mediation model on a subgroup of the sample consisting of normal-weight and obese women (n=409,021) calculated the mediation effect of obesity in the association between maternal race–ethnicity and severe maternal morbidity, and the residual effect not mediated by obesity. A sensitivity analysis was conducted excluding the severe maternal morbidity cases due to blood transfusion.

Results: 

Among 591,455 live births, we identified 15,158 cases of severe maternal morbidity (256.3/10,000 deliveries). The severe maternal morbidity rate among obese women was higher than that of normal-weight women (342 vs 216/10,000 deliveries). Black women had a severe maternal morbidity rate nearly three times higher than White women (420 vs 146/10,000 deliveries) and the severe maternal morbidity rate among Latinas was nearly twice that of White women (285/10,000 deliveries). Among women with normal or obese body mass index (BMI) only (n=409,021), Black race was strongly associated with severe maternal morbidity (adjusted odds ratio [aOR] 3.02, 95% CI 2.88–3.17) but the obesity-mediated effect represented only 3.2% of the total association (aOR 1.03, 95% CI 1.02–1.05). Latina ethnicity was also associated with severe maternal morbidity (aOR 2.01, 95% CI 1.90–2.12) and the obesity-mediated effect was similarly small: 3.4% of the total association (aOR 1.02, 95% CI 1.01–1.03). In a sensitivity analysis excluding blood transfusion, severe maternal morbidity cases found a higher mediation effect of obesity in the association with Black race and Latina ethnicity (15.3% and 15.2% of the total association, respectively).

Conclusion: 

Our findings indicate that prepregnancy obesity, a modifiable factor, is a limited driver of racial–ethnic disparities in overall severe maternal morbidity.

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