Courtney Coughenour

Background: The school food environment significantly influences students’ dietary habits. Adolescents consume approximately one-third to one-half of their meals at school, rendering this a critical context for interventions to improve the food environment. The off-campus food environment also plays a critical role in shaping dietary behaviors, particularly in schools with open-campus policies; greater access to fast-food restaurants and convenience stores is associated with increased consumption of energy-dense, nutrient-poor foods. This systematic review aims to synthesize literature examining associations between open-campus policies or lunch food source and dietary behaviors among high school students (at least 9th grade; aged 12 + years). Methods: In this systematic review (without meta-analysis), a comprehensive literature search was conducted using PubMed, Scopus, Agricola, and Education Full Text, following PRISMA guidelines. Inclusion criteria included: peer-reviewed quantitative studies published in English between 1990 and 2024 that assessed associations between open/closed-campus policies or lunch food source (on- or off-campus) and dietary habits, or lunch policies aimed at keeping students in school for meals and dietary habits. Data extraction was conducted, and study certainty was assessed using the Effective Public Health Practice Project tool. Results: A total of 4,747 articles were imported into Rayyan software. After removing duplicates, 3,708 article titles and abstracts were screened; 14 full-text article screens resulted in five studies that met the eligibility criteria. Two eligible studies were identified through reference list screening, bringing the total number of included studies to seven. Of the seven included studies, five employed a cross-sectional design, one used a quasi-experimental design, and one was a cohort study. Findings reveal a consistent association between open-campus policies and students acquiring lunch from external food outlets during the school day, and with less healthy dietary behaviors. Conclusions: Limitations include protocol constraints like the exclusion of gray literature, as well as limitations in the evidence base itself, which consisted of seven studies of predominantly moderate-to-weak certainty. However, overall findings underscore the potential of school lunch policies, including closed-campus models, as an intervention to mitigate the impact of unhealthy external food environments on adolescent dietary behaviors.

Previous research has shown that low income and otherwise vulnerable populations experience a disproportionate burden of heat-related illness. A heat wave event of unprecedented magnitude occurred in the summer of 2021 in western North America. In some locations, temperatures peaked 10°-20°C above maximum summer temperatures of the previous decade. We obtained gridded temperature estimates for Boise, Las Vegas, Los Angeles, Oakland, Portland, Sacramento, Salt Lake City, San Francisco, and Seattle. We aggregated average minimum and maximum heat wave temperatures and linked to social vulnerability index (SVI) scores, which are based on American Community Survey data. Within each location, we examined if census tract level vulnerability was associated with higher heat wave temperatures. Spearmans’ rank correlation coefficients showed a significant positive association between overall SVI and minimum and/or maximum temperature in all locations except Oakland and San Francisco. Of significant positive results, coefficients ranged from 0.09 to 0.61. Associations between temperature and individual SVI themes (socio-economic status, household characteristics, racial & ethnic minority status, and housing type and transportation) generally mirrored results for the overall SVI. We also evaluated local indicators of spatial association to identify spatial clustering of census tracts experiencing both high SVI and high temperatures. Significant global spatial autocorrelation was identified in all locations except Oakland and San Francisco. Our analysis found that census tracts with higher social vulnerability experienced the hottest temperatures during one of the most intense North American heat waves in recent history, further exacerbating their already elevated risk of heat-related morbidity and mortality.

Background: Diabetes disproportionately affects U.S. subgroups, yet non-Hispanic multiracial adults are underrepresented in epidemiologic studies. This study aimed to examine behavioral and sociodemographic predictors of diabetes in this population. Methods: We analyzed data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) using a cross-sectional design that incorporated survey weights, strata, and primary sampling units. Binary logistic regression was employed to identify predictors of diabetes, including variables with p ≤ 0.20 from bivariate models in the multivariable analysis. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: The study included a total of 6429 participants. Obesity (AOR = 4.16; 95% CI: 3.33, 33.23), being overweight (AOR = 2.05; 1.62, 2.60), poor general health (AOR = 2.82; 2.38, 38.35), age ≥ 65 years (AOR = 3.08; 2.60, 3.65), male sex (AOR = 1.34; 1.15, 1.58), and health insurance (AOR = 2.14; 1.35, 3.61) were associated with higher odds of diabetes. Physical activity (AOR = 0.76; 0.64, 0.90) and alcohol consumption (AOR = 0.55; 0.47, 47.65) were linked to lower odds of diabetes. Smoking status showed no significant association after adjustment. Conclusions: In non-Hispanic multiracial adults, factors such as adiposity and older age increased the risk of diabetes, while physical activity and alcohol consumption offered protective benefits. These findings indicate that current diabetes prevention strategies are applicable to this subgroup, and public health initiatives should prioritize their inclusion in outreach, screening, and intervention efforts.

The COVID-19 pandemic is a catastrophic event highlighting numerous health disparities. The social vulnerability index (SVI) has been widely utilized in COVID-19 research to assess vulnerable communities and to examine how social determinants influence various COVID-19 outcomes. This population-based study aims to determine whether COVID-19 testing and vaccination rates mediate the relationship between the SVI and COVID-19 prevalence. Mediation analysis was conducted using data from 535 census tracts in Clark County, Nevada. Findings indicate that COVID-19 testing rates were lower in areas with high SVI scores, potentially leading to more undetected cases. Moreover, COVID-19 testing, full vaccination, and follow-up vaccination rates significantly mediated the relationship between SVI and COVID-19 prevalence. These results suggest that greater location-based social vulnerability is associated with a sequential pathway of reduced testing and vaccination rates, contributing to underreported COVID-19 cases.

Background: Prior research indicates that enrolling underrepresented populations in clinical research is challenging. Although research has identified some barriers to participation and strategies to overcome them, studies have made little progress in being inclusive and representative. There remains a great need for including racial/ethnic minorities, low-income families, and pregnant women in research. The purpose of this article is to describe the implementation of enrollment strategies used in our study to understand the feasibility of building a maternal cohort and better understand the relationship between environmental and social impacts on maternal exposure and child outcomes. Methods: Working across multiple academic units, our team implemented equity-focused team science strategies to recruit diverse populations into a research study. The phases included development, conceptualization, implementation, and translation. Results: Our interdisciplinary team study used intentionality and commitment to deploy effective strategies including clearly defining the problem, selecting the correct team members to leverage expertise, clearly defining the study, establishing roles and responsibilities, representation, and clear and constant communication. A total of 100 pregnant women enrolled in our study using a team science interdisciplinary model. Discussion: Building interdisciplinary teams can help us understand complex problems, increase innovation, and develop effective solutions in policy and practice. More specifically, interdisciplinary teams can advance our ability to recruit diverse populations into research. Future studies should consider how to harness the strengths of the different research team members to achieve more inclusive participation. Health Equity Implications: This work has the potential to improve representation in research findings, enhance understanding of health disparities, and promote inclusive research practices.

Cross-sector collaboration can improve community health because decisions made across sectors influence health. Health Impact Assessments (HIAs) and other health-focused, cross-sector collaborations encounter challenges. This case study uses a completed HIA to explore factors impeding and supporting health-related cross-sectoral collaboration. Semi-structured key informant interviews with 10 of 12 HIA working group participants were conducted and analysed using a content analysis approach. Analysis generated 48 codes across seven themes in three primary groups: HIA as a collaborative tool; logistical and systemic barriers; and benefits and logistical, interpersonal, and sectoral facilitators. Recognizing the importance of knowledge, analysis, and principles outside of one's field (n = 62) was the most common facilitator. Limited time was the most common barrier (n = 21). Participants discussed more facilitators (n = 303) than barriers (n = 144); perceived multiple benefits (n = 92), including networking and connecting land use and health; and described facilitators like communication, continuity, engagement, project management, compensation, varying perspectives, and diverse skills. They identified coordination challenges, needs to engage more with stakeholders and the community, limited time, and changes among partners as primary barriers. Findings can help prepare cross-sector partners about what to expect, aid in mitigating challenges, and further knowledge about what supports and hinders Health in All Policies collaborations.

Housing insecurity is a critical issue within Southern Nevada. However, little is known about the housing-insecurity-related needs of LGBTQIA+ Southern Nevadans. The aim of this study was to identify strategies to address housing insecurity among this vulnerable community. Utilizing community-based participatory research and concept mapping, the most salient solutions were identified and prioritized at a Community Housing Forum. This Forum brought together stakeholders with expertise in housing or who work with the LGBTQIA+ community. The most important identified solutions consistently emphasized the criticality of culturally competent mental health services; the need for affordable housing options; and various social and environmental factors. There is a continued need for research and collaboration among organizations and providers to better serve LGBTQIA+ individuals experiencing housing insecurity. Additional research is needed to determine the efficacy of the identified solutions and to inform the development of context-specific and broadly applicable strategies to address housing insecurity within this community.

Background: Employment and household responsibility are critical health determinants. The COVID-19 pandemic altered the work and social landscapes in Nevada, USA through closures of workplaces and schools/childcare centers, changing patterns of employment, and household responsibilities. This study aimed to measure changes in employment status and perceived housework responsibilities among Nevada adults in December 2020, before widespread availability of COVID-19 vaccines in a pandemic-affected economy. Methods: Using a cross-sectional telephone survey of 1,000 Nevada adults, this study compared respondent experiences and perceptions of employment and time spent on housework in December 2020 to pre-pandemic using multinominal logistic, proportional odds, and logistic models. Results: 70.52% of participants experienced no employment change; roughly 24% reported being fired/laid-off, working reduced hours, or quitting. Chi-square analyses found participants of color more likely than Whites to report being fired/laid-off or working reduced hours (p-value = 0.0005), though these findings were not significant in our models. Participants in the lowest income bracket had higher odds of being fired/laid off (p-value = 0.0030), and participants aged 65+ were less likely to experience employment change (p-value<0.0001). 32.43% of participants reported more time spent on housework. Multivariate analyses showed age is significantly associated with changes in both employment status (p-value<0.0001) and housework time (p-value<0.0001); income is a significant factor for employment status change (p-value = 0.0024). Of those reporting their households spent more time on housework, females were 2.90 times (95% CI = 1.66, 5.05, p-value = 0.0002) more likely to report taking on the additional work. Conclusions: Results demonstrate a disproportionate burden in employment change and/or more perceived household responsibilities on lower income and younger respondents, and females reporting they are more likely to take on additional housework. Understanding systemic vulnerabilities related to employment status and household responsibilities is necessary to aid impacted communities and to plan for future emergencies.