Association between impulsivity and cognitive capacity decrease is mediated by smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and daytime fatigue among medical students: a path analysis.

BACKGROUND: Medical students are at high risk for sleep disturbance. One possible cause of their sleeping problem is impulsivity. We aim to investigate the possible mediators between medical students' impulsivity and sleep outcomes. Thus, we developed and investigated a model where the predictors were attentional, non-planning, and motor impulsivity subtraits. In the final model, subjective cognitive capacity decrease was the outcome variable. In light of previous findings, academic procrastination, smartphone addiction, and bedtime procrastination were considered important mediators as well as two variables of poor sleep, sleeping insufficiency, and daytime fatigue. METHODS: Medical students (N = 211; ageM = 22.15 years; ageSD = 3.47 years; 71.6% women) were recruited to complete an online survey comprised of demographics (age, gender), self-administered scales (Abbreviated Impulsiveness Scale, Bedtime Procrastination Scale, Abbreviated Impulsiveness Scale, Academic Procrastination Scale-Short Form) and questions on tiredness, daily fatigue and subjective cognitive capacity decrease. Correlation and path analyses were implemented to examine hypothesized relationships between the variables. RESULTS: Both attentional impulsivity (ß = 0.33, p < .001) and non-planning impulsivity (ß = -0.19, p < .01) had a direct relationship with cognitive capacity decrease. Attentional impulsivity was also associated with decreased cognitive capacity with a serial mediation effect via smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.017, p < .01). The indirect link between non-planning impulsivity and cognitive capacity decrease was mediated by academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.011, p < .01). CONCLUSIONS: Inability to stay focused and plan tasks effectively (directly and indirectly) predicts poor sleep outcomes. This relationship is mediated by excessive smartphone use, academic procrastination, and bedtime procrastination. Our findings are relevant in light of self-regulatory learning, which is crucial in medical education. This is a recursive cycle of planning, emotion regulation, proper strategy selection and self-monitoring. Future interventions addressing attentional and non-planning impulsivity, problematic smartphone use, academic procrastination, and in turn, bedtime procrastination might make this routine more effective. In the conclusion section, practical implications of the results are discussed.

Place Still Matters: Social Vulnerabilities, Place-Level Disadvantage, and Food Insecurity during COVID-19.

COVID-19 variants continue to create public health danger impacting mortality and morbidity across the United States. The spillover effects of COVID-19 on the economy and social institutions pose a significant threat to broader wellbeing, including the food security of millions across the country. We aim to explore whether the context of place matters above and beyond individual and social vulnerabilities for food insecurity. To do so, we employ a multi-level framework using data from a survey of over 10,000 U.S. adults from March 2020 with American Community Survey (ACS) and John Hopkins COVID Dashboard county-level data. We find nearly two in five respondents were food insecure by March of 2020 with disparities across race, nativity, the presence of children in the home, unemployment, and age. Furthermore, we note that individuals living in more disadvantaged communities were more likely to report food insecurity above and beyond individual and social vulnerabilities. Overall, food insecurity is driven by complex, multi-level dynamics that remain a pressing public health concern for the current-but also future-public health crisis.

Social Differences in Health Behaviours among Jordanian Adolescents.

Social differences are evident in both developed and developing countries. During adolescence, there are limited differences in morbidity and mortality, but differences do appear in terms of health behaviours. This study aims to examine the relationship(s) between social differences and students' health behaviours. A cross-sectional study was conducted in 2020 with a sample of high school students (N = 2741, aged 13-18 years) in Jordan. Besides descriptive statistics, bivariate logistic regression analysis was used to detect the odds risk for each social difference indicator. Females were engaged in more healthy dietary and hygienic behaviours and less engaged in smoking. Males were more physically active. Adolescents with a higher parental education level were more engaged in healthy behaviours; however, they drank carbonated soft drinks and ate fast food more often. Higher SES (socioeconomic status) self-evaluation was positively associated with eating breakfast and fruit and vegetables, being physically active, drinking carbonated soft drinks, eating fast food, and smoking. Our findings suggest that socioeconomic differences are important to understanding Jordanian adolescents' health behaviours. While females tend to engage in more healthy behaviours, the role of parental education and perceived family affluence is not always beneficial in terms of adolescents' dietary habits, hygienic behaviour, or smoking.

Relationships Among Depression, Online Self-Disclosure, Social Media Addiction, and Other Psychological Variables Among Hungarian University Students.

ABSTRACT: In the digital age, besides the well-known contributors to depression, more research is needed on certain activities of social media, such as online self-disclosure. Using an online survey, we examine the associations of depression with social media addiction, online self-disclosure, loneliness, and life satisfaction among a sample of Hungarian university students ( N = 301, aged between 18 and 30 years). There were no sex differences in depression scores. Findings showed the following: a) lonely students; b) those less satisfied with their lives; c) those sharing negative information; and d) those that engage in deep self-disclosure are more likely to report depressive symptomatology. Although social media addiction was a correlate of depression in bivariate analyses, it became nonsignificant when online self-disclosure and other psychological variables were introduced to the model. A more careful accounting of these relationships is needed to more wisely use social media when disclosing information about ourselves.

Social and behavioral vulnerability, pregnancy, and negative mental health outcomes in the U.S. during the Covid-19 pandemic.

The novel coronavirus (Covid-19) pandemic has had a significant impact on the mental health of the general U.S. population. Extant literature has increasingly linked social vulnerabilities, risky behavior, and limited social and psychological resources to the growing mental health crisis during the virus's spread. The purpose of this study was to examine the impact of pertinent social vulnerabilities and subjective risk factors for both men and women on mental health (i.e., depression, anxiety, isolation) with a closer examination of the influence of pregnancy during the pandemic on mental health. The sample included 740,640 respondents participating in the U.S. Covid-19 Trends and Impact Survey that was deployed between February and March 2021. Descriptive statistics and ordinary least squares regression models are presented with a focus on the factors that shape negative mental health outcomes, particularly on the disparities between pregnant and non-pregnant women relative to men, but also subjective/perception factors (e.g., fear/worry) and social vulnerabilities. Results show that pregnant women were at significantly greater risk of negative mental health outcomes at this stage of the pandemic than either men or non-pregnant women. Overall, respondents who were younger, without children in the household, unemployed, worried generally about infection or their finances, or had ever tested positive for Covid were also more likely to report feelings of anxiety, isolation, and depression than their counterparts. Pregnant women may be especially vulnerable to depression, anxiety, and isolation during the pandemic and our findings suggest the importance of developing targeted mental health support for this sub-population.

A sex-stratified multiple regression on Jordanian adolescents' life satisfaction using different elements of school climate.

BACKGROUND: School climate is one of several important factors influencing adolescent well-being and life satisfaction. Although a growing number of studies investigate the role of school climate, they often apply a global scale and only a few of them measure any specific elements. Likewise, most studies are focused on well-being and not life satisfaction. AIM: The purpose of this study is to investigate how different elements of school climate (teacher responsiveness, disruptive behavior, positive mutual bonds, classroom atmosphere, growth) are related to life satisfaction among a sample of Jordanian high school students. METHODS: Using a self-administered and online questionnaire, the sample consists of adolescents from public schools located in northern Jordan (N = 2141, aged 13-18 years). RESULTS: Jordanian high school students' levels of life satisfaction were higher for girls [t(2139) = -8.2, p < .001]. Disruptive behavior correlated negatively with classroom atmosphere (r = -0.50; p < .001 among girls and r = -0.45; p < .001 for boys); teacher responsiveness was positively correlated with growth (r = 0.49; p < .001 for girls and r = 0.61; p < .001 for boys). However, the role of disruptive behavior was different for girls (negative) compared to boys (positive), although these correlations were weak. In multiple regression analyses, teacher responsiveness (ß = 0.22; p < .001) and positive mutual bonds (ß = 0.19; p < .001) were largest contributors to life satisfaction beyond self-assessed socioeconomic status (ß = 0.27; p < .001). Age (ß = -0.08; p < .01) and growth (ß = 0.27; p < .001) were significant only for boys. CONCLUSIONS: These results demonstrate the importance of examining different elements of school climate in an effort to better understand adolescents' life satisfaction. Certain gender differences may highlight differences in social needs across different classroom settings which require further investigation.

Post-traumatic stress symptomatology and displacement among Hurricane Harvey survivors.

Exposure to natural disasters predisposes individuals to significant physical and mental health consequences. Research identifies a number of stressors important to determining what might exacerbate this exposure risk, as well as what types of social/psychological resources might help mitigate these negative outcomes. Using a targeted quota sample of adults (n = 316) interviewed two months after Hurricane Harvey made landfall on the Gulf Coast of Texas in August 2017, the present study examines the intersection of vulnerabilities, stressors, and resources and their relationship with post-traumatic stress symptomatology. Stress is high among this sampled group with over one-quarter of respondents reporting high enough symptoms to meet the clinical caseness criteria for PTSD. Results show significant variation across categorical groupings of post-traumatic stress symptoms; younger persons, nonwhites, and those displaced from their home during the storm were more likely to be found in the highest symptom count category. Regression results confirm the bivariate results and as hypothesized, stressors were associated with higher symptom reporting among respondents, and social and psychological resources were associated with lower symptom reporting. With one of the only studies to report these relationships between vulnerability, stressors, and resources in the post-disaster Harvey setting, our work underscores the importance of identifying who is at risk, what factors can potentially mitigate that risk, and just how severe the consequences can be for survivors requiring mental health services after a disaster. Clearly, more work is needed, particularly on the identification of resources acting as protection against the overwhelming circumstances of exposure to devastation and destruction caused by natural disasters.

Race and ethnicity, gender, and age on perceived threats and fear of COVID-19: Evidence from two national data sources.

Previous studies find preventative behaviors designed to reduce the number of infections during emerging disease outbreaks are associated with perceived risk of disease susceptibility. Few studies have attempted to identify underlying factors that explain differences in perceptions of risk during an infectious disease outbreak. Drawing from two early waves of American Trends Panel (n=7,441), as well as a National Science Foundation funded, Qualtrics national panel survey from the early stages of the pandemic (n=10,368), we test whether race and ethnicity, gender, and age were associated with six perceived threat and fear outcomes related to COVID-19. Results demonstrate race and ethnicity, gender, and age play a significant role in shaping threat and fear perceptions of COVID-19, but depending on the outcome, relationships vary in direction and magnitude. In some cases, historically marginalized racial and ethnic groups were more likely to report high fear and perceive coronavirus as a major threat to population and individual health, whereas, in others cases, the same marginalized racial and ethnic groups were less likely to perceive coronavirus to be a serious threat to the immune-comprised and the elderly population. We also find women were generally more likely to report high levels of threat and fear of COVID-19. Finally, we observe a clear age difference, whereby adults in older age groups report high-risk perceptions of COVID-19. Findings can inform public health programs designed to educate communities on the benefits of engaging in effective preventative practices during emerging infectious disease outbreaks.

Homeless and hungry: food insecurity in the land of plenty.

Homelessness continues to challenge service providers in the United States where 600,000+ individuals are without their own place to stay on any given night. With significant barriers preventing access to food, homeless persons remain at risk for experiencing long-term food insecurity. As such, the primary intent of this paper was to examine specific hypotheses that explored the impact of both risks/stressors and resources on the reported food insecurity among homeless adults. Using a stratified quota sample, data were collected from homeless adults residing in two counties in Northwest Arkansas. One hundred and sixty-eight face-to-face interviews were conducted with homeless persons living in sheltered and unsheltered environments. We found a strong positive association with persons who had been arrested and reported food insecurity; anxiety symptoms and physical health symptoms were both positively related to food insecurity. Additionally, there were significant resources (access to medical services, and community connectedness) that were negatively related to food insecurity among homeless adults. Findings are discussed in the context of how important it is for service providers to have a clear picture of the health and well-being of their clientele, particularly as they work towards minimizing service disruption and maximizing client access to sustainable food sources.

Food Insecurity in the Post-Hurricane Harvey Setting: Risks and Resources in the Midst of Uncertainty.

Food insecurity is of heightened concern during and after natural disasters; higher prevalence is typically reported in post-disaster settings. The current study examines food insecurity prevalence and specific risk/resource variables that may act as barriers or advantages in accessing food in such a setting. Using a modified quota sample (n = 316), Hurricane Harvey survivors participated in face-to-face interviews and/or online surveys that assessed health, social and household factors, and sociodemographic characteristics. Using logistic regression analyses we find that social vulnerabilities, circumstantial risk, and social and psychological resources are important in determining the odds of food insecurity. Hispanic and/or Nonwhite survivors, renters, and those persons displaced during the natural disaster have higher food insecurity odds. Survivors with stronger social ties, higher levels of mastery, and a greater sense of connectedness to their community are found to have lower food insecurity odds. A more nuanced analysis of circumstantial risk finds that while the independent effects of displacement and home ownership are important, so too is the intersection of these two factors, with displaced-renters experiencing significantly higher odds than any other residence and displacement combinations, and particularly those who are homeowners not displaced during the disaster. Strategies for addressing differential risks, as well as practical approaches for implementation and education programming related to disaster recovery, are discussed.

Suicide ideation and a post-disaster assessment of risk and protective factors among Hurricane Harvey survivors.

BACKGROUND: Previous studies have documented evidence of increased suicidality after natural disasters. While there is some disagreement about when and how long mental health consequences are sustained in the post-disaster setting, it is nevertheless an important outcome requiring further examination. METHOD: In the present study, a sample of Hurricane Harvey survivors (n=316) were interviewed over a three-month period beginning in October 2017, two months after a Category 4 hurricane devastated the Texas Gulf Coast. Using logistic regression, the analysis examines sociodemographic vulnerabilities, as well as individual risks that potentially exacerbate and protections that mitigate the odds of suicide ideation among survivors. RESULTS: Approximately 10 percent of the sampled survivors reported suicide ideation post-Hurricane Harvey. Females, persons with elevated symptoms of post-traumatic stress symptoms, persons reporting moderate to high levels of food insecurity, and those with previous mental health issues were related to higher odds in reported suicide ideation. We examined a number of protective factors and religious social capital and optimism were both negative and statistically significant (p < 0.05) and related to lower odds of suicide ideation. CONCLUSIONS: To our knowledge, these findings are the first to come out of the Hurricane Harvey disaster zone, specifically focusing on suicide ideation. Mental health professionals need to continue to be sensitive to the nuance of disaster impact on the psychological functioning of survivors, with potential negative mental health symptoms persisting 6 to 12 months after a natural disaster event.

Facing new fears during the COVID-19 pandemic: The State of America's mental health.

OBJECTIVE: COVID-19 is rearranging our society with fear and worry about the novel coronavirus impacting the mental health of Americans. The current study examines the intersection of COVID-19 fear, worries and perceived threat with social vulnerabilities and mental health consequences, namely anxiety and depressive symptomatology. METHODS: Using an online platform, a national sample (n = 10, 368) of U.S. adults was surveyed during the week of March 23, 2020. The sample was post-strata weighted to ensure adequate representation of the U.S. population based on population estimates for gender, race/ethnicity, income, age, and geography. RESULTS: Fear and worry are not distributed equally across the country; rather they are concentrated in places where the largest number of confirmed COVID-19 cases is found. Additionally, data highlight significant differences in the subjective perception of distress across groups with varying social vulnerabilities. Women, Hispanics, Asians, families with children under 18, and foreign-born respondents reported higher levels of subjective fear and worry compared to their counterparts. Finally, even after controlling for social vulnerability, subjective assessments of distress were positive, and significantly related to anxiety and depressive symptomatology; prior mental health research from China and Europe confirm what others have begun to document in the United States. CONCLUSIONS: This preliminary work provides practitioners with a glimpse of what lies ahead, which individuals and communities may be the most vulnerable, and what types of strategic interventions might help to address a wide range of mental health consequences for Americans in the months and years ahead.

Living in the midst of fear: Depressive symptomatology among US adults during the COVID-19 pandemic.

BACKGROUND: The current study examines interrelationships between social vulnerability, individual stressors, social and psychological resources, and depressive symptomatology among US adults during the current coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using an online survey platform, a poststratified (by age, gender, race, income, and geography), representative sample (n = 10,368 adults) is used in the analysis. RESULTS: On average, sample respondents report Center for Epidemiological Studies Depression (CES-D) Scale symptomatology nearly a point higher than the often used cutoff score for clinical caseness (16+); one-third of respondents had CES-D scores higher than 25. Multiple regression results show elevated levels of depressive symptomatology among the socially vulnerable (women, Hispanic, unmarried, not working). Those persons expressing heightened COVID-19 fear and moderate to high levels of food insecurity report more depressive symptoms than persons with less fear and low or no food insecurity. All three of the resource variables (mastery of fate, strength of ties, and optimism) are significant and in the negative direction. CONCLUSIONS: In a snapshot, the data provide an important point prevalence assessment of adult depressive symptoms during the current public health crisis. Results highlight the significance of vulnerability and individual stressors in the wake of the COVID-19 pandemic. In addition, the analysis affirms the importance of access to social and psychological resources to combat heightened fear and anxiety that persons report during the current pandemic.

How bad is it? Suicidality in the middle of the COVID-19 pandemic.

OBJECTIVE: The current paper examines the intersection between social vulnerability, individual risk, and social/psychological resources with adult suicidality during the COVID-19 pandemic. METHOD: Data come from a national sample (n = 10,368) of U.S. adults. Using an online platform, information was gathered during the third week of March 2020, and post-stratification weighted to proportionally represent the U.S. population in terms of age, gender, race/ethnicity, income, and geography. RESULTS: Nearly 15 percent of sampled respondents were categorized as high risk, scoring 7+ on the Suicide Behaviors Questionnaire-Revised (SBQ-R). This level of risk varied across social vulnerability groupings: Blacks, Native Americans, Hispanics, families with children, unmarried, and younger respondents reported higher SBQ-R scores than their counterparts (p < .000). Regression results confirm these bivariate differences and also reveal that risk factors (food insecurity, physical symptoms, and CES-D symptomatology) are positive and significantly related to suicidality (p < .000). Additionally, resource measures are significant and negatively related to suicidality (p < .000). CONCLUSIONS: These results provide some insight on the impact COVID-19 is having on the general U.S. POPULATION: Practitioners should be prepared for what will likely be a significant mental health fall-out in the months and years ahead.

Fear of COVID-19 and the mental health consequences in America.

The intent of this work was to examine the intersection of COVID-19 fear with social vulnerabilities and mental health consequences among adults living in the United States. Data are from a nationally representative sample (n = 10,368) of U.S. adults surveyed online during demographic subgroups (gender, age, income, race and ethnicity, geography). The sample week of March 23, 2020. The sample was poststratification weighted to ensure a balanced representation across social and demographic subgroups (gender, age, income, race or ethnicity, geography). The sample comprised 51% female; 23% non-White; 18% Hispanic; 25% of households with children under 18 years of age; 55% unmarried; and nearly 20% unemployed, laid off, or furloughed at the time of the interview. Respondents were fearful, averaging a score of nearly 7 on a scale of 10 when asked how fearful they were of COVID-19. Preliminary analysis suggests clear spatial diffusion of COVID-19 fear. Fear appears to be concentrated in regions with the highest reported COVID-19 cases. Significant differences across several U.S. census regions are noted (p < .01). Additionally, significant bivariate relationships were found between socially vulnerable respondents (female, Asians, Hispanic, foreign-born, families with children) and fear, as well as with mental health consequences (anxiety and depressive symptoms). Depressive symptoms, on average, were high (16+ on the Center for Epidemiologic Studies Depression scale), and more than 25% of the sample reported moderate to severe anxiety symptoms. More in-depth psychosocial research is needed using nationally representative samples that can help to inform potential mental health risks, as well as by targeting specific mental health interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Chronic Disease, the Built Environment, and Unequal Health Risks in the 500 Largest U.S. Cities.

Health is increasingly subject to the complex interplay between the built environment, population composition, and the structured inequity in access to health-related resources across communities. The primary objective of this paper was to examine cardiometabolic disease (diabetes, cardiovascular diseases, stroke) markers and their prevalence across relatively small geographic units in the 500 largest cities in the United States. Using data from the American Community Survey and the 500 Cities Project, the current study examined cardiometabolic diseases across 27,000+ census tracts in the 500 largest cities in the United States. Earlier works clearly show cardiometabolic diseases are not randomly distributed across the geography of the U.S., but rather concentrated primarily in Southern and Eastern regions of the U.S. Our results confirm that chronic disease is correlated with social and built environment factors. Specifically, racial concentration (%, Black), age concentration (% 65+), housing stock age, median home value, structural inequality (Gini index), and weight status (% overweight/obese) were consistent correlates (p < 0.01) of cardiometabolic diseases in the sample of census tracts. The paper examines policy-related features of the built and social environment and how they might play a role in shaping the health and well-being of America's metropolises.

Adolescent food insecurity: the special case of Marshallese youth in north-west Arkansas, USA.

OBJECTIVE: Food insecurity is not randomly dispersed throughout the population; rather, there are a number of risk and protective factors shaping both the prevalence and severity of food insecurity across households and sociodemographic populations. The present study examines some of these factors and the role that race and ethnicity among adolescent individuals in north-west Arkansas might play, paying specific attention to a subgroup of Pacific Islanders: the Marshallese. DESIGN: The study uses cross-sectional survey data collected from a self-administered questionnaire of 10th-12th grade students. SETTING: A city in north-west Arkansas, USA. PARTICIPANTS: The number of enrolled students in the selected high school at the time of the survey was 2148. Ten classrooms (116 students) were unable to participate at the time of the survey, making 2032 students eligible to be surveyed. Approximately 22% refused to participate and 105 students were absent from school, yielding a response rate of approximately 78% (n 1493). RESULTS: Marshallese students had a higher prevalence of food insecurity than all other racial and ethnic groups in the study. After controlling for other sociodemographic, risk and protective factors, their odds of food insecurity remained significantly higher than both non-Hispanic White and Hispanic or Latinx students. CONCLUSIONS: Adolescent food insecurity among Marshallese students must be made sense of in relation to structural-level determinants that shape the distribution of vital resources such as food across racial, ethnic and foreign-born lines.

Adolescents' attitudes towards healthy eating: The role of self-control, motives and self-risk perception.

BACKGROUND: Adolescence is a critical stage in life course development. It is a particularly relevant stage regarding our understanding of eating behaviors since adolescent's evolving, more autonomous food preferences tend to be influenced by peers and media as much if not more than the family. Therefore, exploring adolescent's eating preferences could be an important focus to developing prevention programs. AIMS: To explore the role of psychological variables (namely, self-risk perception, self-control and eating motivations) and their relationships with healthy eating attitudes. METHODS: A sample of adolescents (Szeged, Hungary, N = 274, ages 14-19 years; mean age = 15.95 years, S.D. = 1.17 years; 54% males) was recruited to participate in the study. Data were collected from self-administered/anonymous questionnaires. Besides descriptive statistics, correlations and a path analysis were applied to examine the relationships between self-control, self-risk perception, eating motivations and healthy eating attitudes. RESULTS: Self-control played a decisive role, both directly and indirectly in healthy eating attitudes, while self-risk-perception had a less important mediating role. Eating motives were directly related to eating attitudes but in a different way: health motives were positively associated with healthy eating attitudes, while social and external motives had a negative relationship. CONCLUSIONS: The path analysis suggests that self-control indeed plays an important role in developing healthy attitudes. While health motives play a more decisive role in health-related attitudes than we might expect, self-risk perception plays a limited role perhaps due to the notion that adolescents typically present a feeling of invulnerability. These findings suggest that despite their diminished self-risk perception, adolescents tend to be health conscious in nutrition, particularly when it combines with the underlying impact of self-control and health motives.

Examining food insecurity among high school students: A risks and resources model.

Food insecurity is associated with several negative health outcomes, many of which can be detrimental to youth during the vulnerable life stage of adolescence. Among a sample of 1493 high school students, the current study utilizes a risks and resources model to examine ways that risks and resources come together to shape the lives and health of youth, making them more vulnerable or shielding them from food insecurity and its related negative health outcomes. A number of factors are proposed as important correlates of food insecurity measured at four perceived levels of aggregation: individual, family, school/peer, and community. These risks and resources are analyzed using a three-step ordinal regression model. Analyses reveal depression, intact family, student risk, and neighborhood risk are positively related to food insecurity, despite significant sociodemographic differences. In addition, self-esteem, eating meals with family, and peer social capital are all significant and negatively related to food insecurity. Collectively, these findings tell an important story about adolescent food insecurity and the relationships that social and psychological circumstances have with varying levels of food insecurity. This study highlights the importance of children and adolescents as reliable respondents and spokespersons of their own experiences with food insecurity.

Obesity and place: Chronic disease in the 500 largest U.S. cities.

OBJECTIVES: Extant research clearly points to a correlation between place and health, specifically as it pertains to chronic diseases like obesity. The present study examines this relationship among a diverse set of compositional place indicators and obesity rates across census tracts in the 500 largest cities in the United States. METHODS: Using data compiled from the Robert Wood Johnson Foundation 500 Cities project and the Census' American Community Survey, the analyses examined aggregate relationships between sociodemographic, socioeconomic, and housing characteristics of census tracts and crude prevalence obesity rates in over 27,000 census tracts located in the 500 largest cities in the United States. RESULTS: Multivariate analysis confirms the place-chronic health connection. Regardless of variable groups, deteriorating places with higher concentrations of low-income, minority populations reported more obesity prevalence. CONCLUSIONS: Place matters. The continuing burden of zip code in the United States for disenfranchised populations will likely continue to force policymakers to examine the role that place-based prevention and place-focused medical care plays in the future health and well-being of U.S. residents.