Lack of Association Between Pandemic School Mode Policy and Pediatric Body Mass Index Percentile Over Time.

During the 2020-2021 academic year, schools across the country were closed for prolonged periods. Prior research suggests that children tend to gain more weight during times of extended school closures, such as summer vacation; however, little is known about the impact of school learning mode on changes. Thus, the aim of this study was to measure the association between school mode (in-person, hybrid, remote) and pediatric body mass index (BMI) percentile increases over time. In this longitudinal, statewide retrospective cohort study in Massachusetts, we found that BMI percentile increased in elementary and middle school students in all learning modes, and that increases slowed but did not reverse following the statewide reopening. Body mass percentile increases were highest in elementary school aged children. Hispanic ethnicity and receipt of Medicaid insurance were also associated with increases. Additional research is needed to identify strategies to combat pediatric body mass percentile increases and to address disparities.

The impact of school opening model on SARS-CoV-2 community incidence and mortality.

The role that traditional and hybrid in-person schooling modes contribute to the community incidence of SARS-CoV-2 infections relative to fully remote schooling is unknown. We conducted an event study using a retrospective nationwide cohort evaluating the effect of school mode on SARS-CoV-2 cases during the 12 weeks after school opening (July-September 2020, before the Delta variant was predominant), stratified by US Census region. After controlling for case rate trends before school start, state-level mitigation measures and community activity level, SARS-CoV-2 incidence rates were not statistically different in counties with in-person learning versus remote school modes in most regions of the United States. In the South, there was a significant and sustained increase in cases per week among counties that opened in a hybrid or traditional mode versus remote, with weekly effects ranging from 9.8 (95% confidence interval (CI) = 2.7-16.1) to 21.3 (95% CI = 9.9-32.7) additional cases per 100,000 persons, driven by increasing cases among 0-9 year olds and adults. Schools can reopen for in-person learning without substantially increasing community case rates of SARS-CoV-2; however, the impacts are variable. Additional studies are needed to elucidate the underlying reasons for the observed regional differences more fully.

The Impact of School Opening Model on SARS-CoV-2 Community Incidence and Mortality: A Nationwide Cohort Study.

The role that in-person schooling contributes to community incidence of SARS-CoV-2 infections and deaths remains unknown. We conducted an event study evaluating the effect of in-person school on SARS-CoV-2 cases and deaths per 100,000 persons during the 12-weeks following school opening, stratified by US Census region. There was no impact of in-person school opening and COVID-19 deaths. In most regions, COVID-19 incidence rates were not statistically different in counties with in-person versus remote school modes. However, in the South, there was a significant and sustained increase in cases per week among counties that opened for in-person learning versus remote learning, with weekly effects ranging from 7.8 (95% CI: 1.2-14.5) to 18.9 (95% CI: 7.9-29.9) additional cases per 100,000, driven by increases among 0-9 year olds and adults.

Disparities in Learning Mode Access Among K-12 Students During the COVID-19 Pandemic, by Race/Ethnicity, Geography, and Grade Level - United States, September 2020-April 2021.

In response to the COVID-19 pandemic, schools across the United States began transitioning to virtual learning during spring 2020. However, schools' learning modes varied during the 2020-21 school year across states as schools transitioned at differing times back to in-person learning, in part reflecting updated CDC guidance. Reduced access to in-person learning is associated with poorer learning outcomes and adverse mental health and behavioral effects in children (1-3). Data on the learning modes available in 1,200 U.S. public school districts (representing 46% of kindergarten through grade 12 [K-12] public school enrollment) from all 50 states and the District of Columbia during September 2020-April 2021 were matched with National Center for Education Statistics (NCES) demographic data. Learning mode access was assessed for K-12 students during the COVID-19 pandemic, over time and by student race/ethnicity, geography, and grade level group. Across all assessed racial/ethnic groups, prevalence of virtual-only learning showed more variability during September-December 2020 but declined steadily from January to April 2021. During January-April 2021, access to full-time in-person learning for non-Hispanic White students increased by 36.6 percentage points (from 38.0% to 74.6%), compared with 31.1 percentage points for non-Hispanic Black students (from 32.3% to 63.4%), 23.0 percentage points for Hispanic students (from 35.9% to 58.9%) and 30.6 percentage points for students of other races/ethnicities (from 26.3% to 56.9%). In January 2021, 39% of students in grades K-5 had access to full-time in-person learning compared with 33% of students in grades 6-8 and 30% of students in grades 9-12. Disparities in full-time in-person learning by race/ethnicity existed across school levels and by geographic region and state. These disparities underscore the importance of prioritizing equitable access to this learning mode for the 2021-22 school year. To increase equitable access to full-time in-person learning for the 2021-22 school year, school leaders should focus on providing safety-optimized in-person learning options across grade levels. CDC's K-12 operational strategy presents a pathway for schools to safely provide in-person learning through implementing recommended prevention strategies, increasing vaccination rates for teachers and older students with a focus on vaccine equity, and reducing community transmission (4).

Effectiveness of 3 Versus 6 ft of Physical Distancing for Controlling Spread of Coronavirus Disease 2019 Among Primary and Secondary Students and Staff: A Retrospective, Statewide Cohort Study.

BACKGROUND: National and international guidelines differ about the optimal physical distancing between students for prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission; studies directly comparing the impact of ≥3 versus ≥6 ft of physical distancing policies in school settings are lacking. Thus, our objective was to compare incident cases of SARS-CoV-2 in students and staff in Massachusetts public schools among districts with different physical distancing requirements. State guidance mandates masking for all school staff and for students in grades 2 and higher; the majority of districts required universal masking. METHODS: Community incidence rates of SARS-CoV-2, SARS-CoV-2 cases among students in grades K-12 and staff participating in-person learning, and district infection control plans were linked. Incidence rate ratios (IRRs) for students and staff members in traditional public school districts with ≥3 versus ≥6 ft of physical distancing were estimated using log-binomial regression; models adjusted for community incidence are also reported. RESULTS: Among 251 eligible school districts, 537 336 students and 99 390 staff attended in-person instruction during the 16-week study period, representing 6 400 175 student learning weeks and 1 342 574 staff learning weeks. Student case rates were similar in the 242 districts with ≥3 versus ≥6 ft of physical distancing between students (IRR, 0.891; 95% confidence interval, .594-1.335); results were similar after adjustment for community incidence (adjusted IRR, 0.904; .616-1.325). Cases among school staff in districts with ≥3 versus ≥6 ft of physical distancing were also similar (IRR, 1.015, 95% confidence interval, .754-1.365). CONCLUSIONS: Lower physical distancing requirements can be adopted in school settings with masking mandates without negatively affecting student or staff safety.

Diabetes and Diet: Purchasing Behavior Change in Response to Health Information.

Individuals with obesity and related conditions are often reluctant to change their diet. Evaluating the details of this reluctance is hampered by limited data. I use household scanner data to estimate food purchase response to a diagnosis of diabetes. I use a machine learning approach to infer diagnosis from purchases of diabetes-related products. On average, households show significant, but relatively small, calorie reductions. These reductions are concentrated in unhealthy foods, suggesting they reflect real efforts to improve diet. There is some heterogeneity in calorie changes across households, although this heterogeneity is not well predicted by demographics or baseline diet, despite large correlations between these factors and diagnosis. I suggest a theory of behavior change which may explain the limited overall change and the fact that heterogeneity is not predictable.

Does disease cause vaccination? Disease outbreaks and vaccination response.

Parental fear of vaccines has limited vaccination rates in the United States. I test whether disease outbreaks increase vaccination using a new dataset of county-level disease and vaccination data. I find that pertussis (whooping cough) outbreaks in a county decrease the share of unvaccinated children entering kindergarten. These responses do not reflect changes in the future disease risk. I argue that these facts are best fit by a model in which individuals are both myopic and irrational. This suggests that better promotion of information about outbreaks could enhance the response.

Why Is Infant Mortality Higher in the United States Than in Europe?

The US has higher infant mortality than peer countries. In this paper, we combine micro-data from the US with similar data from four European countries to investigate this US infant mortality disadvantage. The US disadvantage persists after adjusting for potential di erential reporting of births near the threshold of viability. While the importance of birth weight varies across comparison countries, relative to all comparison countries the US has similar neonatal (<1 month) mortality but higher postneonatal (1-12 months) mortality. We document similar patterns across Census divisions within the US. The postneonatal mortality disadvantage is driven by poor birth outcomes among lower socioeconomic status individuals.

Optimal Expectations and Limited Medical Testing: Evidence from Huntington Disease: Corrigendum.

The purpose of this document is to update and correct Figure 4 from "Optimal Expectations and Limited Medical Testing: Evidence from Huntington Disease" (Oster, Shoulson, and Dorsey 2013). This figure documents how perceptions about the risk of HD evolve with symptoms. It compares these perceptions with the "actual risk" of HD based on a Bayesian updating calculation described in the paper. The construction of Figure 4 is correctly described in the text of the paper and the data on perceptions are documented correctly. However, the construction of the "actual risk" series is not accurate. There are two central issues. First, there were data limitations at the time of publication which have since been relaxed and the better data now available changes the picture. Second, there was an error in the construction of Figure 4 which should have been recognized at the time. We detail the issues here and include the corrected figure. The original figure showed evidence of overoptimism at all levels of motor score. The corrected figure shows that for low symptom levels individuals are correct about their risk level, whereas those with more advanced symptoms are overly optimistic. Overall, the levels of overoptimism are lower than documented originally. We will briefly discuss the implications for the theory at the end of this document.

Informativeness of Early Huntington Disease Signs about Gene Status.

BACKGROUND: The cohort-level risk of Huntington disease (HD) is related to the age and symptom level of the cohort, but this relationship has not been made precise. OBJECTIVE: To predict the evolving likelihood of carrying the Huntington disease (HD) gene for at-risk adults using age and sign level. METHODS: Using data from adults with early signs and symptoms of HD linked to information on genetic status, we use Bayes' theorem to calculate the probability that an undiagnosed individual of a certain age and sign level has an expanded CAG repeat. RESULTS: Both age and sign levels have substantial influence on the likelihood of HD onset, and the probability of eventual diagnosis changes as those at risk age and exhibit (or fail to exhibit) symptoms. For example, our data suggest that in a cohort of individuals age 26 with a Unified Huntington's Disease Rating Scale (UHDRS) motor score of 7-10 70% of them will carry the HD mutation. For individuals age 56, the same motor score suggests only a 40% chance of carrying the mutation. Early motor signs of HD, overall and the chorea subscore, were highly predictive of disease onset at any age. However, body mass index (BMI) and cognitive performance scores were not as highly predictive. CONCLUSIONS: These results suggest that if researchers or clinicians are looking for early clues of HD, it may be more foretelling to look at motor rather than cognitive signs. Application of similar approaches could be used with other adult-onset genetic conditions.