Alison K. Cohen

Educational attainment and obesity: A systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer‐reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer‐reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the countrys economic development level: an inverse association was more common in studies of higher‐income countries and a positive association was more common in lower‐income countries, with stronger social patterning among women. Relatively few studies reported on lower‐income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi‐experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Education: A Missed Opportunity for Public Health Intervention

Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education--from preschool to beyond college--is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity.

Education and obesity at age 40 among American adults.

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI≥30) at age 40 in the USAs National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.

Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community

Jason Coburn and Alison Cohen discuss the need for urban health equity indicators, which can capture the social determinants of health, track policy decisions, and promote greater urban health equity.

The accuracy of self‐reported pregnancy‐related weight: a systematic review

Self‐reported maternal weight is error‐prone, and the context of pregnancy may impact error distributions. This systematic review summarizes error in self‐reported weight across pregnancy and assesses implications for bias in associations between pregnancy‐related weight and birth outcomes. We searched PubMed and Google Scholar through November 2015 for peer‐reviewed articles reporting accuracy of self‐reported, pregnancy‐related weight at four time points: prepregnancy, delivery, over gestation and postpartum. Included studies compared maternal self‐report to anthropometric measurement or medical report of weights. Sixty‐two studies met inclusion criteria. We extracted data on magnitude of error and misclassification. We assessed impact of reporting error on bias in associations between pregnancy‐related weight and birth outcomes. Women underreported prepregnancy (PPW: −2.94 to −0.29 kg) and delivery weight (DW: −1.28 to 0.07 kg), and over‐reported gestational weight gain (GWG: 0.33 to 3 kg). Magnitude of error was small, ranged widely, and varied by prepregnancy weight class and race/ethnicity. Misclassification was moderate (PPW: 0–48.3%; DW: 39.0–49.0%; GWG: 16.7–59.1%), and overestimated some estimates of population prevalence. However, reporting error did not largely bias associations between pregnancy‐related weight and birth outcomes. Although measured weight is preferable, self‐report is a cost‐effective and practical measurement approach. Future researchers should develop bias correction techniques for self‐reported pregnancy‐related weight.

Excessive gestational weight gain over multiple pregnancies and the prevalence of obesity at age 40

Objective:Although several studies have found an association between excessive gestational weight gain (GWG) and obesity later in life, to the best of our knowledge, no studies have explored the role of GWG events across the life course.Design and methods:We describe how the prevalence of midlife obesity (BMI⩾30 at age 40 or 41) among women varies by life course patterns of GWG (using 2009 IOM guidelines) in the USA’s National Longitudinal Survey of Youth 1979 cohort.Results:Among women who reported 1–3 births before age 40, the prevalence of midlife obesity increased with a rising number of excessive GWG events: from none (23.4%, n=875) to one (37.6%, n=707), from none (23.4%, n=875) to two (46.8%, n=427) and from none (23.4%, n=875) to three (54.6%, n=108), P<0.00005 for trend. Obesity prevalence was similar for the same number of excessive GWG events, regardless of parity. No clear pattern emerged for the sequencing of excessive GWG event(s) and later obesity.Conclusions:In our descriptive exploratory study, excessive GWG events appear to be associated with increased prevalence of obesity for parous women, suggesting the importance of preventive interventions regardless of timing of pregnancy-related weight changes over the life course.

Fostering Resilience Among Urban Youth Exposed to Violence A Promising Area for Interdisciplinary Research and Practice

Most studies to date have examined negative effects of exposure to community violence, in line with the deficit-based perspective. However, given that most youth exposed to community violence demonstrate positive adaptation or resilience over time, we suggest a shift in perspective, practices, and policies across systems toward identifying and building individual, family, and community assets and strengths that may more effectively support youth who have been exposed to community violence and related risks into competent, caring, and thriving adults. In this article, we review how resilience has been conceptualized and operationalized within the context of community violence, highlight gaps in literature, and offer directions for future public health research and practice. We illustrate this review with practice-based examples from public health work in the San Francisco Bay Area. Future multidisciplinary longitudinal studies that identify protective processes and successful trajectories and rigorous evaluations of strength-based policies, programs, and protective processes are needed.

The relationship between adolescents' civic knowledge, civic attitude, and civic behavior and their self-reported future likelihood of voting

A long-standing objective of American public education is fostering civically engaged youth. Identifying characteristics associated with likelihood of future voting, a measure of democratic participation that predicts future voting behavior, might yield targets for education programs to increase civic participation. Survey data from urban adolescents were analyzed to elucidate how civic knowledge, civic attitudes and civic behaviors are associated with self-reported likelihood of future voting. In a multivariable ordered logistic regression model with latent constructs for civic knowledge, attitudes and behavior, two civic knowledge constructs and two civic attitude constructs maintained a positive, statistically significant independent association with future voting likelihood after adjusting for race/ethnicity and advanced coursework: knowledge of American governance, current events knowledge, general self-efficacy and skill-specific self-efficacy. Further research is necessary to determine whether education programs can intervene upon these civic knowledge and civic attitude factors to increase voting participation later in life.

Socioeconomic disadvantage in childhood as a predictor of excessive gestational weight gain and obesity in midlife adulthood

BackgroundLower childhood socioeconomic position is associated with greater risk of adult obesity among women, but not men. Pregnancy-related weight changes may contribute to this gender difference. The objectives of this study were to determine the associations between: 1. childhood socioeconomic disadvantage and midlife obesity; 2. excessive gestational weight gain (GWG) and midlife obesity; and 3. childhood socioeconomic disadvantage and excessive GWG, among a representative sample of childbearing women.MethodsWe constructed marginal structural models for seven measures of childhood socioeconomic position for 4780 parous women in the United States, using National Longitudinal Survey of Youth (1979–2010) data. Institute of Medicine definitions were used for excessive GWG; body mass index ≥30 at age 40 defined midlife obesity. Analyses were separated by race/ethnicity. Additionally, we estimated controlled direct effects of childhood socioeconomic disadvantage on midlife obesity under a condition of never gaining excessively in pregnancy.ResultsLow parental education, but not other measures of childhood disadvantage, was associated with greater midlife obesity among non-black non-Hispanic women. Among black and Hispanic mothers, childhood socioeconomic disadvantage was not consistently associated with midlife obesity. Excessive GWG was associated with greater midlife obesity in all racial/ethnic groups. Childhood socioeconomic disadvantage was not statistically significantly associated with excessive GWG in any group. Controlled direct effects were not consistently weaker than total effects.ConclusionsChildhood socioeconomic disadvantage was associated with adult obesity, but not with excessive gestational weight gain, and only for certain disadvantage measures among non-black non-Hispanic mothers. Prevention of excessive GWG may benefit all groups through reducing obesity, but excessive GWG does not appear to serve as a mediator between childhood socioeconomic position and adult obesity in women.

Pregnancy and post-delivery maternal weight changes and overweight in preschool children.

OBJECTIVES High maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight. METHODS SAMPLE 4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old. EXPOSURES gestational weight gain (GWG) and post-delivery maternal weight change (PDWC). OUTCOME child overweight (body mass index (BMI) ≥85th percentile). RESULTS Adjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers. CONCLUSIONS Increased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.