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Background: The Healthy, Hunger-Free Kids Act requires access to free drinking water in public school cafeterias during meal times. Previous studies suggest that increasing access to water in schools can increase its consumption among students, potentially reducing their intake of sugar-sweetened beverages. The current study provides a descriptive assessment of water availability, delivery methods, and quality in 96 public schools across four New Jersey school districts. Methods: As part of the New Jersey Child Health Study, we administered an online and paper survey to school nurses at 96 schools to evaluate the availability, delivery, and quality of water in the school cafeteria during lunchtime. Univariate and bivariate statistics were used to analyze the data. Results: In school year 2019–20, 83 (86.5%) schools reported providing free drinking water in the cafeteria during lunch. The most common source of water was water fountains, available in 64 schools (66.7%). Issues related to water quality, specifically cleanliness, temperature, pressure, and taste, were present in 20–30% of schools. Conclusions: While most schools surveyed provide access to clean, free drinking water, students in some schools still lack free access to drinking water during school meals, which may affect overall water consumption among students.

Background Despite the many benefits of school meals, not all students participate. One reason students may not participate in school meals is because they instead purchase breakfast or lunch from food outlets located around schools that mostly carry unhealthy items. This study examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated the association between the community food environment around schools and student meal participation. Methods This study employed a longitudinal repeated-measures design using school-level data collected between 2014 and 2020 within four low-income school districts ( n  = 126 schools) in the US. We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25 miles of schools (characterized as low-density of unhealthy food outlets vs. high-density of unhealthy food outlets) through a latent class analysis. Regression analysis estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models. Results While no moderating effect of school CEP status was observed for breakfast or lunch participation, school breakfast participation was predicted to be 4% lower in high-density food environments than in low-density environments ( P -value = .049) among non-CEP schools, and there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with participation predicted to be 10% lower in high-density environments than in low-density environments among non-CEP middle/high schools ( P -value < .001), whereas such a difference in participation was not observed among non-CEP elementary schools. Conclusions Negative associations between food environment around schools and school breakfast participation were observed only among middle and high schools not participating in CEP, suggesting that policy actions to increase access to free school meals may benefit students, particularly older children and adolescents.

Self-reported fruit and vegetable (FV) consumption in children has limitations that could be overcome with objective measures that are easy to implement. The Veggie Meter (VM) is a non-invasive portable device that measures skin carotenoid levels, a concentration biomarker of usual FV intake. While VM has been used to measure FV consumption in adults, few studies have explored its use in elementary school settings. Designing research studies using the VM with elementary school-age children requires an understanding of how well this device can be used in a school setting and of the distribution of VM scores in this population. We used VM to measure skin carotenoids in a diverse sample of 143 elementary school children who also answered commonly asked questions about consumption frequency of FV the previous day. Multivariable regression was used to assess the independent association of demographic variables with VM scores. VM scores were also compared with student-reported FV intake. There was a weak but statistically significant correlation between reported frequency of total vegetable consumption the previous day and observed VM scores (r = 0.174, p = 0.042). This study provides an example of the successful use of the VM in a school setting to collect an objective measure of FV intake and provides important description of data that can inform future studies.

Background Physical activity (PA) is associated with positive health outcomes over the entire life course. Many community-based interventions that promote PA focus on implementing incremental changes to existing facilities and infrastructure. The objective of this study was to determine if such upgrades were associated with increases in children’s PA. Methods Two cohorts of 3- to 15-year-old children (n = 599) living in 4 low-income New Jersey cities were followed during 2- to 5-year periods from 2009 to 2017. Data on children’s PA were collected at 2 time points (T1 and T2) from each cohort using telephone survey of parents; data on changes to existing PA facilities were collected yearly from 2009 to 2017 using Open Public Records Act requests, publicly available data sources, and interviews with key stakeholders. PA changes were categorized into six domains (PA facility, park, trail, complete street, sidewalk, or bike lane) and coded as new opportunity, renovated opportunity, or amenity. A scale variable capturing all street-related upgrades (complete street, sidewalk, and bike lane) was constructed. PA was measured as the number of days per week the child engaged in at least 60 min of PA. The association between change in PA between T1 and T2, ranging from − 7 to + 7, and changes to the PA environment was modeled using weighted linear regression controlling for PA at T1, child age, sex, race, as well as household and neighborhood demographic and socioeconomic characteristics. Results While most measures of the changes to the PA environment were not associated with change in PA between T1 and T2, the street-related upgrades were positively associated with the change in PA; specifically, for each additional standard deviation in street upgrades within a 1-mile radius of their homes, the change in PA was 0.42 (95% CI: 0.02, 0.82; p = 0.039) additional days. This corresponds to an 11% increase over the mean baseline value (3.8 days). Conclusions The current study supports funding of projects aimed at improving streets and sidewalks in cities, as it was shown that incremental improvements to the PA environment near children’s homes will likely result in increased PA among children.

Findings from a pilot randomized trial of 916 households indicated that outreach text messages were not an effective strategy to increase enrollment in the United States Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among eligible households in Arizona.

Black residential segregation has been declining in the United States. That accomplishment rings hollow, however, if blacks continue to live in much poorer neighborhoods than other Americans. This study uses census data for all US metropolitan areas in 1980 and 2010 to compare decline in the neighborhood poverty gap between blacks and other Americans with decline in the residential segregation of blacks. We find that both declines resulted primarily from narrowing differences between blacks and whites as opposed to narrowing differences between blacks and Hispanics or blacks and Asians. Because black–white differences in neighborhood poverty declined much faster than black–white segregation, the neighborhood poverty disadvantage of blacks declined faster than black segregation—a noteworthy finding because the narrowing of the racial gap in neighborhood poverty for blacks has gone largely unnoticed. Further analysis reveals that the narrowing of the gap was produced by change in both the medians and shapes of the distribution of poverty across the neighborhoods where blacks, whites, Hispanics, and Asians reside.

South Korea has the highest rate and highest rate of increase in suicide among developed countries. The suicide epidemic in Korea is an anomaly, and suicide rates are high for both men and women, with no signs of decreasing. Yet we do not know the extent to which suicide has reduced life expectancy in Korea. We investigated whether and to what extent the rapid increase in suicide has contributed to changes in Korean life expectancy, a key indicator of population health. We used a recently developed decomposition method that separates the contribution of suicide's effect on change in life expectancy into two parts: that due to change in the overall suicide incidence rate and that due to change in the mean age of suicide victims. From 1995 to 2010, life expectancy increased by 6.5 years in Korea, with change in most causes of death contributing to its growth. We nonetheless find, as expected, that the rise in suicides reduced the increase in life expectancy from 1995 to 2010, so life expectancy in Korea is about 0.21 years lower than it would have been without the increase in suicides. Moreover, had the age of suicide victims remained stable, we project that Korea's life expectancy would be fully 0.70 years lower than it is. Although the growth in suicide was the largest single factor slowing the rise in Korean life expectancy, the effect would have been even larger had the age of suicide victims not increased.

Blacks have lower life expectancy than whites in the United States. That disparity could be due to racial differences in the causes of death, with blacks being more likely to die of causes that affect the young, or it could be due to differences in the average ages of blacks and whites who die of the same cause. Prior studies fail to distinguish these two possibilities. In this study we determine how much of the 2000-10 reduction in the racial gap in life expectancy resulted from narrowing differences in the cause-specific mean age at death for blacks and whites, as opposed to changing cause-specific probabilities for blacks and whites. We introduce a method for separating the difference-in-probabilities and difference-inage components of group disparities in life expectancy. Based on the new method, we find that 60% of the decline in the racial gap in life expectancy from 2000 to 2010 was attributable to reduction in the age component, largely because of declining differences in the age at which blacks and whites die of chronic diseases. Our findings shed light on the sources of the declining racial gap in life expectancy in the United States, and help to identify where advances need to be made to achieve the goal of eliminating racial disparities in life expectancy.

This study aims to describe differences in participation in the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women and Children (WIC), and school meal programs by household characteristics prior to and during the pandemic, and to examine the association of program participation with food security status and food pantry use. We analyze secondary data (n = 470) from an online survey collected in July/August 2020 using weighted multiple logistic regression models. Participation in SNAP declined among households with children in the first four months of the pandemic, while participation in WIC increased slightly, and participation in school meals remained unchanged. There were significant differences in SNAP, WIC, and school meal programs use by race/ethnicity, income, and urbanicity before and during the pandemic. Food insecurity prevalence was higher among SNAP participants at both periods but the gap between participants and non-participants was smaller during the pandemic. Pantry use and food insecurity rates were consistently higher among federal nutrition assistance program participants, possibly suggesting unmet food needs. These results highlight the need for increased program benefits and improved access to food, particularly during periods of hardship.

BackgroundAsian–Americans outlive whites by an average of nearly 8 years. By determining the sources of the Asian mortality advantage, we can pinpoint where there is the greatest potential for raising the life expectancy of whites and other groups in the USA.MethodsOur analyses include all Asian and white deaths in the USA between 2006 and 2010, from the Center for Disease Control. Using the International Classification of Diseases (V.10), we code causes of deaths into 19 categories, based on the most common causes as well as causes particularly relevant to racial differences. We then create life tables and apply a newly-developed demographic method to determine whether Asians have longer life expectancy because they are less likely than whites to die of causes of death that strike at younger ages, or because they tend to outlive whites regardless of cause of death.ResultsNearly 90% of the Asian–white life expectancy gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death. The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). Men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian–white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning.ConclusionsFor almost all causes of death, Asian victims tend to be older than white victims. The greatest potential for raising the life expectancy of whites to that of Asians, then, resides in efforts that effectively increase whites’ average age at death for the most common causes of death.