Purpose: Health-promoting resources (i.e., capacities/assets) that foster resiliency to adversity could improve cardiometabolic health among U.S. Hispanic/Latino adults. Whether these resources relate to food security and diet quality—two major cardiometabolic risk factors—is unknown. We sought to identify health-promoting resources associated with household food security and diet quality among Hispanic/Latino adults.

Methods: We analyzed cross-sectional data from adults (n=479) participating in two ancillary studies of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The 18-item Household Food Security Survey Module was used to categorize participants with scores < 3 or ≥ 3 as food secure (FS) or insecure (FI), respectively. The Alternate Healthy Eating Index-2010 assessed diet quality (range: 0-110), with scores < 48.2 or ≥ 48.2 categorized as low or high diet quality, respectively. Adjusted logistic regression models tested associations of self-reported material (e.g., food environment), human (e.g., optimism, education), social (e.g., social support, family cohesion), and cultural (e.g., religiosity) resources with odds [OR (95% Confidence Intervals)] of FI vs. FS and with low vs. high diet quality.

Results: Diet quality scores were low (mean=48.1 +/-7.3) and 40.1% of households were FI. Perceiving neighborhood fruits and vegetables [OR (CI): 0.4 (0.2, 0.6)] or low-fat foods [0.3 (0.1, 0.4)] as affordable (vs. unaffordable) and having higher optimism [0.9 (0.88, 0.99)] or social support [0.94 (0.91, 0.98)] scores related to lower odds of FI. Shopping at small to medium non-ethnic food stores (sometimes vs. never [0.5 (0.2, 0.95)]) or having high school [0.5 (0.3, 0.98)] vs. less educational attainment related to lower odds of having low diet quality. However, select material, social, and cultural resources were associated with higher odds of FI and having low diet quality. For example, higher family cohesion was associated with higher odds of FI [1.2 (1.1, 1.4)].

Conclusions: U.S. Hispanic/Latino adults have existing material, human, social, and cultural resources to protect against FI and low diet quality, but some of these relationships may be nuanced. Additional mixed methods research is required to better understand how these health-promoting resources can be leveraged as a part of programs to promote food security, diet quality, and cardiometabolic health.

Purpose: To describe obesity incidence and crime rate in neighborhood according to environmental and sociodemographic characteristics. Additionally, to assess if crime rate is a predictor of obesity. Methods: Prospective study with data from ISA: Physical Activity and Environment with 931 adults aged 18 and over, residents in Sa Paulo city, Brazil, that participated in baseline (2014/2015) and second wave (2020/2021). The outcome was obesity incidence assessed through body mass index, calculated from self-reported height and weight. The independent variables were terciles of crime rate (vehicle, pedestrian and within public transportation theft, and intentional homicide) and intentional homicide rate per 1000 hab in 2015 within 1000m and 1500m linear buffers from each participant residence at baseline (1st tercile as reference with lower crime rate), obtained from official government dataset provided by the Center for the Study of Violence. Sociodemographic variables (age, skin color, educational level, and sex) and environmental variables (weighted GeoSES - Socioeconomic Index of Geographic Context for Health Studies - and perceived violence of neighborhood) were considered. Chi-square tests examined bivariate associations, and logistic regression models were applied for crude and adjusted analysis (adjusted for sociodemographic variables, perceived violence of neighborhood, and weighted GeoSES). Results: The study identified a 14.8% incidence of obesity during the period, and was higher among women, young adults, and residents in lower-quartile GeoSES areas (1500m buffer). Crime rate showed association with GeoSES for both buffers, while intentional homicide rate was associated with all variables except age and sex. Importantly, crime rate emerged as a predictor of obesity; which individuals residing in areas with higher terciles of crime rate within 1000m and 1500m were 72% (CI95%=1.07-2,76) and 74% (CI95%=1.10-2.76) more likely, respectively, to develop obesity. Intentional homicide rate was not associated with obesity incidence. Conclusion: These findings underscore the inequities in crime exposure, predominantly affecting socially vulnerable populations and environments. Living in areas marked by higher violence rates predicts a higher likelihood of developing obesity. This evidence supports the necessity of considering the social environment regarding obesity prevention actions and health promotion policies.
Funding: São Paulo Research Foundation (FAPESP 2017/17049-3 and 2021/03277-0).

Purpose: Given the increasing concern over childhood obesity and its long-term health implications, this study investigated associations of the neighborhood retail food environment with changes in children’s weight status over five years.

Methods: Height, weight, and home address were obtained for 4,493 children (>75% were Black or Latinx) from primary care visits within a large pediatric health system in the Midwest. Eligible participants had measures collected during two time periods (2012-2014 [Time 1] and 2017-2019 [Time 2]). Home addresses, road network, and establishment-level food environment data from the National Establishment Time Series during both times were used to determine the number of four types of food outlets within a half-mile and three-mile road-network buffer from the children’s residences: supermarkets/large grocery stores, convenience stores/small grocery stores, limited-service restaurants, and full-service restaurants. Food outlets within a half-mile buffer were categorized based on the presence (Yes) or absence (No) of certain stores. Children who moved residences between periods were ‘movers’ (N=1,052). Mixed-effects models, accounting for nesting of children within census tracts, were used to assess the associations of baseline and changes in food outlet number/status with Time 2 weight status. Models adjusted for weight status and socio-demographics of the child and neighborhood at baseline.

Results: Movers without a convenience store within a half-mile of their home (OR=4.706, p=0.032) or those with an increasing number of convenience stores at both times (OR=2.950, p=0.036) had higher odds of overweight or obesity compared to movers with a decreasing number of convenience stores within a half mile distance. Non-movers with limited-service restaurants within a half-mile distance at both times had higher BMIz-score at Time 2 compared with non-movers with decreasing limited -service restaurants at half-mile at Time 2 (B=0.117, p=0.038). No significant associations were observed for the three-mile buffer for both groups.

Conclusions: Findings suggest that reductions in the number of convenience stores and limited-service restaurants may support healthier BMI trajectories. The association differed between movers and non-movers. These insights are significant for public health, particularly in designing multilevel childhood obesity interventions and urban planning.

Purpose: This study explores the role of health and health behaviors in the daily lives of Dutch adults (aged 25-49) experiencing one or more forms of socioeconomic insecurity stemming from their financial, housing, or employment situations. Our aim was to provide guidance for preventive health policies and interventions that correspond with the needs of this understudied population facing socioeconomic insecurity.

Methods: 28 in-depth, semi-structured interviews were conducted in the Netherlands between October 2022 and February 2023. The interview guide included questions on participants’ socioeconomic situation, the role of health in their daily lives, their health-related and other needs. Data was interpreted using reflexive thematic analysis. An advisory board consisting of adults with lived experiences of socioeconomic insecurity were consulted at multiple stages of the study (recruitment, interview guide, interpretation of results).

Results: Participants’ narratives revealed four key themes in relation to the role of health and health behaviors in daily life and associated needs. Firstly, socioeconomic insecurity led to unrest and diminished control over participants’ lives, which led to the disruption of routines. Secondly, experiencing socioeconomic insecurity compelled participants to prioritize stress reduction and mental health improvement through calming yet potentially damaging coping behaviors, such as overeating. Thirdly, those who experienced little opportunity for improvement in their already long-lasting socioeconomic insecurity shared a sense of stagnation in life, which co-occurred with stagnation in unhealthy behavioral routines and diminished well-being. Fourthly, participants expressed the need for a professional to speak with and to help reflect on their lives. This support may help participants regain control, opportunities for more socioeconomic security, more calmness, and increased health and well-being.

Conclusions: This study sheds light on the challenges individuals face in dealing with socioeconomic insecurity, how it may affect their health, their behavior, and their needs. Having perspective to improved socioeconomic security and having easy access to professional support could have health promoting effects for individuals living with socioeconomic insecurity. It is recommended to integrate professional support and assistance regarding social security into health policies and interventions.

Purpose
This paper presents an innovative application of realist-informed configurational comparative analysis to gain insights into the factors influencing reductions in physical activity inequalities. This will evaluate the effects of Sport England’s investment in whole-systems, place-based approaches (WSA) and inform future adoption of such strategies.
Methods
A cross case configurational approach was used to examine diverse causal configurations related to increasing physical activity and decreasing physical inactivity. Short- and medium-term outcomes were also identified to explore pathways to impact.
The ‘cases’ corresponded to local authority areas in England, where collaborative groups were attempting to create conditions to enable people to be active. 'Causes’ were characteristics or features of that case which we had reason to believe were necessary for there to be a change in physical activity inequalities. Causes were selected in a participatory way with stakeholders involved in these cases and with reference to academic literature. Presence or absence of causes were assessed for each case using a mix of data sources, including a questionnaire incorporating a scaled rubric. Responses were triangulated with other data sources, including evaluation outputs and follow-up meetings, to calibrate the scales and ensure consistency of interpretation.
Given the complexity of WSAs, the study utilises an advanced stepwise technique to explore these ‘causes’ from situational context, financial and human resource inputs, areas of action and ‘maturing system conditions’ relating, for example, to the extent of community participation in design and delivery of actions and collaboration across diverse sectors. The theory-informed approach employs the EvalC3 software for hypothesis-led inquiry and inductive algorithm-based searches using predictive analytics.
Findings
The study involves 37 diverse locations, with ongoing analysis to identify necessary or sufficient configurations of conditions and develop causal explanations, in collaboration with stakeholders. The completion of this analysis is expected by March 2023
Conclusion
In conclusion, the paper suggests that the research has developed a valuable approach to understanding change in complex social systems, building on insights generated through realist evaluation and configurational comparative analysis. While further refinement is ongoing, the methodology appears promising for informing strategies to address physical activity inequalities.

Purpose: We examined whether the association between policies implemented in the United States that provided economic support during the COVID-19 pandemic and food insufficiency differed if experiencing rent burden.
Methods: We used the nationally representative U.S. Household Pulse Survey from June 2020 to May 2023. Our sample included renter households with incomes under 200% of the Federal Poverty Threshold (n=67,957). Our exposures were policy indicators for either Supplemental Nutrition Assistance Programs (SNAP) emergency allotments (participants in states and times where allotments were implemented, participants in states and times where allotments were not implemented, or non-participants) or rent assistance (received, waitlisted/denied, or did not apply). Our outcome was experiencing food insufficiency. The moderator was rent burden (rental costs greater than 30% of income or not). We modeled food insufficiency as a function of the policy indicator, rent burden, and their interaction adjusting for demographics, state, and survey cycle and produced predicted probabilities with 95% confidence intervals. Each policy was modeled separately.
Results: The predicted probability of experiencing food insufficiency was lower in SNAP-participating households that received emergency allotments versus those that did not for rent burdened households (25.9 [23.9-27.8] versus 30.2 [28.4-31.9]) but not for non-rent burdened households (23.9 [21.1-26.8] versus 26.1 [23.3-28.8]). There was no difference between rent and non-rent burdened households for SNAP non-participants (27.6 [26.8-28.5] versus 25.7 [24.1-27.3]). The predicted probability of experiencing food insufficiency was lower in households that received rental assistance versus those that were waitlisted/denied for rent burdened households (34.4 [32.5-36.4] versus 40.5 [38.4-42.5]) and non-rent burdened households (30.0 [26.7-33.2] versus 49.6 [43.5.3-55.7]). Households that did not apply for rent assistance had a higher predicted probability of experiencing food insufficiency if they were rent burdened (24.8 [24.1-25.6] versus 21.8 [20.6-23.1]).
Conclusion: SNAP emergency allotments and rental assistance supported low-income renters’ food sufficiency. SNAP emergency allotments appeared to be more impactful at reducing the risk of experiencing food insufficiency among rent burdened households while rent assistance appeared more impactful in non-rent burdened households. Policymakers need to design policies and programs to better support economically marginalized households and account for conditions leading to housing and food insecurity.