Benefits of physical activity (PA) are well-documented, and sedentary behaviors (SB) are risk factors for disease independent of PA. Applying the concept of the movement continuum, this study characterizes all movement behaviors over the 24-hour day using time-use diary data from adolescents 10-18 years old using the U.S. nationally representative Child Development Supplement of the Panel Study of Income Dynamics (n = 631). We grouped activities and assigned metabolic equivalent of task (MET) values to: sedentary activity (1-1.5 METs), light physical activity (1.5-3.0 METs), and moderate-to-vigorous physical activity (MVPA; >3.0 METs). We calculated total daily energy expenditures (TDEE) and durations of each activity category and used multiple linear regression to examine socio-demographic associations with movement behaviors. Average TDEE was 1,423 MET-minutes on weekdays and 1,457 on weekend days; adolescents spent on average 69 minutes/weekday and 139 minutes/weekend day in MVPA; they engaged in sedentary activities 677 minutes/weekday and 466/weekend day; and slept 540 minutes/weekday and 629/weekend day. Girls spent more time lying down (19.9 vs. 7.9 minutes) and doing activities standing (68.1 vs. 50.7 minutes), and boys spent more time playing computer games (68.3 vs. 16.2 minutes) and sports (28.8 vs. 11 minutes). Black girls had the lowest activity levels. MVPA and SB duration were similar for boys and girls, but there were differences in the activities comprising this time. When taking account of the entire movement continuum, the PA duration of U.S. adolescents was on average closer to recommended levels than other methods have indicated.

PurposeTo identify multimorbidity patterns among U.S adults entering their 40s.DesignCross-sectional analysis of cohort data.Setting and SampleData are from the National Longitudinal Study of Youth 1979, a nationally representative cohort born between 1957-1964 (n = 8104) who were followed from adolescence into adulthood; this analysis used data collected when participants entered their 40s (1998-2006).Measures and AnalysisParticipants self-reported whether they had ever been diagnosed with each of 7 chronic conditions: hypertension, diabetes, non-skin cancers, chronic lung disease, heart disease, mental disorders, and arthritis or rheumatism. We used latent class analysis to identify multimorbidity patterns. Multimorbidity was defined as ≥2 diagnosed conditions and obesity as body mass index ≥30 kg/m2 from self-reported height and weight. We used multinomial survey-adjusted logistic regressions to examine associations between obesity and disease clusters.ResultsAt mean age of 41y, 10.8% of adults in the U.S. had multimorbidity; 26.3% had obesity. Three patterns emerged: healthy (≤1 disease), an arthritis-mental health conditions-dominated cluster (5.6%) and a hypertension-diabetes-dominated cluster (2.4%). People with obesity had 5 times higher odds of having a hypertension-diabetes-dominated cluster (OR = 5.2, 95%CI: 3.2-8.5) and double the odds of having an arthritis-mental health conditions-dominated cluster (1.7, 1.2-2.2) compared to normal-weight individuals.ConclusionAmong U.S. adults in their 40s, multimorbidity clusters were dominated by arthritis-mental health and hypertension-diabetes; both disproportionately affected individuals with obesity.

ObjectivesSedentary lifestyles often develop during adolescence and may be deleterious to physical and mental health. Sedentarism is known to be common in high-income countries; this study examines its prevalence in a remote city in India, including the amount of time school-going adolescents spend being sedentary and the activities that make up this time.MethodsWe developed a 24-hour time-use survey and collected data with a sample of school-going adolescents ages 12-17 years in a mid-sized South Indian city (n = 395). We built measures of daily sedentary minutes and frequency (bouts) of sedentary activities and calculated population-based prevalence of sedentary activities across gender and school type. We used survey-weighted distributions and linear regression models to estimate sedentary time after accounting for socio-demographic characteristics.ResultsOn average, adolescents had 7.3 sedentary bouts/day, amounting to 527.7 minutes/day. Compared to private-school students, those in government schools spent 2 fewer hours (-134.5 minutes;-174.4, -194.6) sedentary, including 82 (-122, -42.0) fewer minutes in classroom and tutoring time and an hour (-57.82; -69.4,46.2) less in vehicle-based commuting. Girls spent 44 minutes less time in class and in tutoring (-75.88, -12.11)and more time watching television than boys. Adolescents spent comparable time doing homework and reading for leisure.ConclusionSedentary lifestyles are reaching children even in remote communities in India. A large component of this time is dedicated to learning. Private school students spent the most time sedentary, making them an especially vulnerable group for cardiometabolic disease, in spite of socioeconomic advantages.

Objectives Older adults are at high risk of the negative health impacts of social isolation and loneliness. One of those possible negative health impacts is Alzheimer's disease, a leading cause of death for adults in the United States and many high-income countries. Taking a life course perspective, we explore whether there is a direct causal effect of social isolation on later-life trajectories of cognitive function, the extent to which any effect of social isolation on cognitive impairment operates indirectly through loneliness, who may be most vulnerable, and the potential efficacy of a statistical intervention for those living alone.Methods We use a counterfactual approach, the g-formula, with the U.S. Health and Retirement Study, analyzing data from 30,421 individuals with 137,653 observations across 2004-2018.Results We find a consistent pattern of social isolation having a detrimental direct causal effect on cognitive function, with only 6% of this effect operating through loneliness. Reducing social isolation has a protective effect on cognitive function for all subpopulations regardless of gender, race/ethnicity, and educational level, with only minor differences among social categories. Our statistical intervention shows that targeting social isolation in those living alone may be one viable public health strategy for protecting against cognitive decline.Discussion Our results suggest that addressing social isolation-and, by extension, its effects on health-requires both a broad understanding of its heterogeneous impacts on the general population and a nuanced approach to targeting public health interventions where they can be most effective.

The “public charge” rule assesses whether an immigrant to the U.S. is likely to become dependent on government assistance, particularly for potential use of cash-benefit programs or long-term institutionalization at government expense. Being deemed a public charge can make an applicant for legal status inadmissible. Although the rule applies to specific immigration determinations, its effects may impact health outcomes. This systematic review synthesized evidence on public charge policy and health-related outcomes among U.S. Latino populations. Following PRISMA guidelines and a PROSPERO-registered protocol (CRD42024507861), we searched PubMed, Web of Science, and Scopus for peer-reviewed studies published in English or Spanish from January 1996 through February 20, 2026. Eligible studies included U.S.-based Latino populations, examined the public charge rule as exposure, and reported health-related outcomes, health behaviors, healthcare access, or use of health or social programs. Two reviewers independently screened titles and abstracts, with disagreements resolved by consensus and, when needed, a third reviewer. Data were extracted using a standardized PECO-based form and narratively synthesized. Of 157 citations identified, 19 studies met inclusion criteria. Studies examined program utilization and access (n = 13, 68

Data collection commenced under the auspices of a collaborative global health partnership by the Child Health and Mortality Prevention Surveillance (CHAMPS) network to investigate the impact of the COVID-19 pandemic and related lockdowns on child and maternal health, economic hardships, and access to care for children and pregnant women. Survey data were collected between January and August 2022 within a Health and Demographic Surveillance System (HDSS) in Western Kenya. The data were gathered using a survey instrument designed to measure household knowledge and awareness of COVID-19, experiences of economic and social hardships, changes in food availability, and challenges to accessing healthcare during the pandemic. The data are drawn from two communities in Western Kenya, one rural (Karemo) and one urban (Manyatta) and consist of a survey of 28,677 households.

Immigrants’ health may differ with the characteristics of the place they resettle. We examined eating patterns and weight status across two differing environments - Atlanta, United States and Brussels, Belgium - collecting information on diet and health from a diverse sample of 111 refugees, asylum-seekers and other migrants. Analyses used descriptive statistics, multivariate regressions, and text analysis. People who had resettled in Atlanta reported higher weight categories than those in Belgium. In both locations, the most commonly adopted items were processed foods (71% in Atlanta, 45% in Brussels); many also listed adopting fruits and vegetables (31% in Atlanta, 14% in Brussels). Thus, changes in health-related behaviors after migration included both healthy and unhealthy components of the contexts of reception. Longer time since arrival was associated with lower odds of having adopted processed foods and higher odds of having adopted fresh foods, suggesting that dietary change is nuanced with immigrants’ integration trajectories.

Recent research in life course epidemiology has demonstrated the importance of evaluating how prepregnancy and pregnancy exposures affect later life developmental outcomes. In this scoping review, we identified and described completed or ongoing pregnancy and prepregnancy cohorts to assess gaps in the maternal exposures and child outcomes measured in these initiatives and inform future research investments. We developed a systematic search that included text and MeSH terms and was tailored for four biomedical citation databases. We applied the Arskey and O’Malley scoping review methodology. We selected a scoping review methodology to provide a comprehensive overview of pregnancy and prepregnancy cohorts and their characteristics. Two reviewers independently conducted the title, abstract, full-text screening, and data charting; a third reviewer resolved discrepancies. The results were summarised in narrative form. We reviewed 147 manuscripts that presented findings from 56 pregnancy and two prepregnancy cohorts, 23 of which were ongoing. Half of the pregnancy cohorts were based in Europe. The most commonly described maternal exposures were nutrition, anthropometric measures, non-communicable diseases (NCDs), and demographic factors. Children’s mental, behavioural, neurodevelopmental, and physical outcomes were the most commonly measured outcomes. Fewer studies evaluated infectious disease, biomarkers, and environmental or workplace exposures. No cohorts examined vaccine or climate-related exposures during pregnancy. About half of the cohorts collected samples from pregnant women or the fetus, and a third from children, with blood being the most common sample type. Most studies did not indicate how data or samples could be accessed. This comprehensive overview of pregnancy and prepregnancy cohorts provides a foundation for cross-cohort coordination. Infectious disease, vaccine, environmental, and climate-related exposures and microbiome, immune function, and economic outcomes remain underrepresented in pregnancy and prepregnancy cohorts. This scoping review summarises findings from existing publications in peer-reviewed journals and did not require ethics review.

Abstract Background COVID-19 resulted in vast disruption to life in the 21st century as governments implemented containment measures to quell disease spread. We assessed knowledge of local interventions and household coping strategies used to attenuate the impact of household hardships. We further examined associations between household and community characteristics with household hardships. Methods We conducted a cross-sectional household survey between August and September 2022 through a retrospective questionnaire fielded in the Health and Demographic Surveillance System (HDSS) operating in Bamako, Mali. Logistic regression was used to analyze associations between household characteristics, government interventions, and household hardships during the pandemic. Results The most commonly reported hardships were increases in food prices and food insecurity; roughly 18% of households reported experiencing at least 1 hardship. Common coping strategies included asking for help from family or friends (55.6%). Only 2.8% of households reported seeking government assistance. Households headed by younger individuals, males, and unemployed individuals were at greater risk of experiencing hardships. Government closure of businesses was strongly associated with household hardships. Conclusions Households in the Bamako HDSS experienced a variety of hardships during the pandemic--the most prevalent hardships were increases in local food prices and food insecurity. The association between government closure of businesses and household hardships points to the need for balancing public health measures with socioeconomic considerations. Households headed by individuals with lower education and/or unemployed were at greater risk of experiencing a hardship. Future policies and interventions should target aid to households reflecting these characteristics. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by grant OPP1126780 from the Bill & Melinda Gates Foundation to Dr Cynthia Whitney, principal investigator of CHAMPS project. K.K. and S.S. are contracted to conduct the work in Mali. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. CISM, which conducted this study in Mozambique under the CHAMPS project, receives support from both the Government of Mozambique and the Spanish Agency for International Development (AECID). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Le Comite d'Ethique de l'USTTB, approval reference number No0007 and the University of Maryland, Baltimore Institutional Review Board gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at the CHAMPS Population Surveillance Dataverse.

BACKGROUND:Obesity dynamics early in life are likely important for long-term health, but have only been described piecemeal, because nationally representative longitudinal datasets are few and have limited follow-up duration. METHODS:We created a synthetic cohort by combining two US nationally representative datasets, the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (ECLS98; N = 21,120; ages 4-16 years; birth cohort 1991-1994), and the National Longitudinal Survey of Youth 1997 (NLSY97; N = 8,984; ages 12-41 years; birth cohort 1980-1984). We used the older-age cohort to impute future weight trajectories of children in the younger-age cohort by matching based on subject-level body mass index trajectories estimated via linear mixed models. We projected trajectories to age 41 years in 2035 for children observed up to a mean age of 13.5 years in 2007. RESULTS:The synthetic cohort (N = 10,102) showed that obesity prevalence increases from 10.0% at age 4 years to 56.3% at age 41 years. Obesity incidence peaks at ages 8 years (4.00/100 person-years [PY] [3.29-4.73]), 26 years (4.48/100 PY [3.04-5.92]), and 38 years (3.60/100 PY [0.00-8.91]). CONCLUSIONS:This synthetic cohort approach can be used to characterize dynamics of obesity and other conditions by maximizing data from shorter "life segments." Findings suggest that today's young adults will continue to become heavier as they age. In addition to prevention before kindergarten entry, other periods for obesity prevention could be middle childhood, mid-twenties, and late thirties.

Introduction: Hypertension poses a significant global health challenge, leading to serious health conditions and premature death. Effective blood pressure control is often hindered by patients' nonadherence to self-care behaviors. This study evaluates these behaviors and their influencing factors among hypertensive patients at Dessie Referral Hospital, Ethiopia. Methods: Conducted from October 20 to November 30, 2019, this mixed-methods study involved 370 hypertensive patients from the hospital's outpatient clinic. Data were collected via structured questionnaires and analyzed using multivariable logistic regression. Additionally, 14 in-depth interviews provided qualitative insights, analyzed thematically. Results: Only 29.4% of patients fully adhered to self-care recommendations. Urban dwellers showed 70% less adherence than rural counterparts. Adherence varied with the duration since diagnosis, with medium-duration patients being less likely to adhere. Interviews revealed personal strategies for managing diet, exercise, medication, and lifestyle, highlighting the struggle with adherence and innovative solutions to challenges. Conclusion: Adherence to self-care among hypertensive patients is alarmingly low, influenced by diagnosis duration, residency, and BMI. Addressing hindrances like living conditions, work, cultural norms, and peer influence is vital. Healthcare providers must focus on education that promotes behavior change and support. Patient engagement in self-care is essential. Future research should investigate healthcare organizational and provider influences. Implementing these strategies could markedly improve hypertension management and patient outcomes.

Importance:Medicaid, as the largest U.S. insurer, can reduce cardiometabolic multimorbidity. Objective:Assess patterns and trends in cardiometabolic multimorbidity among Medicaid-enrolled adults. Design:Analysis of 2018-2022 National Health Interview Survey data, a nationally representative cross-sectional survey. Conditions Studied:Hypertension, hyperlipidemia, coronary heart disease, angina, heart attack, stroke, diabetes, and obesity. Setting:U.S., 2018-2022. Participants:11,090 adults (19-64 years) with Medicaid coverage. Main Outcomes:Proportion with one or multiple cardiometabolic conditions. Findings:(a) 29.3% had one cardiometabolic condition; 29.7% had multimorbidity: 14.5% with 2, 8.0% with 3, and 7.1% with 4+ conditions. (b) Obesity, hypertension, and hyperlipidemia were the most common conditions either individually or together. (c) Obesity was more common in women than men, and women were more likely to have a single condition while men were more likely to have multimorbidity; these differences between men and women were larger in younger adults (<41 years) than older adults. (d) There was higher multimorbidity among older, non-working, and less educated Medicaid enrollees. (e) Prevalence of multimorbidity over time did not change but there was a decrease in the proportion of enrollees with no conditions which was offset by an increase in enrollees with a single condition. Conclusion:29.7% of Medicaid-insured adults had cardiometabolic multimorbidity, and another 29.3% were at risk for it. Potential cuts to Medicaid coverage may exacerbate the burden of cardiometabolic multimorbidity in Medicaid enrollees.

Within the spectrum of non-communicable diseases (NCDs), the burden among older adults in India is predominantly driven by degenerative diseases and conditions. Over the past decade, this burden exhibited a cascading effect, increasingly manifesting as the mounting prevalence of multimorbidity. The study estimated that over half of the adult population aged 45 years and above (50.94%) experienced multimorbidity. A pronounced and accelerating prevalence of multimorbidity gradient of up to four to six diseases/conditions was evident in the 45-84 years age groups, and the highest prevalence of 26% was observed in those aged 80 years and above. Among all diseases and conditions, hypertension emerged as the most prevalent condition, affecting 26.72% of older adults. Furthermore, the disease network analysis identified hypertension, followed by eye conditions and gastrointestinal conditions, as the most central and interconnected condition in multimorbidity framework. Notably, hypertension, high cholesterol, and obesity exhibited significant perilous linkages with life-threatening diseases such as heart diseases. The Classification and Regression Tree (CART) model further reveals thathigh cholesterol together with prolonged hypertension significantly elevated the risk of heart diseases. Importantly, this risk was not solely driven by the co-occurrence of diseases and conditions; it was significantly intensified among socioeconomically disadvantaged individuals in the Indian population.

BACKGROUND:Changes in foods consumed by immigrants after arrival to the US are hypothesized to affect health, yet measuring changes in diet after migration is difficult. This study identified patterns of foods newly consumed and no longer consumed among a nationally representative cohort of immigrants resettled in the US. METHODS:We utilized data from 4,937 participants in the New Immigrant Survey (NIS) (average year of entry to US: 1996 [1950-2003]) who completed a freelist module listing foods they had started and stopped eating since resettling in the US. We employed principal components analysis on 24 food groups iteratively and examined differences across gender and time since arrival. RESULTS:The most common food pattern no longer consumed consisted of foods connected to a respondent's home country. Patterns of foods no longer consumed after migration were similar across gender and years in the US. Patterns of foods consumed after migration to the US differed by gender, particularly with women adopting patterns that included fruits and vegetables while men adopted patterns that included junk foods. CONCLUSIONS:We found that, among those who changed their diet post-migration, there are distinct differences in how individuals change their diet based on multiple factors.

[This corrects the article DOI: 10.1371/journal.pgph.0003065.].

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Data were gathered through a collaborative initiative to investigate impacts of the COVID-19 pandemic and related lockdowns on child and maternal health, economic hardships, and access to care for children and pregnant women by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. The data were gathered in Bamako, the capital city of Mali (population ∼2.9 million) between August and September of 2022 through a Health and Demographic Surveillance System (HDSS). Data collectors used a survey instrument specifically designed to measure household awareness, knowledge, and prevalence of COVID-19, as well as hardships that households experienced since the onset of the pandemic in March of 2020. The data are from two neighborhoods of Bamako, Banconi and Djicoroni; the Health and Demographic Surveillance System (HDSS) operating in these neighborhoods tracks the health of approximately 235,000 inhabitants. The data were collected using a stratified random sample of 454 households.

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003-04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease.

Data collection was implemented through an initiative by the Child Health and Mortality Prevention Surveillance (CHAMPS) Network to assess whether lockdowns and other social distancing policies during COVID-19 had implications for household economic status, maternal and child health, and healthcare accessibility for pregnant women and children. The data were collected from April 2021 until February 2022 from a population living in a rural community of Mozambique. This rural community is located within a Health and Demographic Surveillance System (HDSS) that operates in the Manhiça district of Maputo province. The survey instrument used for data collection was specifically designed to examine household awareness, knowledge, and prevalence of COVID-19; it was also designed to document hardships experienced by households during the pandemic period such as food insecurity, job losses and/or business closures of household members, and access to healthcare. The data are generalizable to a contiguous community in Manhiça, Mozambique of approximately 200,000 inhabitants.

Objectives To estimate the association of dietary practices with early life weight among children born in 2001 in the U.S. Methods The Early Childhood Longitudinal Study (ECLS-B) is a population-based cohort followed from 9 months to Kindergarten entry (n~5000). We employed an auto-regressive cross-lagged model to assess the impacts of dietary practices on weight stability over time. We calculated age- and sex-standardized BMI z-scores using WHO growth curves. Results BMI z-scores had a stable increase over time. Later age of solid food introduction was associated with lower BMI z-score at age 2y [-0.03(-0.05,-0.004)]; having dinners more times per week with family at age 2y was associated with higher BMI z-score at 4y [0.03(0.01,0.05)]. These changes, of <0.05 BMI z-score, are small. Children with higher birthweight were introduced to solid foods at younger ages [-0.39 months(-0.45,-0.32)] and were breast fed longer [0.13 months(0.04,0.22)]. For girls, having dinner at a regular time at ages 2y and 4y was associated with lower BMI at ages 4y and 5y. Conclusions Dietary practices in early childhood affect weight trajectories. However, these effects are small and are largely overshadowed by prior weight. Children’s weight in infancy is associated with subsequent dietary practices but also small effects.