Background: Disparities in cardiovascular disease (CVD) outcomes persist across the United States. Social determinants of health play an important role in driving these disparities. The current study aims to identify the most important social determinants associated with CVD mortality over time in US counties. Methods and Results: The authors used the Agency for Healthcare Research and Quality's database on social determinants of health and linked it with CVD mortality data at the county level from 2009 to 2018. The age‐standardized CVD mortality rate was measured as the number of deaths per 100 000 people. Penalized generalized estimating equations were used to select social determinants associated with county‐level CVD mortality. The analytic sample included 3142 counties. The penalized generalized estimating equation identified 17 key social determinants of health including rural–urban status, county's racial composition, income, food, and housing status. Over the 10‐year period, CVD mortality declined at an annual rate of 1.08 (95% CI, 0.74–1.42) deaths per 100 000 people. Rural counties and counties with a higher percentage of Black residents had a consistently higher CVD mortality rate than urban counties and counties with a lower percentage of Black residents. The rural–urban CVD mortality gap did not change significantly over the past decade, whereas the association between the percentage of Black residents and CVD mortality showed a significant diminishing trend over time. Conclusions: County‐level CVD mortality declined from 2009 through 2018. However, rural counties and counties with a higher percentage of Black residents continued to experience higher CVD mortality. Median income, food, and housing status consistently predicted higher CVD mortality.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Data on adolescents’ physical activity and determinants are scarce in Nepal. In this study, we aim to assess the level of physical activity, its correlates and the sedentary behavior of high school students in an urban district of Nepal. This is a cross-sectional study. Participants were selected using two-stage cluster sampling technique. We used Global Physical Activity Questionnaire (GPAQ) to collect information regarding physical activity and sedentary behavior. We also collected information about socio-demographic, academic, environmental and lifestyle-related factors. Data from 945 high school students from 23 randomly selected schools were analyzed. Logistic regression was used to identify correlates of low physical activity separately for male and female students. Based on GPAQ classification, one out of five respondents reported low physical activity. The prevalence of low physical activity was 8% for males and 31% for females. About 31% of the adolescents and 14% of young adults did not meet the WHO recommendations of physical activity. Forty-seven percent of the total physical activity was borne by recreational activities. Correlates of low physical activity included school type and mode of transport among females, family support and drinking among males, and playground/park around home among both. The prevalence estimate of low physical activity among adolescents is high, with higher odds among females. Several different factors are associated with physical activity among males and females, therefore, interventions to promote physical activity in school may need to weigh these factors prior to/during implementation.

Students live outside of their family homes for the first time in college and are expected to make their own decisions regarding dietary choices. College food environment could be a major determinant of dietary intake and is of importance in relation to obesity. This research determines the impact of removing cafeteria trays on student’s food choice. A quasi experimental pre-post research with control treatment was conducted in university dining halls. The participants were the dining hall patrons at a large public university in Southern US, spring 2015. The dining hall trays were removed from the intervened dining hall for five consecutive days during regular university session. Outcome measures of food choice were collected by observing tray waste before and after the tray removal in the intervened dining hall with parallel observation in the control dining hall. Difference-in-difference analysis was done to find the intervention effect. A total of 3153 trays were observed (N = 1564 in control and N = 1589 in intervention dining). Removal of trays resulted in a significant decrease in the total number of lunch plates (1.76 vs 1.66 servings, p < .006), drink glasses (1.32 vs 1.02 servings, p < .0001), dishes with leftovers (0.56 vs 0.39 serving, P < .001), and lunch plates with leftovers (0.51 vs 0.35 servings, p < .005). Student food choices can be affected by removing trays from dining halls, specifically favoring fewer beverages, and without sacrificing salad consumption. Studies with more precise measures of tray waste are needed to understand the direct effect on energy and nutrient consumption.

Previous studies have reported a “weekend effect” on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays. We aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mortality in rural and urban hospitals in the US. We used data from the 2016 National Inpatient Sample and used logistic regression to assess in-hospital mortality for weekday and weekend admissions among stroke patients aged 18 and older by stroke type (ischemic or hemorrhagic) and rural or urban status. Crude stroke mortality was higher in weekend admissions (p <0.001). After adjusting for confounding variables, in-hospital mortality among hemorrhagic stroke patients was significantly greater (22.0%) for weekend admissions compared to weekday admissions (20.2%, p = 0.009). Among rural hospitals, the in-hospital mortality among hemorrhagic stroke patients was also greater among weekend admissions (36.9%) compared to weekday admissions (25.7%, p = 0.040). Among urban hospitals, the mortality of hemorrhagic stroke patients was 21.1% for weekend and 19.6% for weekday admissions (p=0.026). No weekend effect was found among ischemic stroke patients admitted to rural or urban hospitals. Our results help to understand mortality differences in hemorrhagic stroke for weekend vs. weekday admissions in urban and rural hospitals. Factors such as density of care providers, stroke centers, and patient level risky behaviors associated with the weekend effect on hemorrhagic stroke mortality need further investigation to improve stroke care services and reduce weekend effect on hemorrhagic stroke mortality.

Introduction In the United States, physical activity (PA) among adolescents is declining; 75% of high school students do not meet daily PA guidelines. Low rates of PA are more prevalent among high school girls. Schools provide an optimal environment to target and promote PA. However, school climate has not yet been studied for its importance in promoting PA among high school students, particularly girls. Methods A cross-sectional analysis was conducted using the Georgia Student Health Survey (GSHS) 2.0 data on perceptions of different school climate measures and self-reported weekly PA levels to study gender differences in the association of PA with school climate. Results Data from a total of 362,926 students (48% males and 52% females) were analyzed. For both genders, the odds of being physically active increased with a more positive report of supportive school environments, school connectedness, peer social support, school physical environments, cultural acceptance, school safety, and adult social support. Peer victimization was associated with increased odds of PA among females but lower odds for males. Conclusion Results suggest that improving school climate can increase PA among adolescents. As new or existing school-based interventions and policies are considered by states and local governments, improving the school climate should be part of the overall strategy. Future research is needed on peer victimization among physically active females. Implications and Contributions This study evaluated gender differences in the association between measures of school climate and PA among high school students. School climate or policies fostering positive environments including feelings of safety, connectedness, and peer support may increase adolescent PA; addressing peer victimization and fights may reduce gender disparities in PA.