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The “omnibus” hypothesis, as forwarded by Ford and Dzewaltowski (2008), asserts that poor-quality food environments differentially affect low- and high-socioeconomic status (SES) populations. Accordingly, we examine, in a large sample of non-Hispanic (NH) black women, whether low access to healthy food corresponds with increased risk of obesity among residents of low- and high-poverty neighborhoods. In addition, we analyze whether any discovered association between low-food access and obesity appears stronger in neighborhoods with a high proportion of black residents. We retrieved body mass index (BMI) data for 97,366 NH black women residing in 6258 neighborhoods from the California Department of Public Health birth files for years 2007-2010. We linked BMI data with census tract-level data on neighborhood food access from the 2010 Food Access Research Atlas and neighborhood poverty and black composition from the 2006-2010 American Community Survey 5-year estimates. We applied generalized estimating equation methods that permit analysis of clustered data within neighborhoods. Methods also controlled for individual-level characteristics which might confound the relation between food access and obesity, including health insurance status, age, education, and parity. Results indicate that low-food access does not impact risk of obesity among NH black women residing in low-poverty neighborhoods. However, low-food access varies positively with risk of obesity in high-poverty neighborhoods. Moreover, the association between low-food access and obesity appears stronger in high-poverty, high-black composition neighborhoods, relative to high-poverty, low-black composition neighborhoods. Our findings support the omnibus hypothesis and indicate a potential interaction between factors in the local food and social environments on an individual’s risk of obesity.

Background Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding. Methods We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father’s involuntary job loss during his spouse’s pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs. Results Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers’ unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth. Conclusions Findings support the inference that a father’s unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.

Background The Kingdom of Saudi Arabia (KSA), as part of its 2030 National Transformation Program, set a goal of transforming the healthcare sector to increase access to, and improve the quality and efficiency of, health services. To assist with the workforce planning component, we projected the needed number of physicians and nurses into 2030. We developed a new needs-based methodology since previous global benchmarks of health worker concentration may not apply to the KSA. Methods We constructed an epidemiologic “needs-based” model that takes into account the health needs of the KSA population, cost-effective treatment service delivery models, and worker productivity. This model relied heavily on up-to-date epidemiologic and workforce surveys in the KSA. We used demographic population projections to estimate the number of nurses and physicians needed to provide this core set of services into 2030. We also assessed several alternative scenarios and policy decisions related to scaling, task-shifting, and enhanced public health campaigns. Results When projected to 2030, the baseline needs-based estimate is approximately 75,000 workers (5788 physicians and 69,399 nurses). This workforce equates to 2.05 physicians and nurses per 1000 population. Alternative models based on different scenarios and policy decisions indicate that the actual needs for physicians and nurses may range from 1.64 to 3.05 per 1000 population in 2030. Conclusions Based on our projections, the KSA will not face a needs-based health worker shortage in 2030. However, alternative model projections raise important policy and planning issues regarding various strategies the KSA may pursue in improving quality and efficiency of the existing workforce. More broadly, where country-level data are available, our needs-based strategy can serve as a useful step-by-step workforce planning tool to complement more economic demand-based workforce projections.