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Infant mortality has long been viewed as a synoptic indicator of the health and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particular emphasis on how new health care technologies may have altered traditional pathways of social influence. The infant mortality rate is a composite of a series of component rates, each with its own relationship to social factors. Advances in health care have reduced dramatically the risk of mortality for the critically ill newborn, thereby elevating the importance of access to this care in shaping absolute and disparate infant mortality rates. These advances in health services technology have also had the effect of concentrating infant mortality among extremely premature and low birth-weight infants, a group tied directly to social factors operating through maternal influences and the general well-being of women.In this manner, current patterns of infant mortality in the United States provide a useful illustration of the dynamic interaction of underlying social forces and technological innovation in determining trends in health outcomes. We review the implications of this perspective for sociological research into disparate infant mortality, including the social and economic structure of societies, access to health services, the potential for prenatal intervention, women's health status, and racial and ethnic disparities.

National data suggest that children are not consuming enough water. Experimental evidence has linked increased water consumption to obesity prevention, and the National AfterSchool Association has named serving water as ones of its standards for healthy eating and physical activity in out‐of‐school time settings. From fall 2010 to spring 2011, twenty Boston afterschool program sites participated in the Out‐of‐School Nutrition and Physical Activity (OSNAP) initiative, a group‐randomized trial investigating nutrition and physical activity policies and practices that promote child health. Researchers used data from OSNAP to study the key factors that influence the implementation of practices that promote water intake. Aspects of the organizational capacity of the afterschool programs, characteristics of the providers, and the community context were hypothesized to impact changes in children's water consumption. This chapter demonstrates the effectiveness of an afterschool intervention on increases in children's water consumption. It also outlines the substantial influence that implementation factors can have on the effectiveness of an obesity prevention intervention, highlighting the importance of understanding how interventions are delivered in real‐world settings.

Nationally representative data from the National Health Examination Cycle 2 & Cycle 3 Surveys (N = 1,745 children), conducted in 1963-1965 when Ss were ages 6-11, & again at ages 12-17, are used to examine the effects of TV viewing on mental abilities. Simple analysis at just one time-point reveals substantial relationships between the amount of TV viewing & depressed IQ & Wide Range Achievement Test (Reading & Arithmetic) scores of adolescents. When longitudinal controls are added, however, these relationships become statistically insignificant & substantively unimportant. Although these data are 20 years old, they indicate no significant casual relationship between the amount of TV viewed & the mental aptitude & achievement test scores of adolescents. 4 Tables, 23 References. AA

Purpose. Lack of physical activity is associated with increased risk of overweight and cardiovascular disease, conditions associated with lower socioeconomic status (SES). Associations between activity levels of urban youth and limited access to safe recreation areas in their neighborhoods of residence were investigated. Design. Analyses of data from the Project on Human Development in Chicago Neighborhoods, a multilevel longitudinal study of families and communities, are reported. Setting. Chicago, Illinois. Subjects. Individual-level data were obtained from 1378 youth 11 to 16 years old and caregivers living in 80 neighborhood clusters. Neighborhood-level data were collected from 8782 community residents and videotapes of 15,141 block faces. Measures. Parental estimates of hours youth spent in recreational programming were used to estimate physical activity. A scale of residents' assessment of neighborhood safety for children's play was created; disorder measures came from videotaped observations. Results. Physical activity averaged 2.7 hours/week (SD = 5.0), varying significantly across neighborhoods. Using hierarchical linear regression, SES, age, and male gender, but not body mass index, were independently associated with physical activity. Lower neighborhood safety and social disorder were significantly associated with less activity, controlling for demographics. Conclusions. One mechanism for reduced physical activity among youth may be the influence of unsafe neighborhoods. Neighborhood interventions to increase safety and reduce disorder may be efficacious in increasing physical activity, thereby reducing risk of overweight and cardiovascular disease.

Purpose. To study informal skill transfer via staff networks as a complement to formal training among afterschool childcare providers implementing a health promotion program. Design. Cross-sectional, sociometric network analysis. Setting. Boston Young Men's Christian Association (YMCA) afterschool programs implementing the iPLAY program. Participants. All 91 staff members at 20 sites were eligible; 80 completed the survey (88% response rate). Measures. At the network level, network density measured system-level connectedness. At the staff level, the independent variable was out degree, the number of individuals to whom respondents noted a program-related connection. The dependent variable was skill gains, the number of key implementation skills gained from the network. Analysis. We mapped the staff program-related social network. We utilized multiple linear regression to estimate the relationship between out degree and skill gains, and we adjusted for clustering of staff in sites. Results. Most staff (77%) reported gaining at least one skill from the network, but only 2% of potential network connections were established. The regression model showed that out degree (i.e., number of program-related contacts) was significantly associated with skill gains (β = .48, p < .01) independent of other variables. Conclusion. Informal skill transfer in staff networks may be a useful complement to formal training for implementation of health promotion programs, but informal skill transfer was likely underutilized in this network. Future research employing longitudinal and/or multisite data should examine these findings in greater detail.

The Healthy, Hunger-Free Kids Act of 2010 strengthened nutrition standards for meals and beverages provided through the National School Lunch, Breakfast, and Smart Snacks Programs, affecting fifty million children daily at 99,000 schools. The legislation's impact on childhood obesity is unknown. We tested whether the legislation was associated with reductions in child obesity risk over time using an interrupted time series design for 2003–18 among 173,013 youth in the National Survey of Children's Health. We found no significant association between the legislation and childhood obesity trends overall. For children in poverty, however, the risk of obesity declined substantially each year after the act's implementation, such that obesity prevalence would have been 47 percent higher in 2018 if there had been no legislation. These results suggest that the Healthy, Hunger-Free Kids Act's science-based nutritional standards should be maintained to support healthy growth, especially among children living in poverty.

Purpose: We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water. Design: Cross-sectional survey of the US public collected from August to November 2011. Setting: Random digit-dialed telephone survey. Participants: Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states. Measures: Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings. Analysis: Survey-adjusted perceived safety and taste as well as support for required access were estimated. Results: There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%). Conclusion: This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings.

Purpose. To test effectiveness of Active School Day policy implementation on physical activity outcomes and estimate school-level implementation costs. Design. The design of the study was quasi-experimental (pretest–posttest matched controls). Setting. The study took place in six elementary schools with three matched pairs in Boston, Massachusetts, February to June 2011. Subjects. Subjects were 455 consenting fourth- and fifth-grade students among 467 eligible. Intervention. Active School Day policy implementation provided equipment, curricular materials, and training to physical educators and school wellness champions to promote 150 weekly minutes of quality physical education, recess, and physical activity integrated into classrooms. Measures. Accelerometer assessments of accumulated minutes and bouts of moderate, vigorous, and sedentary physical activity on 5 school days before and after implementation were used. Implementation costs were collected by record review and reported resource utilization. Analysis. Analysis was conducted using multivariate mixed models estimated with repeated measures of daily physical activity, adjusted for student demographics and other confounding and design/clustering variables. Results. Accelerometer data were provided by 201 intervention and 192 comparison students for an average of 4 days per period (84% response). During school time, students in intervention schools demonstrated greater increases in minutes per day of moderate-to-vigorous physical activity (3.9, 95% confidence interval [CI] 1.8–6.0; p < .001) and vigorous physical activity (1.8, 95% CI.7–3.0; p < .001), and greater decreases in minutes per day of sedentary time (–10.6, 95% CI—15.3– −5.8; p < .001) than controls. Ongoing annual implementation costs totaled $4,523/school ($14/student). Conclusion. Active School Day implementation increased student moderate-to-vigorous physical activity levels by 24% and decreased sedentary time during school at modest cost.

SummaryPrior studies examining the association between self-reported experiences of racial/ethnic discrimination and obesity have had mixed results and primarily been cross-sectional. This study tests the hypothesis that an increase in self-reported experiences of racial/ethnic discrimination predicts gains in waist circumference and body mass index in Black and White women and men over eight years. In race/ethnicity- and gender-stratified models, this study examined whether change in self-reported experiences of racial/ethnic discrimination predicts changes in waist circumference and body mass index over time using a fixed-effects regression approach in SAS statistical software, providing control for both measured and unmeasured time-invariant covariates. Between 1992–93 and 2000–01, self-reported experiences of racial/ethnic discrimination decreased among 843 Black women (75% to 73%), 601 Black men (80% to 77%), 893 White women (30% to 23%) and 856 White men (28% to 23%). In fixed-effects regression models, controlling for all time-invariant covariates, social desirability bias, and changes in education and parity (women only) over time, an increase in self-reported experiences of racial/ethnic discrimination over time was significantly associated with an increase in waist circumference (β=1.09, 95% CI: 0.00–2.19, p=0.05) and an increase in body mass index (β=0.67, 95% CI: 0.19–1.16, p=0.007) among Black women. No associations were observed among Black men and White women and men. These findings suggest that an increase in self-reported experiences of racial/ethnic discrimination may be associated with increases in waist circumference and body mass index among Black women over time.