Addressing social disadvantages that lead to obesity should be a public health priority. Obesity prevalence among children and adolescents has reached a plateau in countries with high income but it continues rising in low-income and middle-income countries. In high-income countries, an elevated prevalence of obesity is found among racial and ethnic minority groups and individuals from disadvantaged socioeconomic backgrounds. In addition to classic socioeconomic status (SES) factors, like income, parental education, and occupation, recent publications have linked parental social disadvantages, such as minimal social network, non-traditional family structure, migrant status and unemployment, with obesogenic behaviors and obesity among children. Socio-ecological models of obesity in children can explain the influence of classic SES factors, social disadvantages, culture, and genes on behaviors that could lead to obesity, contributing to the elevated prevalence of obesity. Obesity is a multifactorial disease in which multilevel interventions seem to be the most effective approach to prevent obesity in children, but previous meta-analyses have found that multilevel interventions had poor or inconsistent results. Despite these results, some multilevel interventions addressing specific disadvantaged social groups have shown beneficial effects on children's weight and energy balance-related behaviors, while other interventions have benefited children from both disadvantaged and non-disadvantaged backgrounds. Considering obesity as a worldwide problem, the World Health Organization, the European Commission, and the National Institutes of Health recommend the implementation of obesity prevention programs, but the implementation of such programs without taking into consideration social disadvantages may be an unsuccessful approach. Therefore, the present publication consists of a review of the pertinent literature related to social disadvantage and its consequences for behaviors that could lead to childhood obesity. In addition, we will discuss the relationship between social disadvantages and the socio-ecological model of obesity in children. Finally, we will summarize the relevant aspects of multilevel intervention programs aiming to prevent obesity in children and provide recommendations for future research and intervention approaches to improve weight status in children with social disadvantages.

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Background: There has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited. Objectives: Therefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents. Methods: The sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI zscore were covariates in the models. Two-parent biological families were set as the reference category. Results: Children from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40-0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39-4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91-5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99-5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations.

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants ( N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.

The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39–3.67, p < 0.001) and Eastern Europe (OR 1.55–2.47, p < 0.05), received more intensive intervention (OR 1.53–1.90, p = 0.002) and were younger (<40 years old) adults (OR 1.48–1.51, p < 0.05). Furthermore, individuals with tertiary education (OR 2.06, p < 0.001), who were unemployed (OR 1.62–1.68, p < 0.05) and perceived their body weight to be higher than normal (OR 1.58–3.00, p < 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024). These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations.

To effectively tackle obesity, it is necessary to identify all specific socioeconomic factors which contribute to its development. We aimed to highlight the prevalence of adult overweight/obesity in European countries and investigate the association of various socioeconomic factors and their accumulative effect on overweight/obesity status. Cross-sectional data from the Feel4Diabetes study for 24,562 adults residing in low socioeconomic areas were collected, representing Belgium, Finland, Greece, Spain, Bulgaria, and Hungary. Socioeconomic Burden Score (SEBS) was created, accounting for unemployment, financial insecurity, and education ≤ 12 years. Data were analyzed using analysis of variance and logistic regression. In total, 19,063 adults with complete data were included (34.5% overweight and 15.8% obese). The highest overweight/obesity rates occurred in Greece (37.5%/17.8%) and Hungary (35.4%/19.7%). After adjusting for confounders, age of <45 years and female sex were inversely associated with overweight/obesity, while low educational level (≤12 years), unemployment, and financial insecurity were positively associated. The increase in SEBS (clustering of socioeconomic disadvantages) was associated with increased overweight/obesity likelihood. This association of SEBS scores with overweight/obesity was evident for males and females across all examined countries, excluding males in low-income countries (Bulgaria and Hungary), where the highest SEBS score was inversely associated with overweight/obesity. The clustering burden of socioeconomic disadvantages on overweight/obesity was found to be influenced by the countries’ economic state and sex.

Background: Human Papillomavirus (HPV) is a common sexually transmitted infection among college students, a group still eligible for HPV vaccination. The President's Cancer Panel has identified missed opportunities in the promotion for catch-up vaccination for older adolescents and young adults, a group identified for cancer prevention. Community-academic alliances targeting college students can be used to improve HPV vaccination rates in those who have not initiated or completed the 3-doses series. Objective: The purpose of this ongoing effort is to build a community-academic alliance aiming to promote a sustainable infrastructure of research, outreach and service for HPV vaccination among college students. Methods: A multilevel approach consisting of a series of research and outreach activities; training, as well as vaccination clinics targeting college students or parents, has been implemented since December 2014. Our group, the Puerto Rico Community Cancer Control Outreach Program (PRCCCOP) from the U54 University of Puerto Rico (UPR) and the MD Anderson Cancer Center Partnership for Excellence in Cancer Research, established alliances with the Puerto Rico Comprehensive Cancer Control Program, the Puerto Rico Breast and Cervical Early Detection Program and the HPV Committee from the Puerto Rico Cancer Coalition. A new alliance with the UPR system served as the foundation to conduct these activities. Results: Research activities entitled ¡Habla de VPH! educated a total of 40 students and 468 parents. Both groups, significantly increased their HPV and HPV vaccine knowledge (from an average score of 66% and 72% up to an average score 95% and 93%, respectively) (p-value&lt;0.05). Outreach activities reached over 500 students; 34% of them want to receive notifications for future vaccination clinics. To this date, training activities such as capacity building of health professionals and train-the-trainers for peers reached a total of 71 participants. A total of 137 students attended to at least one of the 5 vaccination clinics held in two campuses, where more than half (61%; mean age=20 years old) received their first dose of the HPV vaccine. Conclusion: College students represent a captive community that can benefit from multiple activities, designed in partnerships, aiming to increase HPV vaccination uptake. Existing alliances of PRCCCOP were a facilitator in the design and development of those activities. Another facilitator for these effort was having a contact-person in campus, as part of the alliance, who helped navigate through the administrative process within campus, resulting in less time and resources involved by other alliance members. This ongoing alliance have various milestones: (1) the addition of new partners in the efforts of HPV vaccination uptake; (2) over one-thousand people reached with research, outreach or training activities; and (3) the effectiveness of the educational intervention ¡Habla de VPH! in increasing HPV knowledge. Despite these achievements, and understanding that our educational activities alone does not increase HPV vaccination, we developed a new plan to promote vaccination, with the implementation of vaccination clinics on campus. During the implementation of HPV vaccine clinics, other challenges emerged such as campus size, complexity and diversity of the groups within the university. To address these challenges, future activities will aim at specific targets within the campus, such as faculty or schools, and to engage more professors and students-groups in those specific targets. Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez-Alamo, Hernan Rosado-Carpena, Marievelisse Soto-Salgado, Marta Sanchez-Aracil, Omayra Salgado-Cruz, VOCES Puerto Rico Vaccination Coalition, Dianedis Toro, Shelciy Collazo-Castro, Maria Figueroa-Gonzalez, Willmar Contreras, Guillermo Tortolero-Luna, Maria E. Fernandez. Catching up: Building sustainable community-academic alliance to increase human papillomavirus vaccination uptake among college students. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A36.

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