Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings.

Background-Evidence suggests that minority populations have lower levels of attendance and retention in mental health care than non-Latino whites. Patient activation and empowerment interventions may be effective in increasing minority patients' attendance and retention.

Previous studies have documented diagnostic bias and noted that its reduction could eliminate misdiagnosis and improve mental health service delivery. Few studies have investigated clinicians' methods of obtaining and using information during the initial clinical encounter. We describe a study examining contributions to clinician bias during diagnostic assessment of ethnic/racial minority patients. A total of 129 mental health intakes were videotaped, involving 47 mental health clinicians from 8 primarily safety-net clinics. Videos were coded by another clinician using an information checklist, blind to the diagnoses provided by the original clinician. We found high levels of concordance between clinicians for substance-related disorders, low levels for depressive disorders, and anxiety disorders except panic. Most clinicians rely on patients' mention of depression, anxiety, or substance use to identify disorders, without assessing specific criteria. With limited diagnostic information, clinicians can optimize the clinical intake time to establish rapport with patients. We found Latino ethnicity to be a modifying factor of the association between symptom reports and likelihood of a depression diagnosis. Differential discussion of symptom areas, depending on patient ethnicity, may lead to differential diagnosis and increased likelihood of diagnostic bias. Diagnostic assessment bias occurs when clinicians make systematic errors in the collection or processing of clinical information that could lead to misdiagnosis, 6 false-positives, or falsenegatives. 7 Reducing diagnostic bias is one way to eliminate misdiagnosis 8 and improve service delivery. But identification of the patient's main problem, which is the foundation for the proper treatment of psychiatric disorders, is challenging given the level of unavoidable uncertainty in diagnostic decision making. 9 In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was expected to make substantial improvements to diagnostic formulation by offering a checklist of symptoms, whereby clinicians would first determine which diagnostic criteria were present, whether enough criteria had been fulfilled to justify the diagnosis, and then rule out medical conditions or other psychiatric conditions that could account for these symptoms. 10 However, it is not only the information collected in diagnostic assessment, but also how the information is applied in decision making that is critical for an accurate diagnosis. Paul Meehl 11 showed that "actuarial" methods (eg, formal, algorithmic procedures whereby symptoms are collected in a checklist and statistically analyzed to reach a prediction) for combining diagnostic information were superior to clinical judgments (eg, those that rely on human judgment to merge information, discuss it with others, and reach a diagnostic impression). Yet clinicians resist actuarial or statistical methods in diagnostic formulation. 12 A structured interview may seem to constrain clinicians to prescribed questions and cli...

IntroductionFood security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.MethodsWe surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.ResultsRespondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (βbusyness = −0.40; 95% confidence interval [CI], −0.52 to −0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (βtaste = −0.38; 95% CI, −0.60 to −0.15) and cost (βcost = −0.29; 95% CI, −0.44 to −0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.ConclusionPerceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.

ObjectiveTo conduct a secondary data analysis detailing overweight prevalence and associations between key hypothesised determinants and overweight.DesignThis observational study used publicly available data from the Indonesian Family Life Survey (IFLS) (1993–2014). The IFLS is a home-based survey of adults and children that collected data on household characteristics (size, physical infrastructure, assets, food expenditures), as well as on individual-level educational attainment, occupation type, smoking status and marital status. These analyses used data on the self-reported consumption of ultra-processed foods and physical activity. Anthropometrics were measured.SettingIndonesia.Primary outcome measuresWe described the distribution of overweight by gender among adults (body mass index (BMI) ≥25 kg/m2) and by age among children, over time. Overweight was defined as weight-for-height z-score >2 among children aged 0–5 years and as BMI-for-age z-score >1 among children aged 6–18 years. We also described individuals who were overweight by selected characteristics over time. Finally, we employed multivariable logistic regression models to investigate risk factors in relation to overweight in 2014.ResultsOne-third of adults were overweight in 2014. Between 1993 and 2014, the prevalence of overweight among adults doubled from 17.1% to 33.0%. The prevalence of overweight among children under 5 years increased from 4.2% to 9.4% between 1993 and 2007, but then remained relatively stagnant between 2007 and 2014. Among children aged 6–12 years and 13–18 years, the prevalence of overweight increased from 5.1% to 15.6% and from 7.1% to 14.1% between 1993 and 2014, respectively. Although overweight prevalence remains higher in urban areas, the increase in overweight prevalence was larger among rural (vs urban) residents, and by 2014, the proportions of overweight adults were evenly distributed in each wealth quintile. Data suggest that the consumption of ultra-processed foods was common and levels of physical activity have decreased over the last decade. In multivariable models, urban area residence, higher wealth, higher education and consumption of ultra-processed foods were associated with higher odds of overweight among most adults and children.ConclusionUrgent programme and policy action is needed to reduce and prevent overweight among all ages.

Objective: This longitudinal study aimed to measure precarious employment in the US using a multidimensional indicator. Methods: We used data from the National Longitudinal Survey of Youth (1988–2016) and the Occupational Information Network database to create a longitudinal precarious employment score (PES) among 7568 employed individuals over 18 waves (N=101 290 observations). We identified 13 survey indicators to operationalize 7 dimensions of precarious employment, which we included in our PES (range: 0–7, with 7 indicating the most precarious): material rewards, working-time arrangements, stability, workers’ rights, collective organization, interpersonal relations, and training. Using generalized estimating equations, we estimated the mean PES and changes over time in the PES overall and by race/ethnicity, gender, education, income, and region. Results: On average, the PES was 3.17 [standard deviation (SD) 1.19], and was higher among women (3.34, SD 1.20), people of color (Hispanics: 3.24, SD 1.23; non-Hispanic Blacks: 3.31, SD 1.23), those with less education (primary: 3.99, SD 1.07; high school: 3.43, SD 1.19), and with lower-incomes (3.84, SD 1.08), and those residing in the South (3.23, SD 1.17). From 1988 to 2016, the PES increased by 9% on average [0.29 points; 95% confidence interval (CI) 0.26–0.31]. While precarious employment increased over time across all subgroups, the increase was largest among males (0.35 points; 95% CI 0.33–0.39), higher-income (0.39 points; 95% CI 0.36–0.42) and college-educated (0.37 points; 95% CI 0.33–0.41) individuals. Conclusions: Long-term decreases in employment quality are widespread in the US. Women and those from racialized and less-educated populations remain disproportionately precariously employed; however, we observed large increases among men, college graduates and higher-income individuals.

; for the Child Health Epidemiology Reference Group Preterm Birth-SGA Working Group IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low-and middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7% (95% CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0% (95% CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95% CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95% CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth. We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.