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Slusser W, Schmidt L, Imbery C, Watson T, Moin T, Chobdee J, Alas S, Ezenwugo S, Sheean-Remotto G. Anchor universities as leaders in the well-being movement: lessons learned from the University of California Healthy Campus Network & pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-5. [PMID: 38848274 DOI: 10.1080/07448481.2024.2351407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/19/2024] [Indexed: 06/09/2024]
Abstract
The University of California (UC) Healthy Campus Network (HCN) is a robust network of diverse coalitions across 10 UC campuses, 5 UC teaching hospitals, and UC Agriculture & Natural Resources working to promote individual campus and systemwide changes toward a culture of health and equity. The success of this work has been evident in the HCN's ability to quickly pivot to meet emergent needs during the COVID-19 pandemic, including social support through the UC Diabetes Prevention Program, tap water access for essential workers through the UC Healthy Beverage Initiative, and food security efforts through the UC Global Food Initiative. Building a culture of health and equity across a large public university system generated valuable lessons learned which enhanced the UC's preparedness and resilience in the face of the pandemic, and other institutions may benefit from these best practices to respond effectively to emergencies and thrive in states of relative normalcy.
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Affiliation(s)
- Wendelin Slusser
- Chancellor's Office, University of California at Los Angeles, Los Angeles, California, USA
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Jonathan and Karin Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
| | - L Schmidt
- Philip R Lee Institute for Health Policy Studies and Department of Humanities and Social Sciences, University of California at San Francisco, San Francisco, California, USA
| | - C Imbery
- Chancellor's Office, University of California at Los Angeles, Los Angeles, California, USA
| | - T Watson
- Jonathan and Karin Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
| | - T Moin
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - J Chobdee
- Workplace Health & Wellness/Human Resources, University of California at Riverside, Riverside, California, USA
| | - S Alas
- Chancellor's Office, University of California at Los Angeles, Los Angeles, California, USA
| | - S Ezenwugo
- Chancellor's Office, University of California at Los Angeles, Los Angeles, California, USA
| | - G Sheean-Remotto
- Strategy and Program Management, University of California Office of the President, Oakland, California, USA
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Jacobs LM, Schmidt LA, Schillinger D, Schmidt JM, Alegria KE, Parrett B, Pickett A, Epel ES. Did a workplace sugar-sweetened beverage sales ban reduce anxiety-related sugar-sweetened beverage consumption during the COVID-19 pandemic? Public Health Nutr 2024; 27:e139. [PMID: 38698591 DOI: 10.1017/s1368980024000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Workplace sugar-sweetened beverage (SSB) sales bans can reduce SSB consumption. Because stress and anxiety can promote sugar consumption, we examined whether anxiety among hospital employees during the COVID-19 pandemic was associated with changes in SSB consumption and explored whether this relationship varied by exposure to a workplace SSB sales ban. DESIGN In a prospective, controlled trial of workplace SSB sales bans, we examined self-reported anxiety (generalised anxiety disorder-7) and self-reported SSB consumption (fluid ounces/d) before (July 2019) and during (May 2020) the COVID-19 pandemic. SETTING Hospital sites in two conditions (four with SSB sales bans and three without sales bans) in Northern California. PARTICIPANTS We sampled 580 participants (hospital employees) from a larger trial of sales bans; all were regular consumers of SSB (minimum 3/week at main trial enrollment). This subsample was chosen based on having appropriately timed data for our study questions. RESULTS Across conditions, participants reduced SSB consumption over the study period. However, participants with higher pandemic-era anxiety scores experienced smaller reductions in SSB consumption after 9 months compared with those with lower anxiety scores (β = 0·65, P < 0·05). When the sample was disaggregated by sales ban condition, this relationship held for participants in the control group (access to SSB at work, β = 0·82, P < 0·05), but not for those exposed to an SSB sales ban (β = 0·42, P = 0·25). CONCLUSIONS SSB sales bans likely reduce SSB consumption through multiple pathways; buffering stress-related consumption may be one mechanism.
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Affiliation(s)
- Laurie M Jacobs
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, USA
| | - Laura A Schmidt
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, USA
- Department of Humanities and Social Sciences, University of California at San Francisco, San Francisco, USA
| | - Dean Schillinger
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, USA
- UCSF Division of General Internal Medicine, San Francisco General Hospital, San Francisco, USA
- UCSF Center for Vulnerable Populations, San Francisco, USA
| | - Jamey M Schmidt
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, USA
| | - Katie E Alegria
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, San Francisco, USA
- Center for Health and Community, University of California at San Francisco, San Francisco, USA
| | - Bethany Parrett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, USA
| | - Amanda Pickett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, San Francisco, USA
- Center for Health and Community, University of California at San Francisco, San Francisco, USA
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Greenthal E, Marx K, Grossman ER, Ruffin M, Lucas SA, Benjamin-Neelon SE. Incentives and penalties tied to sales volume in contracts between beverage companies and public universities in the United States. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1279-1288. [PMID: 35623032 DOI: 10.1080/07448481.2022.2076098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 03/16/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess whether and how beverage companies incentivize universities to maximize sugar-sweetened beverage (SSB) sales through pouring rights contracts. METHODS Cross-sectional study of contracts between beverage companies and public U.S. universities with 20,000 or more students active in 2018 or 2019. We requested contracts from 143 universities. The primary measures were presence of financial incentives and penalties tied to sales volume. RESULTS 124 universities (87%) provided 131 unique contracts (64 Coca-Cola, 67 Pepsi). 125 contracts (95%) included at least one provision tying payments to sales volume. The most common incentive type was commissions, found in 104 contracts (79%). Nineteen contracts (15%) provided higher commissions or rebates for carbonated soft drinks compared to bottled water. CONCLUSIONS Most contracts between universities and beverage companies incentivized universities to market and sell bottled beverages, particularly SSBs. Given the health risks associated with consumption of SSBs, universities should consider their role in promoting them.
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Affiliation(s)
- Eva Greenthal
- Center for Science in the Public Interest, Washington, DC
| | - Katherine Marx
- Center for Science in the Public Interest, Washington, DC
| | - Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephanie A Lucas
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Schmidt JM, Epel ES, Jacobs LM, Mason AE, Parrett B, Pickett AM, Mousli LM, Schmidt LA. Controlled trial of a workplace sales ban on sugar-sweetened beverages. Public Health Nutr 2023; 26:2130-2138. [PMID: 37465952 PMCID: PMC10564602 DOI: 10.1017/s1368980023001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/16/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors. DESIGN A controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban n 315; control n 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban. SETTING Sutter Health, a large non-profit healthcare delivery system in Northern California. PARTICIPANTS Full-time employees at Sutter Health screened for heavy SSB consumption. RESULTS Participants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI -4·9, -0·5) fewer ounces of SSB per d while at work, and 4·3 (95 % CI -8·4, -0·2) fewer total ounces per d, compared to controls. Sales ban participants with an elevated BMI or waist circumference had greater post-intervention reductions in workplace SSB consumption. CONCLUSIONS Workplace sales bans can reduce SSB consumption in ethnically diverse employee populations, including those at higher risk for cardiometabolic disease.
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Affiliation(s)
- Jamey M Schmidt
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Laurie M Jacobs
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
| | - Ashley E Mason
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Bethany Parrett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Amanda M Pickett
- Sutter Health California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Leyla M Mousli
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
| | - Laura A Schmidt
- Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California at San Francisco, San Francisco, CA94143, USA
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Barrett EM, Hart AC, Bhat S, Marklund M, Coyle DH, Heenan M, Pettigrew S, Wu JH. The Effect of Retail Food Environment Interventions on Dietary Behavior in Postsecondary Education Settings: A Systematic Review and Meta-analysis. J Nutr 2023; 153:3122-3130. [PMID: 37741633 DOI: 10.1016/j.tjnut.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Postsecondary education institutions, where hundreds of millions of people work and study globally, are a key setting for retail food environment interventions. OBJECTIVE We aimed to synthesize the evidence for the effectiveness of retail food environment interventions in improving the healthiness of dietary behavior of students and staff in postsecondary education settings. METHODS Academic databases were searched for randomized controlled trials (RCTs) and quasi-experimental studies published until August 2023. Studies were eligible if they assessed the impact of a retail food environment intervention on healthiness of dietary behavior (purchases or consumption) in students or staff in postsecondary education settings and targeted one of the following food environment elements: placement, price, product, or promotion. Business-related outcomes (total sales, profit, or revenue) were included as secondary outcomes. Findings were synthesized in narrative form, organized by retail food environment element. Where comparable dietary outcome data were available from ≥10 interventions, findings were pooled using random effects meta-analysis. RESULTS Of 10,126 studies initially identified, 55 (76% quasi-experimental) were included, describing 71 separate interventions (n = 49 single-element and n = 22 multi-element). Two-thirds (n = 47, 66%) of interventions (n = 32 single-element and n = 15 multi-element) demonstrated significant improvements in dietary behavior. Single-element interventions targeting placement (n = 1) and price (n = 3) improved dietary behavior. Most (n = 9/10, 90%) interventions targeting product availability or convenience (product element) improved dietary behavior, while n = 19/35 (54%) targeting promotion did. Pooled findings from 12 interventions reporting changes in energy content demonstrated a significant decrease in purchased or consumed energy (-7.9%; 95% confidence interval: -10.3%, -5.6%). Almost all interventions (n = 11/12, 92%) that evaluated the impact on business-related outcomes found either a significant increase or no change following the intervention. CONCLUSIONS We established encouraging evidence supporting the role of retail food environment interventions in postsecondary education settings to support healthy dietary behaviors of students and staff. REGISTRY PROSPERO (International Prospective Register of Systematic Reviews, URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295836; registration number CRD42022295836).
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Affiliation(s)
- Eden M Barrett
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Ashleigh C Hart
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Saiuj Bhat
- Royal Perth Hospital, Victoria Square, Perth, Western Australia; School of Medicine, The University of Western Australia, Crawley, Western Australia
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Maddie Heenan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jason Hy Wu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Nguyen V, Ferdinand KC. Primordial prevention: Reducing consumption of sugar-sweetened beverages in racial/ethnic populations. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100278. [PMID: 38511089 PMCID: PMC10946006 DOI: 10.1016/j.ahjo.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 03/22/2024]
Abstract
Beyond pharmacotherapy in adulthood, primordial prevention in United States (U.S.) children and adolescents is needed to avoid the upcoming tsunami of cardiometabolic and cardiovascular disease (CVD). Healthcare disparities were unmasked by the disparate morbidity and mortality of COVID-19 in racial/ethnic populations, especially in persons with obesity, diabetes, and CVD. One potential successful strategic improvement of childhood cardiovascular health is to reduce sugar consumption in early life as CVD is the number one cause of death in patients with Type 2 diabetes (T2D). Furthermore, cardiologists treat more patients with T2D than endocrinologists. This commentary challenges cardiovascular specialists and other clinicians to address the increasing burden of cardiometabolic and CVD in adults, especially in racial/ethnic populations, by supporting primordial prevention in childhood.
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Affiliation(s)
- Vi Nguyen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Keith C. Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States of America
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Schillinger D, Bullock A, Powell C, Fukagawa NK, Greenlee MC, Towne J, Gonzalvo JD, Lopata AM, Cook JW, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission. Diabetes Care 2023; 46:e24-e38. [PMID: 36701595 PMCID: PMC9887620 DOI: 10.2337/dc22-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC's population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
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Affiliation(s)
- Dean Schillinger
- Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Clydette Powell
- Division of Neurology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi K. Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Jasmine D. Gonzalvo
- Center for Health Equity and Innovation, Purdue University/Eskenazi Health, Indianapolis, IN
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | | | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
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Pinho-Gomes AC, Dunford E, Jones A. Trends in sugar content of non-alcoholic beverages in Australia between 2015 and 2019 during the operation of a voluntary industry pledge to reduce sugar content. Public Health Nutr 2023; 26:287-296. [PMID: 36274642 PMCID: PMC11077450 DOI: 10.1017/s1368980022002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 09/14/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate changes in mean sugar content of non-alcoholic beverages (overall and sugar-sweetened beverages (SSB)) available for purchase in Australia and to compare signatories v. non-signatories of the Australian Beverages Council voluntary pledge from 2018. DESIGN Retrospective observational study. SETTING Australia. PARTICIPANTS About 1500 non-alcoholic beverages per year included in the FoodSwitch Monitoring Datasets for 2015-2019. RESULTS Overall, mean sugar content fell by 1·3 g/100 ml (17·1 %) from 7·5 g/100 ml in 2015 to 6·2 g/100 ml in 2019. SSB have accounted for about 56 % of all beverages available for purchase since 2015. Between 2015 and 2019, the sugar content of SSB dropped by about 10 % (0·8 g/100 ml). Soft drinks and milk-based drinks were the categories with the largest decrease in sugar content. The greater reduction in sugar observed for beverages overall than SSB suggests at least some of the overall decrease in sugar content is due to the appearance of new products with low or no sugar rather than reformulation. Over the same period, beverages with added non-nutritive sweeteners increased from 41 % to 44 %. The decrease in sugar content for all beverages and SSB was, in general, larger for non-signatories than signatories of the voluntary industry pledge. CONCLUSIONS Between 2015 and 2019, the small reduction in sugar content of non-alcoholic beverages in Australia resulted from the combined effects of introducing low- or no-sugar products and reformulation of some categories of SSB. Further policy and regulatory measures are required to reap the most benefit that sugar reduction among non-alcoholic beverages can bring to population health.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine of Population, King’s College London, London, UK
- The George Institute for Global Health, Imperial College London, 84 Wood Lane, LondonW12 0BZ, UK
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina, Chapel Hill, USA
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review. Nutrients 2022; 15:nu15010055. [PMID: 36615712 PMCID: PMC9823488 DOI: 10.3390/nu15010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.
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Grossman ER, Greenthal E, Marx K, Ruffin M, Lucas S, Benjamin-Neelon SE. Are Students Paid to Market Sugar-Sweetened Beverages to Peers? A Review of University Pouring Rights Contracts. Child Obes 2022; 18:533-539. [PMID: 35325554 DOI: 10.1089/chi.2021.0267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Many university students regularly consume sugar-sweetened beverages (SSBs), which are associated with obesity and related chronic diseases. Moreover, students are strongly influenced by both their peers and product marketing. Our exploratory study examined pouring rights contracts between universities and beverage companies, focusing on provisions establishing campus/brand ambassador positions and marketing/merchandising manager positions whose jobs are to market SSBs on campus. Methods: For this cross-sectional study conducted in late 2020, two independent coders reviewed 131 pouring rights contracts between Coca-Cola or Pepsi and 124 unique public universities with 20,000 or more students enrolled. Contracts were active in 2018 or 2019. Results: Twenty-six contracts (20%) contained provisions specifically establishing either campus/brand ambassador positions (n = 16), marketing/merchandising manager positions (n = 7), both (n = 1), or unclear language related to these positions (n = 2). Thirteen contracts (10%) required that the position be filled by a current student. The objectives for both types of positions included increasing revenue and driving beverage sales. When stated in the contracts (n = 5), the payments allocated for these positions ranged between $5,000 and $10,000 per year. Conclusions: Given the association between SSBs and obesity and other related health outcomes, combined with the influence that peers and product marketing may have on adolescents' and young adults' attitudes toward consumption of these beverages, universities should be more transparent when these provisions are included in their pouring rights contracts and should carefully consider whether it is appropriate for these contracts to include funding for students to market SSBs.
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Affiliation(s)
- Elyse R Grossman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, DC, USA
| | - Katherine Marx
- Center for Science in the Public Interest, Washington, DC, USA
| | - Martha Ruffin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie Lucas
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pressler M, Devinsky J, Duster M, Lee JH, Glick CS, Wiener S, Laze J, Friedman D, Roberts T, Devinsky O. Dietary Transitions and Health Outcomes in Four Populations - Systematic Review. Front Nutr 2022; 9:748305. [PMID: 35252289 PMCID: PMC8892920 DOI: 10.3389/fnut.2022.748305] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/03/2022] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Non-communicable chronic diseases (NCDs) such as obesity, type 2 diabetes, heart disease, and cancer were rare among non-western populations with traditional diets and lifestyles. As populations transitioned toward industrialized diets and lifestyles, NCDs developed. OBJECTIVE We performed a systematic literature review to examine the effects of diet and lifestyle transitions on NCDs. EVIDENCE REVIEW We identified 22 populations that underwent a nutrition transition, eleven of which had sufficient data. Of these, we chose four populations with diverse geographies, diets and lifestyles who underwent a dietary and lifestyle transition and explored the relationship between dietary changes and health outcomes. We excluded populations with features overlapping with selected populations or with complicating factors such as inadequate data, subgroups, and different study methodologies over different periods. The selected populations were Yemenite Jews, Tokelauans, Tanushimaru Japanese, and Maasai. We also review transition data from seven excluded populations (Pima, Navajo, Aboriginal Australians, South African Natal Indians and Zulu speakers, Inuit, and Hadza) to assess for bias. FINDINGS The three groups that replaced saturated fats (SFA) from animal (Yemenite Jews, Maasai) or plants (Tokelau) with refined carbohydrates had negative health outcomes (e.g., increased obesity, diabetes, heart disease). Yemenites reduced SFA consumption by >40% post-transition but men's BMI increased 19% and diabetes increased ~40-fold. Tokelauans reduced fat, dramatically reduced SFA, and increased sugar intake: obesity and diabetes rose. The Tanushimaruans transitioned to more fats and less carbohydrates and used more anti-hypertensive medications; stroke and breast cancer declined while heart disease was stable. The Maasai transitioned to lower fat, SFA and higher carbohydrates and had increased BMI and diabetes. Similar patterns were observed in the seven other populations. CONCLUSION The nutrient category most strongly associated with negative health outcomes - especially obesity and diabetes - was sugar (increased 600-650% in Yemenite Jews and Tokelauans) and refined carbohydrates (among Maasai, total carbohydrates increased 39% in men and 362% in women), while increased calories was less strongly associated with these disorders. Across 11 populations, NCDs were associated with increased refined carbohydrates more than increased calories, reduced activity or other factors, but cannot be attributed to SFA or total fat consumption.
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Affiliation(s)
- Mariel Pressler
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Julie Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Miranda Duster
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Joyce H. Lee
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Courtney S. Glick
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Samson Wiener
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Juliana Laze
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Daniel Friedman
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
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12
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Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
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Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
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13
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Sidossis A, Gaviola GC, Sotos-Prieto M, Kales S. Healthy lifestyle interventions across diverse workplaces: a summary of the current evidence. Curr Opin Clin Nutr Metab Care 2021; 24:490-503. [PMID: 34622825 DOI: 10.1097/mco.0000000000000794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Workplaces provide a unique opportunity to deliver health promotion interventions to their workers. This review summarizes evidence from the most recent studies (September 2019 to April 2021) of workplace healthy lifestyle interventions and identifies gaps in the literature and key aspects for successful future workplace lifestyle interventions. RECENT FINDINGS Recent intervention studies have focused on four health domains: (1) multicomponent wellness programs, (2) healthy diet interventions, (3) physical activity interventions, and (4) mental health/sleep interventions. Within each group of studies, there was significant heterogeneity in study length, intervention components, and worker populations. Nonetheless, most studies across all categories showed positive associations between healthy lifestyle interventions and improved worker health. SUMMARY Although recent literature has shown an overall positive trend between healthy lifestyle interventions implemented at the workplace and improvements in markers of health and wellbeing, further research should include longer follow-up periods, more objective measures of wellbeing, evaluation of worker performance, and analogous interventions between studies to identify the most effective interventions to improve worker health and wellness.
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Affiliation(s)
- Amalia Sidossis
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gabriel C Gaviola
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz)
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Stefanos Kales
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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14
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Boehm R, Cooksey Stowers K, Schneider GE, Schwartz MB. Race, Ethnicity, and Neighborhood Food Environment Are Associated with Adolescent Sugary Drink Consumption During a 5-Year Community Campaign. J Racial Ethn Health Disparities 2021; 9:1335-1346. [PMID: 34351612 PMCID: PMC9249719 DOI: 10.1007/s40615-021-01074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
Background A multi-level county-wide campaign to reduce sugary drink consumption was associated with significant decreases in retail sales of soda and fruit drinks. The aim of the current study was to examine changes in adolescent beverage consumption during the campaign by race/ethnicity and neighborhood food environment. Methods Beverage consumption among adolescents was evaluated at four time points in a repeated cross-sectional survey of a racially and ethnically diverse sample of sixth graders (N = 13,129) from public middle schools in the county. Each school’s surrounding attendance zone (i.e., neighborhoods where students live) was characterized as providing high or low exposure to unhealthy food retail (e.g., convenience stores, fast-food restaurants). Logistic and multiple linear regression models were used to evaluate changes in beverage consumption over time by student race/ethnicity and high versus low unhealthy food exposure. Results Over the 5 years, there were significant declines in the overall share of students who reported daily sugary drink consumption (49.4 to 36.9%) and their reported daily calories from these products (220 to 158 calories). However, disparities were observed, with higher levels of consumption among Black and Hispanic youth and among youth living in neighborhoods with more unhealthy food retail. Notably, Black students living in healthier neighborhood food environments reported significant decreases in daily consumption and calories after 5 years, while Black students living in neighborhoods with more convenience stores and fast-food outlets did not. Conclusion These findings suggest that both race/ethnicity and neighborhood food environments are important considerations when designing interventions to reduce sugary drink consumption among adolescents. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01074-9.
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Affiliation(s)
- Rebecca Boehm
- Food and Environment Program, Union of Concerned Scientists, Washington, DC, USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, CT, USA
| | | | - Marlene B Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT, USA.
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15
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Wojcicki JM, Lustig RH, Jacobs LM, Mason AE, Hartman A, Leung C, Stanhope K, Lin J, Schmidt LA, Epel ES. Longer Leukocyte Telomere Length Predicts Stronger Response to a Workplace Sugar-Sweetened Beverage Sales Ban: An Exploratory Study. Curr Dev Nutr 2021; 5:nzab084. [PMID: 34235373 PMCID: PMC8257411 DOI: 10.1093/cdn/nzab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Shorter leukocyte telomere length (LTL) is associated with increased risk of a number of metabolic diseases including insulin resistance and the development of type 2 diabetes mellitus. Shorter LTL is also associated with stress reactivity suggestive of a possible role for LTL to predict response to behavioral interventions. However, few studies have evaluated how interventions, such as weight loss or dietary changes, are associated with LTL changes or whether LTL can predict behavioral responses to interventions. OBJECTIVES We evaluated metabolic changes in relation to LTL changes and LTL at baseline in a cohort of at-risk adults in response to a 10-mo workplace-based sugar-sweetened beverage (SSB) intervention. METHODS At baseline, metabolic health and LTL measurements were assessed through standard blood draws on 212 participants. Multivariable linear regression models were used to assess changes in anthropometrics, SSB consumption, and 13 blood-based metabolic risk factors, in relation to LTL at baseline and changes in LTL. RESULTS Longer LTL at baseline was associated with decreases in SSB consumption over the 6-mo follow-up period (B = -29.67; P = 0.04). Slower LTL attrition rates were associated with decreases in waist circumference (B = -0.27; P = 0.03), HDL cholesterol (B = -0.20; P = 0.05), and apoA1 (B = -0.09; P = 0.01). CONCLUSIONS Longer LTL at baseline predicted a favorable overall response to a behavioral intervention: decreases in SSB consumption. Abdominal adiposity losses paralleled slower declines in LTL suggestive of overall health benefits, but we found differences in the relations between metabolic changes and LTL at baseline compared with LTL attrition rates. Longer LTL may be a proxy marker of a positive behavioral response.This trial was registered at clinicaltrials.gov as NCT02585336.
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Affiliation(s)
- Janet M Wojcicki
- Department of Pediatrics, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Robert H Lustig
- Department of Pediatrics, University of California, San Francisco, CA, USA
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Laurie M Jacobs
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Ashley E Mason
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA
| | - Alison Hartman
- Center for Health and Community, University of California, San Francisco, CA, USA
| | - Cindy Leung
- Department of Nutritional Science, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kimber Stanhope
- Department of Molecular Biosciences, University of California, Davis, CA, USA
| | - Jue Lin
- Department of Biophysics and Biochemistry, University of California, San Francisco, CA, USA
| | - Laura A Schmidt
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Center for Health and Community, University of California, San Francisco, CA, USA
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16
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Basu S, Jacobs LM, Epel E, Schillinger D, Schmidt L. Cost-Effectiveness Of A Workplace Ban On Sugar-Sweetened Beverage Sales: A Microsimulation Model. Health Aff (Millwood) 2021; 39:1140-1148. [PMID: 32634357 PMCID: PMC7968436 DOI: 10.1377/hlthaff.2019.01483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending—after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.
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Affiliation(s)
- Sanjay Basu
- Sanjay Basu is director of research and population health at Collective Health, in San Francisco, California, and a faculty member at the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts
| | - Laurie M Jacobs
- Laurie M. Jacobs is a researcher at the Institute for Health Policy, University of California San Francisco (UCSF), in San Francisco, California
| | - Elissa Epel
- Elissa Epel is a professor of psychiatry at UCSF
| | - Dean Schillinger
- Dean Schillinger is a professor of general internal medicine at UCSF
| | - Laura Schmidt
- Laura Schmidt is a professor of health policy in the School of Medicine and holds a joint appointment in the Philip R. Lee Institute for Health Policy Studies and the Department of Anthropology, History, and Social Medicine, all at UCSF
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17
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Mason AE, Schmidt L, Ishkanian L, Jacobs LM, Leung C, Jensen L, Cohn MA, Schleicher S, Hartman AR, Wojcicki JM, Lustig RH, Epel ES. A Brief Motivational Intervention Differentially Reduces Sugar-sweetened Beverage (SSB) Consumption. Ann Behav Med 2021; 55:1116-1129. [PMID: 33778854 PMCID: PMC8557363 DOI: 10.1093/abm/kaaa123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Environmental and behavioral interventions hold promise to reduce sugar-sweetened beverage (SSBs) consumption. Purpose To test, among frequent SSB consumers, whether motivations to consume SSBs moderated the effects of (a) a workplace SSB sales ban (environmental intervention) alone, and (b) a “brief motivational intervention” (BI) in addition to the sales ban, on changes in SSB consumption. Methods We assessed whether (1) baseline motivations to consume SSBs (craving, psychological stress, or taste enjoyment) impacted changes in daily SSB consumption at 6-month follow-up among frequent (>12oz of SSBs/day) SSB consumers (N = 214); (2) participants randomized to the BI (n = 109) versus to the sales ban only (n = 105) reported greater reductions in SSB consumption at follow-up; and (3) motivations to consume SSBs moderated any changes in SSB consumption. Results In response to the sales ban alone, individuals with stronger SSB cravings (+1 SD) at baseline showed significantly smaller reductions in daily SSB consumption at 6-month follow-up relative to individuals with weaker (−1 SD) SSB cravings (2.5 oz vs. 22.5 oz), p < .01. Receiving the BI significantly increased reductions for those with stronger SSB cravings: Among individuals with stronger cravings, those who received the BI evidenced significantly greater reductions in daily SSB consumption [M(SE) = −19.2 (2.74) oz] than those who did not [M(SE) = −2.5 (2.3) oz, p < .001], a difference of 16.72 oz. Conclusions Frequent SSB consumers with stronger SSB cravings report minimal reductions in daily SSB consumption with a sales ban only, but report greater reductions if they also receive a motivational intervention. Future multilevel interventions for institutions should consider both environmental and individualized multi-level interventions. Clinical Trial information NCT02585336.
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Affiliation(s)
- Ashley E Mason
- Osher Center for Integrative Medicine, University of California San Francisco (UCSF), San Francisco, USA.,Department of Psychiatry, UCSF, San Francisco, USA
| | - Laura Schmidt
- Phillip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, USA
| | - Laura Ishkanian
- Campus Life Services, UCSF Wellness Program, UCSF, San Francisco, USA
| | - Laurie M Jacobs
- Phillip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, USA
| | - Cindy Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Leeane Jensen
- Campus Life Services, UCSF Wellness Program, UCSF, San Francisco, USA
| | - Michael A Cohn
- Osher Center for Integrative Medicine, University of California San Francisco (UCSF), San Francisco, USA
| | | | - Alison R Hartman
- Department of Psychology, College of Arts & Sciences, Drexel University, Philadelphia, USA
| | | | - Robert H Lustig
- Phillip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, USA.,Department of Pediatrics, UCSF, San Francisco, USA
| | - Elissa S Epel
- Osher Center for Integrative Medicine, University of California San Francisco (UCSF), San Francisco, USA.,Department of Psychiatry, UCSF, San Francisco, USA.,Phillip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, USA.,Department of Psychiatry, Center for Health and Community, UCSF, San Francisco, USA
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18
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Liu Z, Chen C, Yu F, Yuan D, Wang W, Jiao K, Yang S, Zhang Y, Wang Y, Liu L, Xu H, Zhang Y, Zhu G, Hu B, Zhu J. Association of Total Dietary Intake of Sugars with Prostate-Specific Antigen (PSA) Concentrations: Evidence from the National Health and Nutrition Examination Survey (NHANES), 2003-2010. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4140767. [PMID: 33506014 PMCID: PMC7811566 DOI: 10.1155/2021/4140767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 12/05/2022]
Abstract
BACKGROUND There is increasing evidence that dietary intake of sugars may be a risk factor for prostate cancer (PCa) and elevate the concentration of serum prostate-specific antigen (PSA). However, there is limited evidence of the correlation between total dietary intake of sugars and serum PSA concentrations for adult American males. Herein, we evaluated the association between total dietary intake of sugars and serum PSA concentrations in men without a malignant tumor diagnosis in the United States (US) National Health and Nutrition Examination Survey (NHANES) database. Material and Methods. In this secondary data analysis, a total of 6,403 men aged ≥40 years and without malignant tumor history were included from 2003 to 2010. The independent variable of this study was the total dietary intake of sugars, and the dependent variable was serum PSA concentrations. Covariates included dietary, comorbidity, physical examination, and demographic data. RESULTS The average age of participants included in this study was 58.1 years (±13.6). After adjusting for the dietary, comorbidity, physical examination, and demographic data, we observed that a dietary intake increase of one gram of total dietary intake of sugars was associated with an increase of serum PSA concentrations by 0.003 ng/mL (after log2 transformed, 95% CI: 0.001 to 0.005) with a P value for trend less than 0.05. Sensitivity analysis using the generalized additive model (GAM) supported the linear association between total dietary intake of sugars and serum PSA concentrations. CONCLUSION The total dietary intake of sugars is independently and positively associated with serum PSA concentrations in adult American males who are without a personal history of malignant tumors.
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Affiliation(s)
- Zhangcheng Liu
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
- Department of Urology, The Second People's Hospital of Neijiang, Neijiang, Sichuan Province 641000, China
| | - Chi Chen
- Department of Immunology and Microbiology, Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou Province 550001, China
| | - Fuxun Yu
- The National Health Commission's Key Laboratory of Immunological Pulmonary Disease, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province 550002, China
| | - Dongbo Yuan
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Wei Wang
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Ke Jiao
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Shengbang Yang
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First Municipal People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province 510180, China
| | - Yongqiang Zhang
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Yong Wang
- Department of Urology, The Second People's Hospital of Neijiang, Neijiang, Sichuan Province 641000, China
| | - Linhai Liu
- Department of Urology, The Second People's Hospital of Neijiang, Neijiang, Sichuan Province 641000, China
| | - Huali Xu
- Department of Urology, The Second People's Hospital of Neijiang, Neijiang, Sichuan Province 641000, China
| | - Yang Zhang
- Department of Urology, The Second People's Hospital of Neijiang, Neijiang, Sichuan Province 641000, China
| | - Guohua Zhu
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Bin Hu
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
| | - Jianguo Zhu
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province 550002, China
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First Municipal People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province 510180, China
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Leung CW, Wolfson JA, Hsu R, Soster K, Mangan S, Falbe J. Warning Labels Reduce Sugar-Sweetened Beverage Intake among College Students. J Nutr 2020; 151:179-185. [PMID: 33245125 PMCID: PMC7779215 DOI: 10.1093/jn/nxaa305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Health-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established. OBJECTIVES We investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university. METHODS We conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics. RESULTS In the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P = 0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P = 0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites. CONCLUSIONS Warning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.
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Affiliation(s)
| | - Julia A Wolfson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Robert Hsu
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Keith Soster
- Michigan Dining, University of Michigan, Ann Arbor, MI, USA
| | - Steve Mangan
- Michigan Dining, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, Davis, CA, USA
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Ultraprocessed Food: Addictive, Toxic, and Ready for Regulation. Nutrients 2020; 12:nu12113401. [PMID: 33167515 PMCID: PMC7694501 DOI: 10.3390/nu12113401] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
Past public health crises (e.g., tobacco, alcohol, opioids, cholera, human immunodeficiency virus (HIV), lead, pollution, venereal disease, even coronavirus (COVID-19) have been met with interventions targeted both at the individual and all of society. While the healthcare community is very aware that the global pandemic of non-communicable diseases (NCDs) has its origins in our Western ultraprocessed food diet, society has been slow to initiate any interventions other than public education, which has been ineffective, in part due to food industry interference. This article provides the rationale for such public health interventions, by compiling the evidence that added sugar, and by proxy the ultraprocessed food category, meets the four criteria set by the public health community as necessary and sufficient for regulation—abuse, toxicity, ubiquity, and externalities (How does your consumption affect me?). To their credit, some countries have recently heeded this science and have instituted sugar taxation policies to help ameliorate NCDs within their borders. This article also supplies scientific counters to food industry talking points, and sample intervention strategies, in order to guide both scientists and policy makers in instituting further appropriate public health measures to quell this pandemic.
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21
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The University of British Columbia healthy beverage initiative: changing the beverage landscape on a large post-secondary campus. Public Health Nutr 2020; 24:125-135. [PMID: 32943122 DOI: 10.1017/s1368980020003316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Environmental interventions are more effective at changing nutrition behaviour than educational campaigns alone. As part of their health promotion efforts, the University of British Columbia (UBC) developed the Healthy Beverage Initiative (HBI) to ultimately reduce the consumption of sugar-sweetened beverages (SSB) on campus. We describe the development, implementation, preliminary evaluation and future of the HBI. DESIGN Naturalistic observation of environmental changes to induce behaviour change. SETTING Large urban research university campus. PARTICIPANTS University community members and campus visitors. RESULTS Three main activities have been implemented since the initiation of the UBC HBI: renegotiation of the cold beverage agreement, a media campaign to promote tap water consumption and the removal of SSB from select retail locations on campus (residence dining hall). No significant loss of revenue was observed following the removal of SSB from a residence dining hall compared with similar locations. Compensatory purchasing behaviour of SSB was not observed at the closest retail locations where they were still available. After the removal of SSB, ~75% of survey respondents were not aware that the beverages had been removed. CONCLUSIONS The implementation of the HBI has met little resistance from the UBC community. The removal of SSB from residence dining locations did not result in any significant revenue loss or compensatory purchasing behaviour. This suggests that environmental intervention initiatives appear to be a viable option that may reduce SSB consumption on post-secondary campuses.
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Abstract
PURPOSE OF REVIEW This review is an assessment of the state of the science on nutrition disparities and their contribution to disparities in cardiovascular health. RECENT FINDINGS Nutrition disparities remain pervasive by race/ethnicity, sex/gender, socioeconomic status, and geography. They are rooted in differences in social, cultural, and environmental determinants of health, behavioral and lifestyle factors, and the impact of policy interventions. Systematic differences in diet quality, dietary patterns, and nutrient intakes contribute to cardiovascular disparities and are mediated by microbiota, and CVD risk factors including high levels of blood pressure, low density lipoprotein cholesterol (LDL), and glucose; oxidative stress, pro-inflammatory cytokines, and endothelial dysfunction. Despite the progress made in nutrition research, important gaps persist that signal the need for more effective interventions at multiple levels to reduce cardiovascular disparities. Research opportunities include (1) exploring the gene-nutrient-environment interactions in the context of ancestral diversity; (2) investigating the causal link between diet and gut microbiota and impact of social determinants of health; (3) understanding resilience; (4) testing the effectiveness of multi-level interventions that address social and environmental determinants; and (4) supporting intervention research informed by validated implementation science frameworks.
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Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6705 Rockledge Drive, Suite 6070, Bethesda, MD, 20892, USA.
| | - Alison G M Brown
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
| | - Charlotte A Pratt
- Division of Cardiovascular Sciences, NHLBI, NIH, 6710 Rockledge Drive, Suite 10115, Bethesda, MD, 20892, USA
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Duong TV. A workplace sales ban and motivational intervention can reduce sugar-sweetened beverage intake and improve cardiometabolic health. Evid Based Nurs 2020; 24:43. [PMID: 32132123 DOI: 10.1136/ebnurs-2019-103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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