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Williams PA, Rotunda W, Porterfield D, Skeete RA, Smith AD, Proia KK. Implementation of Session Zero as a Recruitment Strategy in the National Diabetes Prevention Program's Lifestyle Change Program. Sci Diabetes Self Manag Care 2024; 50:74-86. [PMID: 38158815 PMCID: PMC10995983 DOI: 10.1177/26350106231215767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of the study was to understand the extent to which organizations offering the Centers for Disease Control and Prevention's (CDC) National Diabetes Prevention Program (National DPP) lifestyle change program implement session zero (a pre-enrollment session designed to recruit, engage, and enroll participants in programs), the stated purpose(s) for offering session zero, the content of session zero, and best practices for using session zero for recruitment. METHODS Researchers conducted a survey of all organizations offering the National DPP lifestyle change program that were registered with the CDC's Diabetes Prevention Recognition Program and their affiliated delivery locations. RESULTS Most (79.5%) delivery locations reported implementing session zero; of these, most used session zero as a recruitment strategy (81.1%) and orientation session (72.8%), whereas few (17.7%) used session zero solely to complete participant enrollment paperwork. Most (60.7%) delivery locations that implement session zero offer all their sessions at the same location, offer one session per upcoming participant cohort (66.7%), and use a consistent agenda (83.0%). Out of a list of activities informed by behavior change theory, the most common was offering an opportunity to enroll in the year-long lifestyle change program at the end of session zero (71.1%). CONCLUSIONS Most National DPP delivery locations implement session zero as a recruitment and orientation session. Most delivery locations reported including some activities informed by behavior change theory, but delivery locations could offer more theoretically informed activities during their session zero. The findings provide practice-based considerations for implementing session zero for recruitment into lifestyle change programs.
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Affiliation(s)
| | - Wendi Rotunda
- RTI International, Research Triangle Park, North Carolina
| | | | | | - Akimi D Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista K Proia
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Essman M, Burgoine T, Cameron A, Jones A, Potvin Kent M, Polden M, Robinson E, Sacks G, Smith RD, Vanderlee L, White C, White M, Hammond D, Adams J. A multi-country comparison of jurisdictions with and without mandatory nutrition labelling policies in restaurants: analysis of behaviours associated with menu labelling in the 2019 International Food Policy Study. Public Health Nutr 2023; 26:2595-2606. [PMID: 37661595 PMCID: PMC10641604 DOI: 10.1017/s1368980023001775] [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: 10/21/2022] [Revised: 07/06/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups. DESIGN Cross-sectional data from the International Food Policy Study (IFPS) online survey. SETTING IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019. PARTICIPANTS Adults aged 18-99; n 19 393. RESULTS Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy. CONCLUSIONS Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
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Affiliation(s)
- Michael Essman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Thomas Burgoine
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Adrian Cameron
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Andrew Jones
- School of Psychology, Liverpool John Moore’s University, Liverpool, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Megan Polden
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Eric Robinson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Gary Sacks
- Institute for Health Transformation, Deakin University, Burwood, Australia
| | | | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, Canada
| | - Christine White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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McCurley JL, Buckholtz JW, Roberto CA, Levy DE, Anderson EM, Chang Y, Thorndike AN. The association of impulsivity with effects of the ChooseWell 365 workplace nudge intervention on diet and weight. Transl Behav Med 2023; 13:281-288. [PMID: 36548448 PMCID: PMC10182420 DOI: 10.1093/tbm/ibac103] [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] [Indexed: 12/24/2022] Open
Abstract
Impulsivity is associated with unhealthy food choices. Nudge interventions in the food environment may be particularly helpful for individuals with high impulsivity. To examine if trait, choice, and action impulsivity were associated with the effectiveness of a workplace-based nudge intervention to improve diet and weight. This was a planned secondary analysis of 487 participants of ChooseWell 365, a randomized controlled trial that tested a 12-month nudge intervention to improve cafeteria purchases among hospital employees. Trait impulsivity was measured with the Barratt Impulsiveness Scale. Choice and action impulsivity were assessed with delay discounting and response inhibition tasks, respectively. Tertiles were generated for each measure. Multivariable regression models examined the association of impulsivity with cafeteria purchases [Healthy Purchasing Score (HPS)] over 12 months, dietary intake [Healthy Eating Index-2015 (HEI) score], and body mass index (BMI) measured at 12 months. Interaction terms tested differences in intervention effect by level of impulsivity. Participants with higher trait (p = .02) and choice (p < .001) impulsivity had lower baseline HPS than those with lower impulsivity. Employees of all impulsivity levels increased healthy eating, but higher trait impulsivity was associated with smaller increase in HPS over 12 months (p = .03). In the highest action impulsivity tertile, 12-month BMI increased less for intervention vs. control participants (0.3 vs. 0.5 kg/m2; p-interaction = .04). There were no interaction effects for trait or choice impulsivity. A workplace nudge intervention improved food choices among employees of all impulsivity levels and attenuated weight gain in those with higher action impulsivity.
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Affiliation(s)
- Jessica L McCurley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychology, San Diego State University, San Diego, CA
| | - Joshua W Buckholtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychology, Harvard University, Cambridge MA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Douglas E Levy
- Harvard Medical School, Boston, MA
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Yuchiao Chang
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
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Rummo PE, Roberto CA, Thorpe LE, Troxel AB, Elbel B. Effect of Financial Incentives and Default Options on Food Choices of Adults With Low Income in Online Retail Settings: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e232371. [PMID: 36897592 PMCID: PMC10789116 DOI: 10.1001/jamanetworkopen.2023.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Despite recent growth in online redemption of Supplemental Nutrition Assistance Program (SNAP) benefits, no previous work has tested the impact of economic and behavioral economic strategies on food purchasing behaviors in an online grocery retail setting among adults with low income. Objective To examine the extent to which financial incentives and default shopping cart options influence fruit and vegetable purchases. Design, Setting, and Participants This randomized clinical trial used an experimental online grocery store for adults who currently or have ever received SNAP benefits. From October 7 to December 2, 2021, participants were instructed to shop for a week's worth of groceries for their household, with a budget tailored to household size; no payment was taken. Interventions Random assignment to 1 of 4 conditions: no intervention, 50% discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (ie, default options), or a combination of the discount and default options. Main Outcomes and Measures The primary outcome was the percentage of nondiscounted dollars spent on eligible fruit and vegetables per basket. Results Of 2744 participants, mean (SD) age was 46.7 (16.0) years, and 1447 (52.7%) identified as women. A total of 1842 participants (67.1%) reported currently receiving SNAP benefits and 1492 (54.4%) reported shopping online for groceries in the previous 12 months. Participants spent a mean (SD) 20.5% (23.5%) of total dollars on eligible fruits and vegetables. Compared with no intervention, those in the discount condition spent 4.7% (98.3% CI, 1.7%-7.7%) of more total dollars on eligible fruits and vegetables; those in the default condition, 7.8% (98.3% CI, 4.8%-10.7%) more; and those in the combination condition, 13.0% (98.3% CI, 10.0%-16.0%) more (P < .001 for all). There was no difference between the discount and the default conditions (P = .06), but the effect in the combination condition was significantly larger than both discount and default conditions (P < .001). Default shopping cart items were purchased by 679 participants (93.4%) in the default condition and 655 (95.5%) in the combination condition, whereas 297 (45.8%) in the control and 361 (52.9%) in the discount conditions purchased those items (P < .001). No variation was observed by age, sex, or race and ethnicity, and results were similar when those who reported never shopping online for groceries were excluded. Conclusions and Relevance In this randomized clinical trial, financial incentives for fruits and vegetables and default options, especially in combination, led to meaningful increases in online fruit and vegetable purchases among adults with low income. Trial Registration ClinicalTrials.gov Identifier: NCT04766034.
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Affiliation(s)
- Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | | | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Andrea B. Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Wagner Graduate School of Public Service, New York University, New York, NY
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Eid AM, Issa L, Kamal K, Hosheya O, Sara H, Alkader SA. Comparing and contrasting different herbal products intended for the management of obesity approved in the Palestinian markets. BMC Complement Med Ther 2023; 23:3. [PMID: 36604684 PMCID: PMC9813894 DOI: 10.1186/s12906-022-03830-8] [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: 07/17/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The use of conventional medical therapies has proven to have many setbacks and safety concerns that need further improvement. However, herbal medicine has been used for over 2000 years, and many studies have proven the use of herbs to be effective and safe. This article discussed the efficacy of different herbal products used in the management of obesity. To evaluate the efficacy of seven herbal-based weight loss products currently available on the Palestinian market, using in vitro assays to screen for antioxidants, anti-amylase, and anti-lipase effects for each product. METHOD Pancreatic lipase and salivary amylase inhibitory activities, as well as antioxidant analysis, were tested in vitro on a variety of herbal products. Then the IC50 was measured for each test. RESULTS The anti-lipase assay results, IC50 values in (μg/mL) of each of the seven products (Product A, product B, product C, product D, product E, product F, and product G) were 114.78, 532.1, 60.18, 53.33, 244.9, 38.9, and 48.97, respectively. The IC50 value for orlistat (Reference) was 12.3 μg/ml. On the other hand, the IC50 value for alpha amylase inhibition of the seven products (Product A, product B, product C, product D, product E, product F, and product F) were 345.93, 13,803.84 (Inactive), 73.79, 130.91, 165.95, 28.18, and 33.11 μg/ml respectively, while acarbose (Reference) was 23.38 μg/ml. The antioxidant activity (IC50 values) for the seven products (Product A, product B, product C, product D, product E, product F, and product F) were 1258.92, 707.94, 79.43, 186.20, 164.81, 17.53, and 10.47 μg/ml respectively. While the IC50 value for Trolox was 2.70 μg/ml. CONCLUSION It can be concluded that the seven products showed varied anti-lipase, anti-amylase, and antioxidant effects. However, products F and G showed superiority in all categories.
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Affiliation(s)
- Ahmad M. Eid
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Linda Issa
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Karmah Kamal
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Omran Hosheya
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Hla Sara
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Sally Abed Alkader
- grid.11942.3f0000 0004 0631 5695Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
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Caso G, Vecchio R. Nudging low-medium income mothers towards healthy child options in an online restaurant scenario. Appetite 2023; 180:106360. [PMID: 36343869 DOI: 10.1016/j.appet.2022.106360] [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: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Helping mothers make the healthiest choices for their children when eating out can contribute to preventing the prevalence of childhood overweight and obesity, particularly in economically disadvantaged classes. Herein, we tested whether two different nudges (a default option and a social norm prompt) could guide low- and middle-income mothers towards healthier children's menu choices in a fictive restaurant setting and investigated the drivers of healthy child menu selection. A cross-sectional online survey was performed among 809 Italian mothers with children aged between 3 and 12 years, and a between-subjects design (control, nudge 1, and nudge 2) was applied. The findings revealed that both nudges had no significant effect on the number of healthy menu selections compared with the healthy choices made in the control condition. Furthermore, considering the entire sample, the results show that certain characteristics of a mother (e.g., authoritative parenting style) and child (younger age) duo increase the likelihood of the former selecting a healthy children's menu. Similarly, a positive correlation between the likelihood of choosing a healthy children's menu and the mother's involvement in the child's nutrition (meal preparation and weekly diet) was observed.
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Affiliation(s)
- Gerarda Caso
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Portici, Italy.
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Waterworth SP, Kerr CJ, McManus CJ, Costello R, Sandercock GRH. Obese individuals do not underreport dietary intake to a greater extent than nonobese individuals when data are allometrically‐scaled. Am J Hum Biol 2022; 34:e23743. [PMID: 35257435 PMCID: PMC9286371 DOI: 10.1002/ajhb.23743] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to assess the extent of misreporting in obese and nonobese adults on an absolute, ratio‐scaled, and allometrically‐scaled basis. Method Self‐reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male, 115 female; age 53 ± 17 years, stature 1.68 ± 0.09 m, mass 79.8 ± 17.2 kg) who participated in a doubly‐labeled water (DLW) subsection of 2013–2015 National Diet and Nutrition Survey. Data were log transformed and expressed as absolute values, according to simple ratio‐standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio‐scaled misreporting were examined using full‐factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within‐subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and physical activity level (PAL) were the between‐factor variables. Results On an absolute‐basis, self‐reported EI (2759 ± 590 kcal·d−1) was significantly lower than TEE measured by DLW (2759 ± 590 kcal·d−1: F1,205 = 598.81, p < .001, ηp2 =0.75). We identified significantly greater underreporting in individuals with an obese BMI (F1,205 = 29.01, p <.001, ηp2 =0.12), in more active individuals (PAL > 1.75; F1,205 = 34.15, p <.001, ηp2 =0.14) and in younger individuals (≤55 years; F1,205 = 14.82, p < .001, ηp2 =0.07), which are all categories with higher energy needs. Ratio‐scaling data reduced the effect sizes. Allometric‐scaling removed the effect of body mass (F1,205 =0.02, p = 0.887, ηp2 =0.00). Conclusion In weight‐stable adults, obese individuals do not underreport dietary intake to a greater extent than nonobese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting.
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Affiliation(s)
- Sally P. Waterworth
- School of Sport, Rehabilitation, and Exercise Sciences University of Essex Essex UK
| | - Catherine J. Kerr
- School of Sport, Rehabilitation, and Exercise Sciences University of Essex Essex UK
| | | | - Rianne Costello
- Oxford Brookes Centre for Nutrition and Health Oxford Brookes University Oxford UK
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Grummon AH, Petimar J, Soto MJ, Bleich SN, Simon D, Cleveland LP, Rao A, Block JP. Changes in Calorie Content of Menu Items at Large Chain Restaurants After Implementation of Calorie Labels. JAMA Netw Open 2021; 4:e2141353. [PMID: 34967879 PMCID: PMC8719240 DOI: 10.1001/jamanetworkopen.2021.41353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018. OBJECTIVE To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels. DESIGN, SETTING, AND PARTICIPANTS This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021. INTERVENTION Nationwide implementation of menu calorie labeling. MAIN OUTCOMES AND MEASURES Changes in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately. RESULTS Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = -2.0 calories; 95% CI, -8.5 to 4.4 calories) or continuously available items (change = -2.3 calories; 95% CI, -11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = -112.9 calories; 95% CI, -208.6 to -25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, -79.4 to 84.0 calories). CONCLUSIONS AND RELEVANCE In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.
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Affiliation(s)
- Anna H. Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Mark J. Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Denise Simon
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Lauren P. Cleveland
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anjali Rao
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason P. Block
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Cory M, Loiacono B, Clark Withington M, Herman A, Jagpal A, Buscemi J. Behavioral Economic Approaches to Childhood Obesity Prevention Nutrition Policies: A Social Ecological Perspective. Perspect Behav Sci 2021; 44:317-332. [PMID: 34632280 PMCID: PMC8476712 DOI: 10.1007/s40614-021-00294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/21/2022] Open
Abstract
Childhood obesity is a significant public health concern associated with the development of the leading causes of death. Dietary factors largely contribute to childhood obesity, but prevention interventions targeting these factors have reported relatively small effect sizes. One potential explanation for the ineffectiveness of prevention efforts is lack of theoretical grounding. Behavioral economic (BE) theory describes how people choose to allocate their resources and posits that some children place higher value on palatable foods (relative reinforcing value of food) and have difficulty delaying food rewards (delay discounting). These seemingly individual-level decision making processes are influenced by higher-level variables (e.g., environment/policy) as described by the social ecological model. The purpose of this manuscript is to provide a theoretical review of policy-level childhood obesity prevention nutrition initiatives informed by BE. We reviewed two policy-level approaches: (1) incentives-/price manipulation-based policies (e.g., sugary drink tax, SNAP pilot) and (2) healthful choices as defaults (Healthy Hunger Free Kids Act/National School Lunch Program, advertising regulations, default items). We review current literature as well as its limitations and future directions. Exploration of BE theory applications for nutrition policies may help to inform future theoretically grounded policy-level public health interventions.
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Affiliation(s)
- Molly Cory
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | | | | | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | - Anjana Jagpal
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL 60614 USA
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Mecheva MDV, Rieger M, Sparrow R, Prafiantini E, Agustina R. Snacks, nudges and asymmetric peer influence: Evidence from food choice experiments with children in Indonesia. JOURNAL OF HEALTH ECONOMICS 2021; 79:102508. [PMID: 34333202 DOI: 10.1016/j.jhealeco.2021.102508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Many children in low- and middle-income countries are growing up during a rapid nutrition transition. Experimental evidence on food choice in developing countries is scarce, while it is unclear to what extent evidence from high-income countries can be generalized. Children participated in a snack choice experiment. We expose some children to emoji labels encouraging healthy snacks, while others observe healthy or unhealthy snacking by peers. While emoji labels moderately promote healthy snacking, the adverse effect of observing a peer eating the unhealthy snack is very large. The effect associated with observing a healthy peer is insignificant. Additionally, cross-randomized blocks of children watched a nutrition video to study the interaction of information provision and nudging. The video independently improves healthy choices but does not aid the emoji nudge and cannot counter the strong negative peer effect. We compare our findings to studies conducted in developed countries and discuss policy implications.
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Affiliation(s)
| | - Matthias Rieger
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands.
| | - Robert Sparrow
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands; Development Economics Group, Wageningen University, the Netherlands
| | - Erfi Prafiantini
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
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Requero B, Briñol P, Petty RE. The impact of hope and hopelessness on evaluation: A meta‐cognitive approach. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/ejsp.2726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Blanca Requero
- Department of Psychology Universidad Villanueva Madrid Spain
| | - Pablo Briñol
- Department of Psychology Universidad Autónoma de Madrid Madrid Spain
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Requero B, Santos D, Cancela A, Briñol P, Petty RE. Promoting Healthy Eating Practices through Persuasion Processes. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1080/01973533.2021.1929987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Woodbury MJ, Cohen JM, Merola JF, Perez-Chada LM. Leveraging behavioral economics to promote treatment adherence: A primer for the practicing dermatologist. J Am Acad Dermatol 2021; 87:1075-1080. [PMID: 34098000 DOI: 10.1016/j.jaad.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 01/23/2023]
Abstract
The problem of suboptimal treatment adherence among patients with dermatologic or other diseases has not been adequately addressed in health care. Despite a wide range of efficacious therapies, nonadherence remains a primary driver of suboptimal clinical outcomes. Novel solutions to address this unmet need can be found in behavioral economics. By leveraging our understanding of human decision-making, we may better promote treatment adherence, thereby improving quality of life and decreasing economic burdens. Behavioral economics has been studied extensively in relation to topics such as health policy and health behaviors; however, there is a dearth of research applying this approach to chronic diseases and only a handful within dermatology. We conducted a scoping review in PubMed to identify articles that discuss behavioral economics and its application to treatment adherence in dermatologic patients, with a particular focus on psoriasis, followed by a summary of key ethical considerations. We found that such principles can be employed in cost-effective, scalable interventions that improve patient adherence to a range of medical therapies and lifestyle modifications.
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Affiliation(s)
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Joseph F Merola
- Division of Rheumatology, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Mizota Y, Yamamoto S. Rainbow of KIBOU project: Effectiveness of invitation materials for improving cancer screening rate using social marketing and behavioral economics approaches. Soc Sci Med 2021; 279:113961. [PMID: 34000582 DOI: 10.1016/j.socscimed.2021.113961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/27/2023]
Abstract
Studies to date have shown that individual invitation (call) and re-invitation (recall) are effective in improving cancer screening rate. Also, by dividing subjects into segments and sending unique messages to each segment, the cancer screening rate is further improved. However, this approach is not realistic in the local governments due to limited resources, so we used social marketing and nudge techniques to develop cancer screening recommendation materials that do not need to send separately. This study therefore aimed to verify the effect of these materials in the real world. We compared the cancer screening rates in municipalities within Japan that used the invitation materials we developed (colorectal, breast, lung, cervical and stomach cancer), with those from the previous year. In addition, the usefulness of the materials in the real world was examined multilaterally using RE-AIM framework (Reach, Effectiveness, Adaption, Implementation, Maintenance). From 2015 to 2018, 4.3 million residents (Reach) from 787 municipalities (Adaption) were sent invitation materials for cancer screening. Of 167 municipalities that were compared, 141 (83%) showed an increase in screening rate when our materials were used. Overall, the screening rate improved by 2.6% or 1.44 fold (p < 0.001) (Effectiveness). However, the screening rate varied greatly depending on how screening is provided. Of the four years studied, 75 municipalities used the same materials for two or more years (Implementation). The material developed in this study improved the cancer screening rate in the real world, and it may be possible to further improve the screening rate if the number of opportunities for screening and its capacity is increased at the timing of sending materials. The materials can be found on the website (http://rokproject.jp/kenshin/) and free electronic files are available to municipalities wishing to use them.
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Affiliation(s)
- Yuri Mizota
- Center for Cancer Information and Control Services, National Cancer Center, 5-1-1, Tsukij, Chuo-ku, Tokyo, 104-0045, Japan; Health Service Division, Health Service Bureau, Ministry of Health, Labour, and Welfare, 1-2-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-8916, Japan; Shizuoka Graduate University of Public Health, 4-27-2, Kitaando, Aoiku, Shizuoka, 420-0881, Japan.
| | - Seiichiro Yamamoto
- Center for Cancer Information and Control Services, National Cancer Center, 5-1-1, Tsukij, Chuo-ku, Tokyo, 104-0045, Japan; Shizuoka Graduate University of Public Health, 4-27-2, Kitaando, Aoiku, Shizuoka, 420-0881, Japan; Centre for the Fourth Industrial Revolution Japan, World Economic Forum, ARK Mori Building, 37th Floor 1-12-32, Akasaka, Minato-ku, Tokyo, 107-6037, Japan.
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15
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Satoh M, Sato N. Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation. BMC WOMENS HEALTH 2021; 21:171. [PMID: 33882923 PMCID: PMC8061057 DOI: 10.1186/s12905-021-01317-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
Backgroundcxs Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women. Methods Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed. Results Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32; p = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30; p = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83; p = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72; p = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42; p = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42; p < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86; p = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46; p < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90; p = 0.022). No significant relationship was observed between time preference and screening participation. Conclusions The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.
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Affiliation(s)
- Miho Satoh
- Department of Fundamental Nursing, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Naoko Sato
- Department of Clinical Nursing, Fukushima Medical University, Fukushima, Fukushima, Japan
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16
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McGurk MD, Cacal SL, Vu U, Sentell T, Beckelman T, Lee J, Yang A, Pirkle CM. Baseline Assessment of Children's Meals and Healthy Beverage Options Prior to a State-Level Healthy Default Beverage (HDB) Law. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2021; 1:63-73. [PMID: 37789908 PMCID: PMC10544922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
In January 2020, Hawai'i became the second state with a healthy default beverage (HDB) law, requiring restaurants to offer HDBs with their children's meals. This observational study presents baseline characteristics of restaurants with a children's menu and meal. The study describes pre-law beverage options to inform future HDB policy language, implementation, and evaluation. Between November and December 2019, data were collected from a statewide sample of unique restaurants (N = 383) with health inspection permits. Restaurants were assessed separately for a children's menu and meal using website reviews, telephone calls, and in-person visits. Meals were evaluated for pre-law beverage type and compliance. Logistic regression was used to estimate the likelihood of having a children's menu and meal. Most of the restaurants were full-service (70.2%) and non-chains (67.9%). While 49.3% of restaurants had a children's menu, only 16.7% had a children's meal. Significant predictors of having a children's menu were being full-service, national/international or local chains, neighbor island (non-Honolulu) locations, and hotel locations. Only being a national/international chain significantly predicted having a children's meal. Although 35.9% of children's meals offered a non-sugar-sweetened beverage (SSB) option, only 3.1% offered law-compliant beverages. Inclusion of an SSB default option (60.9%) and not specifying the type of default beverage were the predominant factors for pre-law non-compliance. Results support the need for HDB regulations, especially for national/international chains, which were most likely to have children's meals, and provide data to inform policies in other jurisdictions.
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Affiliation(s)
| | | | - Uyen Vu
- University of Hawai‘i at Mānoa, Honolulu, Hawai‘i
| | | | | | - Jessica Lee
- Hawai‘i State Department of Health, Honolulu, Hawai‘i
| | - Alyssa Yang
- Hawai‘i State Department of Health, Honolulu, Hawai‘i
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17
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Chambers T, Segal A, Sassi F. Interventions using behavioural insights to influence children's diet-related outcomes: A systematic review. Obes Rev 2021; 22:e13152. [PMID: 33462932 DOI: 10.1111/obr.13152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
The global prevalence of children with overweight and obesity continues to rise. Obesity in childhood has dire long-term consequences on health, social and economic outcomes. Promising interventions using behavioural insights to address obesity in childhood have emerged. This systematic review examines the effectiveness and health equity implications of interventions using behavioural insights to improve children's diet-related outcomes. The search strategy included searches on six electronic databases, reference lists of previous systematic reviews and backward searching of all included studies. One-hundred and eight papers describing 137 interventions were included. Interventions using behavioural insights were effective at modifying children's diet-related outcomes in 74% of all included interventions. The most promising approaches involved using incentives, changing defaults and modifying the physical environment. Information provision alone was the least effective approach. Health equity implications were rarely analysed or discussed. There was limited evidence of the sustainability of interventions-both in relation to their overall effectiveness and cost-effectiveness. The limited evidence on health equity, long-term effectiveness and the cost-effectiveness of these interventions limit what can be inferred for policymakers. This review synthesises the use of behavioural insights to improve children's diet-related outcomes, which can be used to inform future interventions.
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Affiliation(s)
- Timothy Chambers
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK.,Health Environment & Infection Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Alexa Segal
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK
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18
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Gantiva C, Jiménez-Leal W, Urriago-Rayo J. Framing Messages to Deal With the COVID-19 Crisis: The Role of Loss/Gain Frames and Content. Front Psychol 2021; 12:568212. [PMID: 33584464 PMCID: PMC7876407 DOI: 10.3389/fpsyg.2021.568212] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
The goal of this study was to test the role of message framing for effective communication of self-care behaviors in the context of the COVID-19 pandemic, contrasting health and economic-focused messages. We presented 319 participants with an unforced choice task where they had to select the message that they believed was more effective to increase intentions toward self-care behaviors, motivate self-care behaviors in others, increase perceived risk and enhance perceived message strength. Results showed that gain-frame health messages increased intention to adopt self-care behaviors and were judged to be stronger. Loss-framed health messages increased risk perception. When judging effectiveness for others, participants believed other people would be more sensitive to messages with an economic focus. These results can be used by governments to guide communication for the prevention of COVID-19 contagion in the media and social networks, where time and space for communicating information are limited.
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Affiliation(s)
- Carlos Gantiva
- Psychology Department, Universidad de los Andes, Bogotá, Colombia
| | - William Jiménez-Leal
- Psychology Department, Universidad de los Andes, Bogotá, Colombia.,Laboratorio de Cognición, Universidad de los Andes, Bogotá, Colombia
| | - Joan Urriago-Rayo
- Psychology Department, Universidad de los Andes, Bogotá, Colombia.,Laboratorio de Cognición, Universidad de los Andes, Bogotá, Colombia
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19
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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20
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Boonmanunt S, Pattanaprateep O, Ongphiphadhanakul B, McKay G, Attia J, Thakkinstian A. Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e046035. [PMID: 33371052 PMCID: PMC7754655 DOI: 10.1136/bmjopen-2020-046035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obesity and being overweight are major risk factors for metabolic syndrome and non-communicable diseases. Despite the recommendation that a healthy diet and physical activity can reduce the severity of these diseases, many fail to adhere to these measures. From a behavioural economic perspective, adherence to such measures can be encouraged through financial incentives. However, additional related behavioural economic approaches may improve the effectiveness of an incentive programme. As such, we have developed a protocol for a systematic review and network meta-analysis to summarise the current evidence from financial incentive programmes with and without behavioural economic insights for promoting healthy diet and physical activity. METHODS AND ANALYSIS Previous systematic reviews, meta-analyses and individual studies were identified from Medline and Scopus in June 2020 and will be updated until December 2020. Individual studies will be selected and data extracted by two reviewers. Disagreement will be resolved by consensus or adjudicated by a third reviewer. A descriptive analysis will summarise the effectiveness of behavioural economic incentive programmes for promoting healthy diet and physical activity. Moreover, individual studies will be pooled using network meta-analyses where possible. I2 statistics and Cochran's Q test will be used to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as the overall strength of the evidence. ETHICS AND DISSEMINATION Ethics approval for a systematic review and meta-analysis is not required. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020198024.
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Affiliation(s)
- Suparee Boonmanunt
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | | | - Gareth McKay
- Centre for Public Health, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - John Attia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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21
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Colby H, Li M, Chapman G. Dodging dietary defaults: Choosing away from healthy nudges. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2020. [DOI: 10.1016/j.obhdp.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Orders of Healthier Adult Menu Items in a Full-Service Restaurant Chain with a Healthier Children's Menu. Nutrients 2020; 12:nu12113253. [PMID: 33114155 PMCID: PMC7690819 DOI: 10.3390/nu12113253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
This study evaluated orders of adult menu items designated as healthier at the Silver Diner, a regional full-service restaurant chain serving over 4 million customers annually. This restaurant implemented a healthier children’s menu in April 2012. Orders of adult menu items were abstracted from before (September 2011–March 2012; PRE; n = 1,801,647) and after (September 2012–March 2013; POST; n = 1,793,582) the healthier children’s menu was introduced. Entrées, appetizers, and sides listed as healthier options on the menu were coded as healthier. PRE to POST changes in the percentage of orders of healthier items, soda, and dessert were evaluated using McNemar tests of paired proportions. Orders of healthier entrées, appetizers, and sides on the adult menu increased PRE to POST (8.9% to 10.4%, 25.5% to 27.5%, and 7.3% to 9.3%, respectively), and soda and dessert orders decreased (23.2% to 21.7% and 29.0% to 28.3%, respectively). All shifts were statistically significant (p < 0.0001). Our findings demonstrate improvements in orders of healthier adult menu options during the same time frame as a healthy children’s menu change. Future research can help elucidate mechanisms to inform future health promotion efforts in restaurants in ways that have the potential to impact both adults and children.
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23
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Capuano AM, Killu K. Understanding and addressing pseudoscientific practices in the treatment of neurodevelopmental disorders: Considerations for applied behavior analysis practitioners. BEHAVIORAL INTERVENTIONS 2020. [DOI: 10.1002/bin.1750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Angela M. Capuano
- College of Education, Health, and Human Services University of Michigan‐Dearborn Dearborn Michigan USA
| | - Kim Killu
- College of Education, Health, and Human Services University of Michigan‐Dearborn Dearborn Michigan USA
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24
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Blitstein JL, Guthrie JF, Rains C. Low-Income Parents' Use of Front-of-Package Nutrition Labels in a Virtual Supermarket. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:850-858. [PMID: 32475704 DOI: 10.1016/j.jneb.2020.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine the impact front-of-package nutrition labels (FOPLs) have on decision-making abilities among low-income parents in a virtual supermarket. DESIGN A 4-by-2 experimental design with 3 FOPLs (summary, nutrient-specific, hybrid) and a no-FOPL comparison. Within the FOPL condition, participants either shopped with a time limit (10 minutes) or with no time limit. SETTING A web-based, 3-dimensional virtual supermarket. PARTICIPANTS Parents (n = 1,452) from low-income households with at least 1 child aged 4-12 years. MAIN OUTCOMES MEASURED Index derived from the United Kingdom's Nutrient Profiling Model that summarized the overall nutrient profile of the participant's shopping basket. ANALYSIS Analysis of covariance with post hoc estimations (pairwise) of condition means adjusted for multiple comparisons. RESULTS All FOPLs led to healthier nutrient profiles than the no-FOPL condition (P < .001). Simple FOPLs (ie, summary, hybrid) led to healthier nutrient profiles than nutrient-specific FOPLs (P = .02 and P < .001, respectively). Among parents exposed to simple FOPLs, those under time pressure made less healthy choices than those who were not under time pressure (P = .05 and P = .03, respectively). Time pressure did not affect parents exposed to nutrient-specific FOPLs (P = .69). CONCLUSIONS AND IMPLICATIONS Front-of-package nutrition labels can aid parents in selecting healthier products. Simple FOPLs provide greater utility for selecting healthier products than FOPLs that present an array of nutrient information. Time pressure can influence how parents interact with different types of label information.
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Affiliation(s)
| | - Joanne F Guthrie
- Economic Research Service, US Department of Agriculture, Washington, DC
| | - Caroline Rains
- Public Health Research Division, RTI International, Research Triangle Park, NC
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25
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Karl FM, Holle R, Schwettmann L, Peters A, Laxy M. Status quo bias and health behavior: findings from a cross-sectional study. Eur J Public Health 2019; 29:992-997. [PMID: 30778558 DOI: 10.1093/eurpub/ckz017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Status quo bias (SQB) has often been referred to as an important tool for improving public health. However, very few studies were able to link SQB with health behavior. METHODS Analysis were based on data from the population-based KORA S4 study (1999-2001, n = 2309). We operationalized SQB through two questions. The first asked whether participants switched their health insurance for financial benefits since this was enabled in 1996. Those who did were assigned a 'very low SQB' (n = 213). Participants who did not switch were asked a second hypothetical question regarding switching costs. We assigned 'low SQB' to those who indicated low switching costs (n = 1035), 'high SQB' to those who indicated high switching costs (n = 588), and 'very high SQB' to those who indicated infinite switching costs (n = 473). We tested the association between SQB and physical activity, diet, smoking, alcohol consumption, the sum of health behaviors, and body mass index (BMI) using logistic, Poisson and ordinary least square regression models, respectively. Models were adjusted for age, sex, education, income, satisfaction with current health insurance and morbidity. RESULTS SQB was associated with a higher rate of physical inactivity [OR = 1.22, 95% CI (1.11; 1.35)], a higher sum of unhealthy lifestyle factors [IRR = 1.05, 95% CI (1.01; 1.10)] and a higher BMI [β = 0.30, 95% CI (0.08; 0.51)]. CONCLUSION A high SQB was associated with unfavorable health behavior and higher BMI. Targeting SQB might be a promising strategy for promoting healthy behavior.
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Affiliation(s)
- Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Centre for Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Centre for Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Centre for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- German Centre for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München (GmbH), German Research Centre for Environmental Health, Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Centre for Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
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26
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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Yang YT, Benjamin-Neelon SE. Recent progress in children's meals law in restaurants in Baltimore City and California State: Making a healthy beverage option the default choice. Prev Med 2019; 123:160-162. [PMID: 30910520 DOI: 10.1016/j.ypmed.2019.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/08/2019] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
In July 2018, Baltimore became the largest US city to prohibit restaurants from including sugar-sweetened beverages on kids' menus. In September 2018, California made history by becoming the first US state to require either water or milk as the default beverage with children's meals at all restaurants. Supporters of children's meals laws view them as helping to change the culture of health on beverage preferences and subtly influencing the choices of patrons. Using subtle methods of influencing children's beverage choices at restaurants, or nudges, will not on its own eradicate childhood obesity. However, the law aims to make healthier choices easier options and to influence people's choices in predictable ways without restricting their options. Evidence from a wide range of fields shows that people tend to stick with defaults and that setting beneficial defaults has high rates of acceptability. The laws in Baltimore and California, along with the other jurisdictions that have passed similar legislation, reflect a growing understanding - among restaurant owners, community members and policymakers alike - of the importance of feeding children healthy meals. They also signal that making healthier beverages the default option on children's menus is gaining strength in the US. Cities and states across the country should consider enacting similar laws as part of a greater public health initiative to combat the childhood obesity epidemic.
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Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, United States of America; Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, United States of America.
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America
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Røed M, Hillesund ER, Vik FN, Van Lippevelde W, Øverby NC. The Food4toddlers study - study protocol for a web-based intervention to promote healthy diets for toddlers: a randomized controlled trial. BMC Public Health 2019; 19:563. [PMID: 31088438 PMCID: PMC6518752 DOI: 10.1186/s12889-019-6915-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating habits are established during childhood and track into adolescence and later in life. Given that these habits have a large public health impact and influence the increasing rates of childhood obesity worldwide, there is a need for effective, evidence-based prevention trials promoting healthy eating habits in the first 2 years of life. The aim of this study was to develop and evaluate the effect of an eHealth intervention called Food4toddlers, aiming to promote healthy dietary habits in toddlers by targeting parents' awareness of their child's food environment (i.e., how food is provided or presented) and eating environment (e.g., feeding practices and social interaction). This paper describes the rationale, development, and evaluation design of this project. METHODS/DESIGN We developed a 6-month eHealth intervention, with the extensive user involvement of health care nurses and parents of toddlers. This intervention is in line with the social cognitive theory, targeting the interwoven relationship between the person, behavior, and environment, with an emphasis on environmental factors. The intervention website includes recipes, information, activities, and collaboration opportunities. The Food4toddlers website can be used as a mobile application. To evaluate the intervention, a two-armed pre-post-follow-up randomized controlled trial is presently being conducted in Norway. Parents of toddlers (n = 404) were recruited via social media (Facebook) and 298 provided baseline data of their toddlers at age 12 months. After baseline measurements, participants were randomly allocated to an intervention group or control group. Primary outcomes are the child's diet quality and food variety. All participants will be followed up at age 18 months, 2 years, and 4 years. DISCUSSION The results of this trial will provide evidence to increase knowledge about the effectiveness of an eHealth intervention targeting parents and their toddler's dietary habits. TRIAL REGISTRATION ISRCTN92980420 . Registered 13 September 2017. Retrospectively registered.
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Affiliation(s)
- Margrethe Røed
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway.
| | - Elisabet R Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
| | - Wendy Van Lippevelde
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway.,Department of Marketing, Innovation and Organization, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Nina Cecilie Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
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Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050778. [PMID: 30836633 PMCID: PMC6427413 DOI: 10.3390/ijerph16050778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022]
Abstract
Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).
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Chauvenet C, De Marco M, Barnes C, Ammerman AS. WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction. J Acad Nutr Diet 2019; 119:416-424.e2. [DOI: 10.1016/j.jand.2018.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022]
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Sotos-Prieto M, Jin Q, Rainey D, Coyle M, Kales SN. Barriers and solutions to improving nutrition among fire academy recruits: a qualitative assessment. Int J Food Sci Nutr 2019; 70:771-779. [PMID: 30764673 DOI: 10.1080/09637486.2019.1570087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The primary health concerns among US firefighters are cardiovascular disease, cancer, and depression and occur in an occupational setting where dietary habits are suboptimal. To understand if a diet or lifestyle modification works in a fire academy training setting, it is important to evaluate the cultural barriers and challenges that might be faced. A semi-structured telephone interview method followed by a focus group was used to gather common themes among fire service leaders. Twelve leaders participated in the telephonic interviews and a subset of five in the subsequent group session. Five main themes were identified. The study identified a need for staff and recruits to develop a cohesive culture that facilitates long-term change. Participants reported that incentives for good choices and the elimination of certain poor choices from the food environment would promote healthier choices. The study supports an intervention using education of fire recruits and modifications of the fire academy food environment.
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Affiliation(s)
- Mercedes Sotos-Prieto
- a Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness , Ohio University , Athens , OH , USA.,b The Diabetes Institute, Ohio University , Athens , OH , USA.,c Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Qi Jin
- a Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness , Ohio University , Athens , OH , USA
| | - David Rainey
- c Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Maria Coyle
- a Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness , Ohio University , Athens , OH , USA
| | - Stefanos N Kales
- c Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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Moran AJ, Subramanian SV, Rimm EB, Bleich SN. Characteristics Associated with Household Purchases of Sugar-Sweetened Beverages in US Restaurants. Obesity (Silver Spring) 2019; 27:339-348. [PMID: 30609301 PMCID: PMC6345589 DOI: 10.1002/oby.22380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/26/2018] [Accepted: 11/01/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to describe beverages purchased in restaurants among a nationally representative sample of US households. METHODS Data were obtained from the US Department of Agriculture National Household Food Acquisition and Purchase Survey, 2012 to 2013. Survey-weighted multiple regressions assessed correlates of purchasing a sugar-sweetened beverage (SSB), purchasing a low-calorie beverage, and per capita beverage calories and grams of sugar among purchases from US restaurants (n = 14,669). RESULTS Dining at a top fast-food chain (odds ratio = 1.9 [95% CI = 1.6, 2.3] vs. small chain or independent restaurants) and ordering a combination meal (2.8 [1.3, 3.3]) or from the kids' menu (2.1 [1.2, 3.4]) were positively associated with purchasing an SSB. Age (young adult and adolescent vs. older adult; 0.7 [0.5, 0.9] and 0.4 [0.3, 0.7], respectively), race (Black vs. White; 0.4 [0.3, 0.6]), ethnicity (Hispanic vs. non-Hispanic; 0.8 [0.6, 0.9]), and household food security (very low vs. high; 0.7 [0.5, 0.8]) were associated with purchasing a low-calorie beverage. Caloric beverage purchases contained the most calories and grams of sugar per capita when purchased by Hispanic and non-Hispanic Black adolescents. CONCLUSIONS US households purchase a considerable amount of SSBs from the nation's largest chain restaurants, particularly when combination meals or kids' menu items are ordered, and there are disparities by age, race/ethnicity, and household food security.
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Affiliation(s)
- Alyssa J Moran
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - S V Subramanian
- Department of Social & Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric B Rimm
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sara N Bleich
- Department of Health Policy & Management, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Hunter RF, Tang J, Hutchinson G, Chilton S, Holmes D, Kee F. Association between time preference, present-bias and physical activity: implications for designing behavior change interventions. BMC Public Health 2018; 18:1388. [PMID: 30567532 PMCID: PMC6300013 DOI: 10.1186/s12889-018-6305-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/05/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The decision to initiate or maintain a healthy habit, such as physical activity involves a trade-off between a short-term cost, such as time and effort, which are commonly identified as barriers to physical activity, and a long-term health benefit. Research suggests that individual time preference may be associated with unhealthy behaviors. However, empirical evidence of this for physical activity is scant. This study investigated the relationship between time preference and physical activity, and how this might influence behavior change. METHODS Employees (n = 176; mean age 42.2 years) who participated in a physical activity intervention were invited to take part in a behavioral economic field experiment. Two economic experiments, using multiple price lists and monetary trade-off tables involving real money choices, were conducted face-to-face with participants to measure the two components of time preference, namely present-bias and discount rate. Together with individual risk preferences, these three variables were jointly estimated by maximum likelihood. These three parameters were expressed as a linear function of the levels of physical activity while controlling for socio-demographic variables within the same maximum likelihood framework. RESULTS Those who were present-biased and who had higher discount rates did significantly less physical activity than their patient and non present-biased counterparts. A 3% lower discount rate and 1.14 unit decrement in the present-bias parameter was associated with a 30 min increase of physical activity per week. This negative association was more significant for certain sub-groups, such as younger and married adults and those with higher staff grade and those who have children. Participants who dropped out of the study earlier were more present-biased. CONCLUSIONS Results demonstrated that discount rate and present-biasedness have a significant impact on physical activity levels. Such concepts have been largely overlooked and underutilized in physical activity interventions. Promising implications include 1) utilizing individuals' time preferences to better target interventions; 2) taking account of time preferences in the intervention design; 3) interventions attempting to correct for present-biasedness.
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Affiliation(s)
- Ruth F. Hunter
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, 100872 China
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
- Institute of Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Susan Chilton
- Business School—Economics, Newcastle University, Newcastle, England UK
| | - David Holmes
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
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Reprint of: Cardiovascular Disease Prevention by Diet Modification. J Am Coll Cardiol 2018; 72:2951-2963. [DOI: 10.1016/j.jacc.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022]
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Nelson BW, Allen NB. Extending the Passive-Sensing Toolbox: Using Smart-Home Technology in Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2018; 13:718-733. [PMID: 30217132 DOI: 10.1177/1745691618776008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New smart-home devices provide the opportunity to advance psychological science and theory through novel research opportunities in home environments. These technologies extend the in vivo research and intervention capabilities afforded by other assessment techniques such as Ecological Momentary Assessment methods as well as mobile and wearable devices. Smart-home devices contain a multitude of sensors capable of continuously and unobtrusively collecting multimodal data within home contexts. These devices have some complementary strengths and limitations compared with other assessment methods. This article (a) briefly reviews data collection methods in home environments, (b) discusses the unique advantages of smart-home devices, (c) describes the extant smart-home literature, (d) explores how these devices may advance evaluation and refinement of psychological theories, (e) describes examples of psychological processes that are potential targets for smart-home assessment and intervention, (f) considers methodological challenges and barriers, (g) discusses ethical considerations, and (h) concludes with a discussion of future directions for research and the merging of passive-sensing technologies with active self-report methods. This article aims to highlight the potential utility of smart-home devices within psychological research to evaluate psychological theories related to behavior within the home context.
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Affiliation(s)
- Benjamin W Nelson
- Department of Psychology and The Center for Digital Mental Health, University of Oregon
| | - Nicholas B Allen
- Department of Psychology and The Center for Digital Mental Health, University of Oregon
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Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72:914-926. [PMID: 30115231 PMCID: PMC6100800 DOI: 10.1016/j.jacc.2018.02.085] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.
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Affiliation(s)
- Edward Yu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vasanti S Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Seah SSY, Rebello SA, Tai BC, Tay Z, Finkelstein EA, van Dam RM. Impact of tax and subsidy framed messages on high- and lower-sugar beverages sold in vending machines: a randomized crossover trial. Int J Behav Nutr Phys Act 2018; 15:76. [PMID: 30103793 PMCID: PMC6090625 DOI: 10.1186/s12966-018-0711-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Framing of fiscal incentives has been suggested to be important in influencing purchase decisions. We aimed to examine the effect of framing a modest price difference between high- and lower-sugar beverages as a tax or a subsidy respectively, using messages placed on vending machines to influence beverage purchases. DESIGN/SETTING This is an 11-week randomized crossover trial conducted between August and November 2015, with a two-week run-in period before intervention, targeted at students, staff and faculty of a university campus in Singapore. Twenty-one beverage vending machines were used to implement the intervention involving 'tax message', 'subsidy message' and 'no message (control)'. The former two messages suggest 'a tax for high sugar beverages' or 'a subsidy for lower sugar beverages' respectively. Prices of the beverages offered were fixed at baseline and remained the same in all three experimental conditions: lower-sugar beverage options were priced ~ 10% lower than the corresponding high-sugar option. The machines were randomized to one of the 6 sequences of intervention. Each message intervention period was 3 weeks. The effect of messages was assessed by comparing average weekly units of beverages sold between interventions using mixed effects model. RESULTS The average weekly units of high and lower-sugar beverages sold per vending machine were 115 and 98 respectively in the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. There was no difference in the weekly units of high-sugar beverages sold for the tax message (- 2, 95% CI -8 to 5, p = 0.61) or the subsidy message (0, 95% CI -10 to 10, p = 0.96) conditions as compared with the control condition. Similarly, there was no difference in the weekly units of lower-sugar beverages sold for the tax message (4, 95% CI -4 to 13, p = 0.32) or the subsidy message (7, 95% CI -4 to 18, p = 0.18) conditions as compared with the control condition. CONCLUSIONS The use of tax and subsidy messages to highlight modest price differences did not substantially reduce high-sugar beverage sales in vending machines on an Asian university campus.
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Affiliation(s)
- Sharna Si Ying Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Salome A. Rebello
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Health Services & Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
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Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial. Public Health Nutr 2018; 21:1426-1434. [PMID: 29493476 DOI: 10.1017/s1368980018000319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the present study was to test the effectiveness of financial incentives and traffic-light labels to reduce purchases of sugar-sweetened beverages in a community supermarket. DESIGN In this randomized controlled trial, after a 2-month baseline period (February-March 2014), in-store traffic-light labels were posted to indicate healthy (green), less healthy (yellow) or unhealthy (red) beverages. During the subsequent five months (April-August 2014), participants in the intervention arm were eligible to earn a $US 25 in-store gift card each month they refrained from purchasing red-labelled beverages. SETTING Urban supermarket in Chelsea, MA, USA, a low-income Latino community. SUBJECTS Participants were customers of this supermarket who had at least one child living at home. A total of 148 customers (n 77 in the intervention group and n 71 in the control group) were included in the final analyses. RESULTS Outcomes were monthly in-store purchases tracked using a store loyalty card and self-reported consumption of red-labelled beverages. Compared with control participants, the proportion of intervention participants who purchased any red-labelled beverages decreased by 9 % more per month (P=0·002). More intervention than control participants reduced their consumption of red-labelled beverages (-23 % v. -2 % for consuming ≥1 red beverage/week, P=0·01). CONCLUSIONS Overall, financial incentives paired with in-store traffic-light labels modestly reduced purchase and consumption of sugar-sweetened beverages by customers of a community supermarket.
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Zhang D, Li Y, Wang G, Moran AE, Pagán JA. Nutrition Label Use and Sodium Intake in the U.S. Am J Prev Med 2017; 53:S220-S227. [PMID: 29153124 PMCID: PMC5808587 DOI: 10.1016/j.amepre.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION High sodium intake is a major risk factor for hypertension, but evidence is limited on which interventions are effective in reducing sodium consumption. This study examined the associations between frequent use of nutrition labels and daily sodium intake and the consumption of high-sodium foods in the U.S. METHODS Using the 2007-2008 and 2009-2010 Flexible Consumer Behavior Survey, this study compared sodium intake measured from the 24-hour dietary recalls, availability of salty snacks at home, and frequencies of eating frozen meals/pizzas between frequent (i.e., always or most of the time) and infrequent nutrition label users. Also, the study examined the association between nutrition label use and sodium-related dietary behaviors across different demographic and socioeconomic groups. Data were analyzed in 2016. RESULTS Frequent users of nutrition labels consumed 92.79 mg less sodium per day (95% CI= -160.21, -25.37), were less likely to always or most of the time have salty snacks available at home (OR=0.86, 95% CI=0.76, 0.97), but were just as likely to eat frozen meals or pizzas (incidence rate ratio=0.96, 95% CI=0.84, 1.08) compared with infrequent label users. The associations between nutrition label use and sodium intake differed considerably across age, gender, and socioeconomic groups. CONCLUSIONS Frequent use of nutrition labels appears to be associated with lower consumption of sodium and high-sodium foods in the U.S. Given this small reduction, interventions such as enhancing nutrition label use could be less effective if implemented without other strategies.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Yan Li
- Center for Health Innovation, The New York Academy of Medicine, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew E Moran
- Division of General Internal Medicine, Columbia University Medical Center, New York, New York; College of Physicians and Surgeons, Columbia University, New York, New York
| | - José A Pagán
- Center for Health Innovation, The New York Academy of Medicine, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Pérez-Escamilla R, Lutter CK, Rabadan-Diehl C, Rubinstein A, Calvillo A, Corvalán C, Batis C, Jacoby E, Vorkoper S, Kline L, Ewart-Pierce E, Rivera JA. Prevention of childhood obesity and food policies in Latin America: from research to practice. Obes Rev 2017; 18 Suppl 2:28-38. [PMID: 28741904 DOI: 10.1111/obr.12574] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Addressing childhood obesity in Latin America requires a package of multisectoral, evidence-based policies that enable environments conducive to healthy lifestyles. OBJECTIVE Identify and examine key elements to translating research into effective obesity policies in Latin America. METHODS We examined obesity prevention policies through case studies developed with an expert in the specific policy. Policies were selected based on their level of implementation, visibility and potential impact to reduce childhood obesity. They include: (i) excise taxes on sugar sweetened beverages and energy-dense foods; (ii) front-of-package food label legislation; (iii) trans fatty acids removal from processed foods; and (iv) Ciclovías recreativas or 'open streets'. Case studies were coded to identify components that explained successful implementation and sustainability using the Complex Adaptive Health Systems framework. RESULTS The analysis identified key elements for effective and sustainable policy, including evidence justifying policy; evidence-based advocacy by civil society; political will; and legislation and skillful negotiations across government, academia, the private sector and civil society. Scientific evidence and evaluation played an important role in achieving tipping points for policies' launch and sustain effective implementation. CONCLUSIONS Well-coordinated, intersectoral partnerships are needed to successfully implement evidence-based anti-obesity policies. Prospective policy research may be useful for advancing knowledge translation.
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Affiliation(s)
| | - C K Lutter
- Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - C Rabadan-Diehl
- Department of Health and Human Services, Office of Global Affairs, Washington, DC, USA
| | - A Rubinstein
- Centro de Excelencia en Salud Cardiovascular para América del Sur, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - A Calvillo
- El Poder del Consumidor, Mexico City, Mexico
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - C Batis
- National Institute of Public Health, Cuernavaca, Mexico.,Mexican Council for Science and Technology (CONACyT), Mexico
| | - E Jacoby
- Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - S Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - L Kline
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - E Ewart-Pierce
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - J A Rivera
- National Institute of Public Health, Cuernavaca, Mexico
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Shuval K, Leonard T, Drope J, Katz DL, Patel AV, Maitin-Shepard M, Amir O, Grinstein A. Physical activity counseling in primary care: Insights from public health and behavioral economics. CA Cancer J Clin 2017; 67:233-244. [PMID: 28198998 DOI: 10.3322/caac.21394] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.
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Affiliation(s)
- Kerem Shuval
- Director, Physical Activity and Nutrition Research, Economic & Health Policy Research Program, American Cancer Society, Atlanta, GA
| | - Tammy Leonard
- Associate Professor, Department of Economics, University of Dallas, Irving, TX
| | - Jeffrey Drope
- Vice President, Economic & Health Policy Research Program, American Cancer Society, Atlanta, GA
| | - David L Katz
- Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT
| | - Alpa V Patel
- Strategic Director, Cancer Prevention Study-3, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | | | - On Amir
- Associate Professor, Rady School of Management, University of California-San Diego, La Jolla, CA
| | - Amir Grinstein
- Associate Professor of Marketing, D'Amore-McKim School of Business, Northeastern University, Boston, MA
- Associate Professor of Marketing, Faculty of Economics and Business Administration, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Mueller MP, Anzman-Frasca S, Blakeley CE, Folta SC, Wilde P, Economos CD. Ordering patterns following the implementation of a healthier children's restaurant menu: A latent class analysis. Obesity (Silver Spring) 2017; 25:192-199. [PMID: 27860318 DOI: 10.1002/oby.21708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/09/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Identify ordering patterns following implementation of a healthier children's menu. METHODS A healthier children's menu was introduced in 2012 at a regional restaurant chain, featuring more meals meeting Kids LiveWell (KLW) nutrition standards, KLW side dishes bundled with meals, and the removal of French fries and soda. Latent class analysis was conducted on child meal orders placed after menu implementation (n = 8,611). The average calorie content and proportion of orders meeting calorie recommendations (≤600 kcal) in each class were evaluated. RESULTS The best-fitting model contained six latent classes representing different ordering patterns: "healthy meals" (27.0%), "healthy meals, add-ons" (9.6%), "unhealthy sides" (9.2%), "healthy substitutions" (30.9%), "healthy substitutions, add-ons" (1.0%), and "unhealthy substitutions" (22.4%). Classes denoted as "healthy" were likely to contain meals with KLW items. Orders in the healthy meals class contained fewer calories than orders in all other classes (P < 0.0001). The majority of orders meeting calorie recommendations were in the healthy meals (59.4%) and healthy substitutions (27.1%) classes. CONCLUSIONS Ordering patterns consistent with the healthier menu were common and more likely to meet calorie recommendations. Ordering patterns inconsistent with menu changes also emerged and can inform intervention efforts to reach patrons who may reject or compensate for healthier items.
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Affiliation(s)
- Megan P Mueller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | | | - Caitlin E Blakeley
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- ChildObesity180, Tufts University, Boston, Massachusetts, USA
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Context-specific complementary feeding recommendations developed using Optifood could improve the diets of breast-fed infants and young children from diverse livelihood groups in northern Kenya. Public Health Nutr 2016; 20:971-983. [PMID: 27917743 DOI: 10.1017/s1368980016003116] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To formulate age- and context-specific complementary feeding recommendations (CFR) for infants and young children (IYC) and to compare the potential of filling population-level nutrient gaps using common sets of CFR across age groups. DESIGN Linear programming was used to develop CFR using locally available and acceptable foods based on livelihood- and age-group-specific dietary patterns observed through 24 h dietary recalls. Within each livelihood group, the nutrient potential of age-group-specific v. consolidated CFR across the three age groups was tested. SETTING Three food-insecure counties in northern Kenya; namely, settled communities from Isiolo (n 300), pastoralist communities from Marsabit (n 283) and agro-pastoralist communities from Turkana (n 299). SUBJECTS Breast-fed IYC aged 6-23 months (n 882). RESULTS Age-specific CFR could achieve adequacy for seven to nine of eleven modelled micronutrients, except among 12-23-month-old children in agro-pastoralist communities. Contribution of Fe, Zn and niacin remained low for most groups, and thiamin, vitamin B6 and folate for some groups. Age-group-consolidated CFR could not reach the same level of nutrient adequacy as age-specific sets among the settled and pastoralist communities. CONCLUSIONS Context- and age-specific CFR could ensure adequate levels of more modelled nutrients among settled and pastoralist IYC than among agro-pastoralist communities where use of nutrient-dense foods was limited. Adequacy of all eleven modelled micronutrients was not achievable and additional approaches to ensure adequate diets are required. Consolidated messages should be easier to implement as part of a behaviour change strategy; however, they would likely not achieve the same improvements in population-level dietary adequacy as age-specific CFR.
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Cantor J, Torres A, Abrams C, Elbel B. Five Years Later: Awareness Of New York City’s Calorie Labels Declined, With No Changes In Calories Purchased. Health Aff (Millwood) 2015; 34:1893-900. [DOI: 10.1377/hlthaff.2015.0623] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan Cantor
- Jonathan Cantor is a doctoral student at New York University’s Robert F. Wagner Graduate School of Public Service and an analyst at the New York University School of Medicine, both in New York City
| | - Alejandro Torres
- Alejandro Torres is a medical student at the New York University School of Medicine
| | - Courtney Abrams
- Courtney Abrams is a program manager at the New York University School of Medicine
| | - Brian Elbel
- Brian Elbel (
) is an associate professor at the New York University School of Medicine and New York University’s Robert F. Wagner Graduate School of Public Service
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Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. "You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions. J Med Internet Res 2015; 17:e202. [PMID: 26290186 PMCID: PMC4642375 DOI: 10.2196/jmir.4209] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/03/2015] [Accepted: 07/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as "quantified self" advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. OBJECTIVE Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? METHODS We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. RESULTS Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients' self-tracked data. CONCLUSIONS Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered "illness work" connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their "illness work" more efficiently and effectively.
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Affiliation(s)
- Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy and Research, Division of Health Informatics, New York, NY, United States.
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Kondo N. Epidemiologic Study on Social Determinants of Health: What's Next? J Epidemiol 2015; 25:461-2. [PMID: 26005068 PMCID: PMC4483370 DOI: 10.2188/jea.je20150082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Naoki Kondo
- Department of Health and Social Behaviour/Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo
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Anzman-Frasca S, Mueller MP, Sliwa S, Dolan PR, Harelick L, Roberts SB, Washburn K, Economos CD. Changes in children's meal orders following healthy menu modifications at a regional U.S. restaurant chain. Obesity (Silver Spring) 2015; 23:1055-62. [PMID: 25919925 DOI: 10.1002/oby.21061] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/30/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine changes in children's meal orders, price, and revenue following the implementation of a healthier children's menu in a full-service restaurant chain. METHODS In April 2012, the healthier menu was implemented, featuring more meals meeting nutrition standards, healthy side dishes by default, and removal of French fries and soda (which could be substituted). Orders (n = 352,192) were analyzed before (September 2011 to March 2012; PRE) and after (September 2012 to March 2013; POST) implementation. RESULTS Children's meal prices increased by $0.79 for breakfasts and $0.19 for non-breakfast meals from PRE to POST. Revenue continued to increase post-implementation. Orders of healthy meals, strawberry and vegetable sides, milk, and juice increased, and orders of French fries and soda decreased (P < 0.0001). Orders at POST were more likely to include healthy sides (P < 0.0001) and substitutions (P < 0.0001) and less likely to include a la carte sides (P < 0.0001) and desserts (P < 0.01), versus PRE. Total calories ordered by children accepting all defaults decreased (684.2 vs. 621.2; P < 0.0001) and did not change for those not accepting defaults (935.0 vs. 942.9; P = 0.57). CONCLUSIONS Healthy children's menu modifications were accompanied by healthier ordering patterns, without removing choice or reducing revenue, suggesting that they can improve child nutrition while restaurants remain competitive.
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Affiliation(s)
- Stephanie Anzman-Frasca
- ChildObesity180 and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, 02111, USA
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