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Carr KA, Black W, Guth C, Shapiro L, Leone LA, Temple JL, Epstein LH. Reinforcing value of food, enriched home environment, and changes in percent overweight in children. Obesity (Silver Spring) 2023; 31:1075-1084. [PMID: 36855013 DOI: 10.1002/oby.23685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE The decision to eat is often a choice made in the context of food and non-food alternatives. However, no research, to the authors' knowledge, has assessed the combination of the motivation to eat, as indexed by the relative reinforcing value of food (RRVFOOD ), and the enriched home environment, i.e., access to activities that can serve as alternatives to eating on weight gain. METHODS This study used a cross-sectional design to study how RRVFOOD and the enriched home environment predict percent overweight change over 2 years in 291 children aged 6 to 9 years and of varying socioeconomic status. RESULTS Results showed that RRVFOOD and access to food were positively associated with baseline percent overweight, and an enriched home environment was negatively related to baseline percent overweight. RRVFOOD and an enriched home environment interacted to predict change in percent overweight. Children with a high relative RRVFOOD and a relatively non-enriched environment showed the greatest relative weight gain. CONCLUSIONS These results suggest that providing an enriched home environment may reduce the effects of food reinforcement and being motivated to eat on weight gain in childhood, and this represents a novel approach to intervention that can be used to strengthen current behavioral approaches to prevent obesity in children.
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Affiliation(s)
- Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Whitney Black
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Catherine Guth
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Lilianna Shapiro
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Lucia A Leone
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
| | - Jennifer L Temple
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Sciences, Buffalo, New York, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Kong KL, Eiden RD, Morris KS, Paluch RA, Carr KA, Epstein LH. Reducing relative food reinforcement of infants using a music enrichment program: a randomized, controlled trial. Am J Clin Nutr 2022; 116:1642-1653. [PMID: 36250608 PMCID: PMC9761746 DOI: 10.1093/ajcn/nqac209] [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: 03/04/2022] [Revised: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Food reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement. OBJECTIVES We implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat. METHODS The 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRVfood), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)]. RESULTS There were significant differential group changes across time for RRVfood (group × month; P = 0.016; Cohen's f2 = 0.034). The music group had significantly greater RRVfood decreases than the control group from baseline to the end of the intensive intervention phase (music change = -0.211; control change = -0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12-24 (music change = -0.187; control change = -0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group. CONCLUSIONS This study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat.This trial was registered at clinicaltrials.gov as NCT02936284.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri–Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rina D Eiden
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katherine S Morris
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Crandall AK, Epstein LH, Fillo J, Carfley K, Fumerelle E, Temple JL. The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091338. [PMID: 36138648 PMCID: PMC9498192 DOI: 10.3390/children9091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022]
Abstract
This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7−10 dyads & 53 parent/adolescent aged 15−17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.
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Affiliation(s)
- Amanda K. Crandall
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Correspondence:
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, 915 Greene St Discovery I, Suite 551, Columbia, SC 29208, USA
| | - Kevin Carfley
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Eleanor Fumerelle
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer L. Temple
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
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Epstein LH, Carr KA, Guth C, Shapiro L, Leone LA, Temple JL. The enriched home environment and dietary intake are related to percent overBMI in children. Prev Med Rep 2021; 23:101440. [PMID: 34178591 PMCID: PMC8209748 DOI: 10.1016/j.pmedr.2021.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child's enriched home environment along with energy and macronutrient intake. A sample of 158 6-9-year-old children measured between February 2017 - April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid's Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child's home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child's home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Katelyn A. Carr
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Catherine Guth
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Lilianna Shapiro
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behaviors, University at Buffalo, School of Public Health and Health Sciences, USA
| | - Jennifer L. Temple
- Department of Exercise and Nutrition Sciences, University at Buffalo, School of Public Health and Health Sciences, USA
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Epstein LH, Carr KA. Food reinforcement and habituation to food are processes related to initiation and cessation of eating. Physiol Behav 2021; 239:113512. [PMID: 34217735 DOI: 10.1016/j.physbeh.2021.113512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
An individual bout of eating involves cues to start eating, as well as cues to terminate eating. One process that determines initiation of eating is food reinforcement. Foods with high reinforcing value are also likely to be consumed in greater quantities. Research suggests both cross-sectional and prospective relationships between food reinforcement and obesity, food reinforcement is positively related to energy intake, and energy intake mediates the relationship between food reinforcement and obesity. A process related to cessation of eating is habituation. Habituation is a general behavioral process that describes a reduction in physiological or affective response to a stimulus, or a reduction in the behavioral responding to obtain a stimulus. Repeated exposure to the same food during a meal can result in habituation to that food and a reduction in consumption. Habituation is also cross-sectionally and prospectively related to body weight, as people who habituate slower consume more in a meal and are more overweight. Research from our laboratory has shown that these two processes independently influence eating, as they can account for almost 60% of the variance in ad libitum intake. In addition, habituation phenotypes show reliable relationships with reinforcing value, such that people who habituate faster also find food less reinforcing. Developing a better understanding of cues to start and stop eating is fundamental to understanding how to modify eating behavior. An overview of research on food reinforcement, habituation and food intake for people with a range of weight status and without eating disorders is provided, and ideas about integrating these two processes that are related to initiation and termination of a bout of eating are discussed.
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Affiliation(s)
- Leonard H Epstein
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
| | - Katelyn A Carr
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
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Lumeng JC, Weeks HM, Asta K, Sturza J, Kaciroti NA, Miller AL, Rosenblum K, Gearhardt AN. Sucking behavior in typical and challenging feedings in association with weight gain from birth to 4 Months in full-term infants. Appetite 2020; 153:104745. [PMID: 32439604 PMCID: PMC7324912 DOI: 10.1016/j.appet.2020.104745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 02/05/2023]
Abstract
Sucking behavior has been described as an obesity risk marker. Sucking behavior in response to challenge has not been examined as a prospective predictor of infant weight gain. Healthy, full term infants had sucking behavior assessed at ages 2 weeks and/or 2 months via a sucking pressure measurement device in two feeding conditions: during a standard feeding and during a feeding with a more challenging nipple. Weight and length were measured at 2 weeks, 2 months, and 4 months and weight-for-length z-score (WLZ) calculated. Among 45 full term infants, adjusted for age at measurement and time since last feeding, the challenging versus typical feedings differed with regard to amount consumed (54.1g vs. 65.6g, p < .05), maximum sucking pressure (121.3 mmHg vs. 99.2 mmHg, p < .05), mean burst duration (17.5s vs. 28.4s, p < .05), and feeding duration (18.51 min vs. 13.89 min, p < .01). Grams consumed in the challenging, but not typical, feeding, adjusted for age and time since last feeding, predicted rate of change in WLZ from time of measurement to age 4 months (r = 0.46, p = .013 for challenging, r = -0.07, p = .702 for typical). Nipples that are more challenging to suck from change the sucking behavior and intake among full term infants. Infants who consume more when the nipple is more challenging have greater prospective weight gain. This persistent sucking behavior in the face of challenge may reflect that a greater willingness to work for food, a known obesity risk factor, is detectable in early infancy.
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Affiliation(s)
- Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Katharine Asta
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Julie Sturza
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Niko A Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Kong KL, Anzman-Frasca S, Epstein LH, Eiden RD, Paluch RA. Infants with big appetites: The role of a nonfood environment on infant appetitive traits linked to obesity. Am J Clin Nutr 2020; 112:948-955. [PMID: 32652028 PMCID: PMC7762759 DOI: 10.1093/ajcn/nqaa175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Individual differences in appetitive traits present in the first few weeks of life. Research has shown that infants with a greater food reinforcement ratio (FRR) have higher obesity risk. To date, limited work has examined the relation between FRR and appetitive traits of infants, and how FRR relates to appetitive traits and obesity development. OBJECTIVES To examine the relation between appetitive traits and food and nonfood reinforcement of infants aged 9-18 mo, and to examine whether food and nonfood reinforcement mediate the relation between appetitive traits and weight-for-length z-score (zWFL). METHOD This secondary data analysis was conducted by combining 4 different cohorts of infants (n = 143) who have complete data on the food/nonfood reinforcement task, Baby Eating Behavior Questionnaire, and anthropometrics and demographics assessments. Three different nonfood reinforcers were used: video (DVD; n = 27), playing with bubbles (Bubbles; n = 67), and music accompanied by instruments (Music; n = 49) for the nonfood portion of the task. For the food portion of the task, the infant's favorite food was used. RESULTS General appetite positively correlated with FRR and zWFL, but negatively correlated with nonfood reinforcement; satiety responsiveness negatively correlated with food reinforcement, FRR, and zWFL. Mediational analysis showed that effects of general appetite on zWFL were mediated by FRR (indirect effect = 0.100, 95% CI: 0.041, 0.187) and nonfood reinforcement (indirect effect = 0.076, 95% CI: 0.025, 0.156). We also observed the mediating effect of FRR on the relation of satiety responsiveness and zWFL (indirect effect = -0.097, 95% CI: -0.204, -0.026). CONCLUSIONS Our work contributes to the mechanistic understanding of the ontogeny of obesity development early in life among individuals who are born with appetitive drive for overconsumption. During early infancy, the nonfood environment may protect against this drive and prevent obesity development.
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Affiliation(s)
| | - Stephanie Anzman-Frasca
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA,Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA,Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Rina D Eiden
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Carr KA, Epstein LH. Choice is relative: Reinforcing value of food and activity in obesity treatment. AMERICAN PSYCHOLOGIST 2020; 75:139-151. [PMID: 32052990 PMCID: PMC7313531 DOI: 10.1037/amp0000521] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Persons with obesity find high-energy-dense food and sedentary behaviors highly reinforcing. Diets and exercise programs deprive individuals of many favorite foods and activities, which can counterproductively heighten their value and lead to relapse. Since the value of reinforcers depend on the alternatives available, one approach to reducing food and sedentary activity reinforcement is to build healthy alternative reinforcers. Current behavioral treatment programs for children and adults do not attempt to build alternative reinforcers as substitutes for unhealthy behaviors to reduce the impact of food or activity deprivation on the motivation to eat or be inactive. A goal of the next generation of obesity treatment programs should focus on development of healthy behaviors as reinforcers so that people will be motivated to engage in them. This article provides an overview of relationships among reinforcers, how understanding substitutes and complements can influence eating and activity, and how enriching a person's environment and providing choice architecture can enhance weight control. Ideas for translation of these basic behavioral economic principles to obesity treatment programs are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Katelyn A Carr
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
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Intégration de la tablette tactile dans les programmes de prévention bucco-dentaire destinés aux personnes en situation de handicap cognitif : étude exploratoire chez l’enfant. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Higgins ST. Editorial: 3rd Special Issue on behavior change, health, and health disparities. Prev Med 2016; 92:1-5. [PMID: 27693562 PMCID: PMC5384999 DOI: 10.1016/j.ypmed.2016.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 01/22/2023]
Abstract
This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, United States.
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