Resistant to the recession: low-income adults' maintenance of cooking and away-from-home eating behaviors during times of economic turbulence

European mature adults and elderly are moving closer to the Mediterranean diet-a longitudinal study, 2013-19

BACKGROUND

The decreasing adherence in Mediterranean Diet (M.D.) during the last decades has been attributed to social, cultural and economic factors. However, recent efforts to improve dietary habits and the economic improvement might be reversing this trend. We analyze the changes in M.D. adherence between 2013 and 2019 among a sample of European mature adults and the elderly.

METHODS

Using data from the Survey of Health, Ageing and Retirement in Europe for adults over 50 years old, we designed a longitudinal cohort study with a sample of participants from waves 5 (2013) and 8 (2019/20). Logistic regressions were used to model the consumption of M.D. adherence as a function of the year. We then stratified the analyses by education, age and transitions in economic status, employment and self-perceived health.

RESULTS

There was in 2019/20 a significant increase in the M.D. adherence (10.8% vs. 14.3%, OR = 1.367, P < 0.01). The rise was mainly related to the decrease of meat and fish (38.4% vs. 30.5%, OR = 0.703, P < 0.01) and growth of legumes and eggs intake (36.3% vs. 41.8%, OR = 1.260 P < 0.01). The results were consistent in all European regions and most sociodemographic groups. Younger people with higher income and education had a greater rise in adherence.

CONCLUSIONS

Our analysis shows a generalized growth in adherence to the M.D. across most socioeconomic subpopulations and countries in Europe, suggesting a shift to healthier diet patterns. The more noticeable increase among affluent, educated and healthy respondents, may further entrench dietary and health inequalities.

The Development and Validation of the Planning to Make Meals Performance Measure

The Planning to Make Meals Performance Measure (PMMPM) was initially created as an outcome measure for an occupation-based program dedicated to helping individuals living in poverty maximize their food resources. This article briefly describes the PMMPM and the results of a cross-sectional study examining construct validity. Forty-two participants completed the PMMPM, Food Skills Confidence Measure (FSCM), and Cooking Skills Confidence Measure (CSCM). Analysis using Spearman's correlations revealed that one or more PMMPM score significantly correlated with the FSCM (r = .37-.50, p ≤ .05) and the CSCM (r = .44-.49, p = .01). These findings add to the psychometric properties of the PMMPM, promoting its usefulness as an alternative to self-report measures for programs seeking to enhance food, cooking, or resource management skills. Creating authentic and direct performance measures that assess complex constructs or skills is another way occupational therapy can contribute to health and well-being.

An Evaluation of the COVID-19 Pandemic and Perceived Social Distancing Policies in Relation to Planning, Selecting, and Preparing Healthy Meals: An Observational Study in 38 Countries Worldwide

Objectives

To examine changes in planning, selecting, and preparing healthy foods in relation to personal factors (time, money, stress) and social distancing policies during the COVID-19 crisis.

Methods

Using cross-sectional online surveys collected in 38 countries worldwide in April-June 2020 (N = 37,207, Mage 36.7 SD 14.43, 73.6% women), we compared changes in food literacy behaviors to changes in personal factors and social distancing policies, using hierarchical multiple regression analyses controlling for sociodemographic variables.

Results

Increases in planning (4.7 SD 1.2, 4.9 SD 1.3), selecting (3.8 SD 1.7, 3.8 SD 1.7), and preparing (4.6 SD 1.3, 4.7 SD 1.3) healthy foods were found for women and men, and positively related to perceived time availability among women and stay-at-home policies for planning and preparing in women. Psychological distress was a barrier for women, and an enabler for men. COVID-19 induced financial stress was a barrier depending on various sociodemographic variables (all p < 0.01).

Conclusion

Stay-at-home policies and feelings of having more time during COVID-19 seem to have improved food literacy among women. Stress and other social distancing policies relate to food literacy in more complex ways, highlighting the necessity of a health equity lens.

Unemployment during the Great Recession and large-for-gestational age births

BACKGROUND

Several studies have suggested that record high unemployment during the Great Recession was associated with deleterious changes in diet and weight-related health. However, studies have yet to explore whether the Great Recession was also associated with obesity-related health in utero.

METHODS

We investigated whether increasing county-level unemployment was associated with large-for-gestational age (LGA) births, using repeated cross-sectional data from California birth records between 2008 and 2011 (n = 1,715,052). LGA was defined as >90th percentile, using the Oken reference. We use the annual 1-year lagged value for county-level unemployment (2007-2010) and limit our analyses to singleton, term births. Linear probability models, with county and year fixed-effects were used to examine the unemployment-LGA association. All models control for county-level foreclosure rates, child gender, and maternal age, parity, education, and race/ethnicity.

RESULTS

An increase in county-level unemployment was not statistically significantly associated with the prevalence of LGA (percentage point [PP]: 0.12; 95% CI: -0.02, 0.25). But, over the period of observation, for every one standard deviation increase in unemployment, LGA prevalence increased by 5% and p = 0.08.

CONCLUSIONS

These results cautiously suggest some deleterious effects of the Great Recession on obesity-related health in utero.

Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research

There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000–2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggest actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide.

The Great Recession and adverse birth outcomes: Evidence from California, USA

Objectives

Prior studies of the health effects of recessions have shown mixed results. Ecological studies often report a positive relationship between economic downturns and population health while individual-level studies often show that conditions related to recessions are deleterious. Our study examines the spatially and temporally heterogenous effects of the Great Recession (TGR) on adverse birth outcomes, a contemporaneous measure of population health that is highly responsive to changing social conditions.

Methods

We use restricted birth cohort data from California (2004–2012) merged with both county- and tract-level socio-demographic data, to explore birth selectivity and temporal and unemployment effects during TGR on adverse birth outcomes.

Results

We find that gestational exposure – more specifically, second trimester exposure – during or adjacent to the months of TGR was generally deleterious for birth outcomes, more so, in some cases, for mothers with lower levels of education, and that increases in county-level unemployment were generally deleterious for birth outcomes.

Conclusions

Although recessionary effects on population health are problematic and may have far-reaching effects, it appears that these effects may be largely universal, even given potential selective fertility favoring advantaged groups.

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We use restricted data from California to determine the effects of The Great Recession on adverse birth outcomes.

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We find that increases in unemployment are generally harmful to birth outcomes.

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We also find these effects to be largely universal and not differential in disparity populations.

Consumers' Views on the Importance of Specific Front-of-Pack Nutrition Information: A Latent Profile Analysis

Nutrition labelling can influence consumers’ assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers’ preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.

Dietary changes during the Great Recession in Portugal: comparing the 2005/2006 and the 2014 health surveys

OBJECTIVE

We aimed at analysing changes in consumption of selected food groups in the Portuguese population before and after the Great Recession, which hit the country between 2008 and 2013.

DESIGN

We used pooled cross-sectional data from the Portuguese National Health Interview Surveys of 2005/2006 and 2014. We modelled the probability of consumption of soup, fish, meat, potatoes/rice/pasta, bread, legumes, fruit, vegetables and sweets/desserts, as a function of the year, controlling for age, sex and education, using logistic regressions. Then, we stratified the analysis by age group and education level. Analyses were adjusted for survey weights.

SETTING

Portugal (2005/2006 to 2014).ParticipantsAdults (n 43273) aged 25-79 years.

RESULTS

From 2005/2006 to 2014, there was a significantly lower consumption of fish, soup, fruit and vegetables. Conversely, the consumption of legumes and sweets/desserts was significantly higher in 2014. The changes in the selected food groups were consistent across most education levels. Among people aged 65 years or above, there were no significant changes in most foods, except an increase in the consumption of legumes and sweets/desserts. In contrast, people aged 25-39 and 40-64 years significantly decreased their intakes of fish and soup and increased their consumption of sweets/desserts.

CONCLUSIONS

The consistent results across education levels suggest that changes in dietary habits are not linked to the economic downturn. By contrast, our findings suggest a shift away from foods commonly linked to the Mediterranean diet, particularly among younger people.

Barriers to healthy food access: Associations with household income and cooking behavior

To examine how barriers to healthy food access and household income are associated with cooking and eating behaviors we fielded a nationally representative survey among 1112 adults in the United States in 2015. The survey included measures of barriers to accessing healthy food, household income, and frequency of cooking and eating meals, cooking practices, and other eating behaviors. We used multivariable poisson regression to examine the association of household income and barriers to healthy food access with cooking and eating behavior outcomes. We find that low income was associated with higher barriers to accessing healthy food (barriers) and that both income and barriers were associated with differences in cooking frequency/practices, and consumption behaviors. In interaction models, cooking and eating behaviors did not vary based on barriers for the lowest income level (<$25,000). In the middle income level ($25,000-$59,000), barriers were associated with cooking breakfast (3.35 vs. 2.64 times/week, p = 0.03) and lunch (3.32 vs. 2.56 times/week, p = 0.02) more frequently compared to those who never/rarely encountered barriers. At the highest income level (≥$60,000), barriers were associated with less frequently eating breakfast (4.29 vs. 5.11 times/week, p < 0.001) and lunch (4.77 vs. 5.56, times/week, p < 0.001) compared to those who never/rarely encountered barriers. Barriers to healthy food access are related to both household income and cooking and eating behaviors important for diet quality and healthy eating. Targeted interventions to address time available to shop, and the price, selection and quality of healthy foods, are necessary.

Which activities count? Using experimental data to understand conceptualizations of physical activity

US health surveys consistently report that men and those with higher socioeconomic status (SES) engage in more physical activity than women and lower SES counterparts, using questions that ask about physical activity during leisure time. However, social characteristics such as gender and SES shape understandings of and access to leisure-based physical activity as well as other domains where healthy activity is available – namely house work, care work, and paid work. Thus, the physical activity of US adults may look different when what counts as physical activity expands beyond leisure activity.

The current study uses Amazon’s Mechanical Turk platform to conduct a 2-by-2-by-2 factorial experiment that crosses three types of physical activities: leisure, house or care work, and paid work. We find that physical activity questions that prime respondents – that is, ask respondents – to consider house/care work or paid work lead to increased minutes reported of physical activity compared to not priming for physical activity, while asking about leisure is no different from having no physical activity primed. The effect on reported physical activity of priming with house/care work is stronger for women than men, demonstrating support for gendered specialization of time spent in the house and care work domain. The effects on reported physical activity of priming with house/care work and paid work are stronger for those with less education compared to more education, consistent with socioeconomic divisions in access to physical activity in house/care work and employment. This study highlights the contingence of our understanding of the physical activity of US adults on both its measurement in surveys and the social forces which shape understanding of and access to physical activity.

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Leisure questions may not capture gender and socioeconomic patterns shaping access to and opportunity for physical activity.

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Priming for house/care work or paid work increases minutes reported of physical activity compared to no prime.

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The effect on physical activity of priming respondents for house/care work is stronger for women than men.

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The effects on physical activity of priming with house/care work and paid work are stronger for those with less education.

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Understandings of physical activity of US adults relies on measurement and the social forces shaping access and opportunity.

Faithful Families Cooking and Eating Smart and Moving for Health: Evaluation of a Community Driven Intervention

Background: There is an increasing need to adapt and use community interventions to address modifiable behaviors that lead to poor health outcomes, like obesity, diabetes, and heart disease. Poor health outcomes can be tied to community-level factors, such as food deserts and individual behaviors, like sedentary lifestyles, consuming large portion sizes, and eating high-calorie fast food and processed foods. Methods: Through a social ecological approach with family, organization and community, the Faithful Families Cooking and Eating Smart and Moving for Health (FFCESMH) intervention was created to address these concerns in a rural South Carolina community. FFCESMH used gatekeepers to identify 18 churches and four apartment complexes in low-income areas; 176 participants completed both pre- and post-survey measures. Results: Paired t-test measures found statistically significant change in participant perception of food security (0.39, p-value = 0.005, d = 0.22), self-efficacy with physical activity and healthy eating (0.26, p-value = 000, d = 0.36), and cooking confidence (0.17, p-value = 0.01, d = 0.19). There was not significant change in cooking behaviors, as assessed through the Cooking Behaviors Scale. Conclusion: FFCESMH shows that a social ecological approach can be effective at increasing and improving individual healthy behaviors and addressing community-level factors in low-income rural communities.

Obesity and the food system transformation in Latin America

The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.

Who's cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016

BACKGROUND

While US home cooking declined in the late twentieth century, it is unclear whether the trend has continued. This study examines home cooking from 2003 to 2016 by gender, educational attainment, and race/ethnicity.

METHODS

Nationally representative data from the American Time Use Study from 2003 to 2016 and linear regression models were used to examine changes in the percent of adults aged 18-65 years who cook and their time spent cooking, with interactions to test for differential changes by demographic variables of gender, education, and race/ethnicity.

RESULTS

Cooking increased overall from 2003 to 2016. The percent of college-educated men cooking increased from 37.9% in 2003 to 51.9% in 2016, but men with less than high school education who cook did not change (33.2% in 2016) (p < 0.05). College-educated women who cook increased from 64.7% in 2003 to 68.7% in 2016, while women with less than high school education had no change (72.3% in 2016) (p < 0.05). Women with less education spent more time cooking per day than high-educated women, but the reverse was true for men. Among men, the percent who cook increased for all race/ethnic groups except non-Hispanic blacks. Among women, only non-Hispanic whites increased in percent who cook. Among both men and women, non-Hispanic blacks had the lowest percentage who cooked, and non-Hispanic others spent the greatest amount of time cooking.

CONCLUSIONS

Home cooking in the United States is increasing, especially among men, though women still cook much more than men. Further research is needed to understand whether the heterogeneity in home cooking by educational attainment and race/ethnicity observed here contributes to diet-related disparities in the United States.

Determinants of eating at local and western fast-food venues in an urban Asian population: a mixed methods approach

BACKGROUND

Like several Southeast Asian countries, Singapore has a complex eating-out environment and a rising eating-out prevalence. However the determinants and drivers of eating-out in urban Asian environments are poorly understood.

METHODS

We examined the socio-demographic characteristics of persons who frequently ate away from home in local eateries called hawker centres and Western fast-food restaurants, using data from 1647 Singaporean adults participating in the National Nutrition Survey (NNS) 2010. We also assessed the underlying drivers of eating out and evaluated if these were different for eating at local eateries compared to Western fast-food restaurants using 18 focus group discussions of women (130 women).

RESULTS

Participants reported a high eating-out frequency with 77.3% usually eating either breakfast, lunch or dinner at eateries. Main venues for eating-out included hawker centres (61.1% usually ate at least 1 of 3 daily meals at this venue) and school/workplace canteens (20.4%). A minority of participants (1.9%) reported usually eating at Western fast-food restaurants. Younger participants and those of Chinese and Malay ethnicity compared to Indians were more likely to eat at Western fast-food restaurants. Chinese and employed persons were more likely to eat at hawker centres. The ready availability of a large variety of affordable and appealing foods appeared to be a primary driver of eating out, particularly at hawker centres.

CONCLUSIONS

Our findings highlight the growing importance of eating-out in an urban Asian population where local eating venues play a more dominant role compared with Western fast-food chains. Interventions focusing on improving the food quality at venues for eating out are important to improve the diet of urban Asian populations.

Cooking at Home: A Strategy to Comply With U.S. Dietary Guidelines at No Extra Cost

INTRODUCTION

Cooking at home is associated with better diet quality. This study examined the frequency of home-cooked dinners versus eating out in relation to the Healthy Eating Index (HEI), and food expenditures.

METHODS

The Seattle Obesity Study used a stratified random sample of 437 King County adults. In-person computer-assisted interviews collected sociodemographic and behavioral data during 2011-2013. HEI-2010 and 2005 were computed using Food Frequency Questionnaires. Multivariable regression analyses, conducted in 2015, examined associations among HEI scores, food expenditures, and frequency of cooking at home versus eating out variables.

RESULTS

Frequent home-cooked dinners were associated with being married, unemployed, larger households, presence of children aged <12 years, and lower frequency of eating out, but unrelated to education or income. In adjusted models, frequent at-home cooking was associated with higher HEI-2010 (β=7.4, p<0.001), whereas frequent eating out was associated with lower HEI-2010 (β= -6.6, p<0.001). Frequent home cooking was linked with reduced per capita food expenditures overall ($330/month among low vs $273/month among high cooking group, p<0.001), and reduced away-from-home expenditures ($133 and $65, respectively), without any significant increase in at-home food expenditures. However, frequent eating out was associated with significantly higher per capita food expenditures overall ($261 in low vs $364 among high eating out group, p=0.001), and higher away-from-home expenditures.

CONCLUSIONS

Home-cooked dinners were associated with greater dietary guideline compliance, without significant increase in food expenditures. By contrast, frequent eating out was associated with higher expenditures and lower compliance. Home cooking may be a component of nutrition resilience.

Effects of the Global Financial Crisis on Health in High-Income Oecd Countries

A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.

Lifecycle effects of a recession on health behaviors: Boom, bust, and recovery in Iceland

This study uses individual-level longitudinal data from Iceland, a country that experienced a severe economic crisis in 2008 and substantial recovery by 2012, to investigate the extent to which the effects of a recession on health behaviors are lingering or short-lived and to explore trajectories in health behaviors from pre-crisis boom, to crisis, to recovery. Health-compromising behaviors (smoking, heavy drinking, sugared soft drinks, sweets, fast food, and tanning) declined during the crisis, and all but sweets continued to decline during the recovery. Health-promoting behaviors (consumption of fruit, fish oil, and vitamins/minerals and getting recommended sleep) followed more idiosyncratic paths. Overall, most behaviors reverted back to their pre-crisis levels or trends during the recovery, and these short-term deviations in trajectories were probably too short-lived in this recession to have major impacts on health or mortality. A notable exception is for binge drinking, which declined by 10% during the 2 crisis years, continued to fall (at a slower rate of 8%) during the 3 recovery years, and did not revert back to the upward pre-crisis trend during our observation period. These lingering effects, which directionally run counter to the pre-crisis upward trend in consumption and do not reflect price increases during the recovery period, suggest that alcohol is a potential pathway by which recessions improve health and/or reduce mortality.

Multiple pathways from the neighborhood food environment to increased body mass index through dietary behaviors: A structural equation-based analysis in the CARDIA study

OBJECTIVES

To examine longitudinal pathways from multiple types of neighborhood restaurants and food stores to BMI, through dietary behaviors.

METHODS

We used data from participants (n=5114) in the United States-based Coronary Artery Risk Development in Young Adults study and a structural equation model to estimate longitudinal (1985-86 to 2005-06) pathways simultaneously from neighborhood fast food restaurants, sit-down restaurants, supermarkets, and convenience stores to BMI through dietary behaviors, controlling for socioeconomic status (SES) and physical activity.

RESULTS

Higher numbers of neighborhood fast food restaurants and lower numbers of sit-down restaurants were associated with higher consumption of an obesogenic fast food-type diet. The pathways from food stores to BMI through diet were inconsistent in magnitude and statistical significance.

CONCLUSIONS

Efforts to decrease the numbers of neighborhood fast food restaurants and to increase the numbers of sit-down restaurant options could influence diet behaviors. Availability of neighborhood fast food and sit-down restaurants may play comparatively stronger roles than food stores in shaping dietary behaviors and BMI.

The food retail revolution in China and its association with diet and health

The processed food sector in low- and middle-income countries has grown rapidly. Little is understood about its effect on obesity. Using data from 14,976 participants aged two and older in the 2011 China Health and Nutrition Survey, this paper examines patterns of processed food consumption and their impacts on obesity while considering the endogeneity of those who purchase processed foods. A major assumption of our analysis of the impact of processed foods on overweight and obesity was that the consumption of processed foods is endogenous due to their accessibility and urbanicity levels. The results show that 74.5% of participants consumed processed foods, excluding edible oils and other condiments; 28.5% of participants' total daily energy intake (EI) was from processed foods. Children and teenagers in megacities had the highest proportion of EI (40.2%) from processed foods. People who lived in megacities or highly urbanized neighborhoods with higher incomes and educational achievement consumed more processed foods. When controlling for endogeneity, only the body mass index (BMI) and risk of being overweight of children ages two to eighteen are adversely associated with processed foods (+4.97 BMI units, 95% confidence interval (CI): 1.66-8.28; odds ratio (OR) = 3.63, 95% CI: 1.45-9.13). Processed food purchases represent less than a third of current Chinese food purchases. However, processed food purchases are growing at the rate of 50% per year, and we must begin to understand the implications for the future.

Meal preparation and cleanup time and cardiometabolic risk over 14 years in the Study of Women's Health Across the Nation (SWAN)

OBJECTIVE

To determine whether baseline levels and longitudinal changes in meal preparation and cleanup time are associated with changes in cardiometabolic risk factors in midlife women.

METHODS

Subjects were 2755 midlife women enrolled in the Study of Women's Health Across the Nation, a multi-ethnic, longitudinal cohort study in the United States. The five diagnostic components of the metabolic syndrome and meal preparation/cleanup time were assessed repeatedly across 14 years of follow-up (spanning 1996-2011) at seven U.S. sites. Mixed-effects logistic and ordered logistic models tested associations between meal preparation/cleanup time and odds of meeting criteria for metabolic syndrome and its individual diagnostic components.

RESULTS

Women who spent more time preparing and cleaning up meals at baseline, or demonstrated greater increases in this activity, had greater increases over time in their odds of having metabolic syndrome and in the number of metabolic syndrome components for which they met criteria. Adjusted associations were observed between meal preparation/cleanup time and hypertension, impaired fasting glucose, hypertriglyceridemia, and low high-density lipoprotein cholesterol, but not abdominal obesity.

CONCLUSIONS

In midlife women, greater meal preparation/cleanup time is associated with the development of an adverse cardiometabolic risk profile. Public health interventions should place greater emphasis on cooking healthfully, not just cooking frequently.

No time for the gym? Housework and other non-labor market time use patterns are associated with meeting physical activity recommendations among adults in full-time, sedentary jobs

Physical activity and inactivity have distinct cardio-metabolic consequences, suggesting that combinations of activities can impact health above and beyond the effects of a single activity. However, little work has examined patterns of non-labor market time activity in the US population, particularly among full-time employees in sedentary occupations, who are at increased risk of adverse health consequences associated with a sedentary lifestyle. Identification of these patterns, and how they are related to total physical activity levels, is important for developing effective, attainable physical activity recommendations among sedentary employees, who typically have less time available for exercise. This is especially the case for low-income employees who face the highest time and financial barriers to achieving physical activity goals. This study uses cluster analysis to examine patterns of non-labor market time use among full-time (≥40 h/week) employed adults in sedentary occupations (<3 MET-h) on working days in the American Time Use Study. We then examine whether these patterns are associated with higher likelihood of meeting physical activity recommendations and higher overall physical activity (MET-h). We find that non-labor market time use patterns include those characterized by screen activities, housework, caregiving, sedentary leisure, and exercise. For both genders, the screen pattern was the most common and increased from 2003 to 2012, while the exercise pattern was infrequent and consistent across time. Screen, sedentary leisure, and community patterns were associated with lower likelihoods of meeting physical activity recommendations, suggesting that interventions targeting screen time may miss opportunities to improve physical activity among similarly sedentary groups. Alternately, non-labor market time use patterns characterized by housework and caregiving represented feasible avenues for increasing overall physical activity levels, especially for those with low financial and time resources. Consideration of non-labor market time use patterns may improve strategies to increase physical activity and decrease inactivity among full-time employed adults in sedentary jobs.