Evaluating a Food Pantry–Based Intervention to Improve Food Security,Dietary Intake,and Quality in Midwestern Food Pantries

BackgroundVoices for Food was a longitudinal community, food pantry–based intervention informed by the social ecological model, and designed to improve food security, dietary intake, and quality among clients, which was carried out in 24 rural food pantries across 6 Midwestern states.ObjectiveOur objective was to evaluate changes in adult food security, dietary intake, and quality from baseline (2014) to follow-up (2016), and to assess the role of adult food security on dietary outcomes.DesignA multistate, longitudinal, quasi-experimental intervention with matched treatment and comparison design was used to evaluate treatment vs comparison group changes over time and changes in both groups over time.Participants/settingAdult food pantry clients (n = 617) completed a demographic food security survey, and up to three 24-hour dietary recalls at baseline (n = 590) and follow-up (n = 160).InterventionCommunity coaching served as the experimental component, which only “treatment” communities received, and a food council guide and food pantry toolkit were provided to both “treatment” and matched “comparison” communities.Main outcome measuresChange in adult food security status, mean usual intakes of nutrients and food groups, and Healthy Eating Index-2010 scores were the main outcome measures.Statistical analyses performedLinear mixed models estimated changes in outcomes by intervention group and by adult food security status over time.ResultsImprovements in adult food security score (–0.7 ± 0.3; P = .01), Healthy Eating Index-2010 total score (4.2 ± 1.1; P < .0001), and empty calories component score (3.4 ± 0.5; P <.0001) from baseline to follow-up were observed in treatment and comparison groups, but no statistically significant changes were found for adult food security status, dietary quality, and usual intakes of nutrients and food groups between the 2 groups over time. The intervention effect on dietary quality and usual intake changes over time by adult food security status were also not observed.ConclusionsFood pantry clients in treatment and comparison groups had higher food security and dietary quality at the follow-up evaluation of the Voices for Food intervention trial compared with baseline, despite the lack of difference among the groups as a result of the experimental coaching component.     

Do Perceived Cues,Benefits, and Barriers to Physical Activity Differ Between Male and Female Adolescents?

A four-page survey was administered to 535 adolescents at two single-sex (one male, one female) high schools in Cincinnati, Ohio, to examine whether perceptions of physical activity differed by gender. More specifically, the survey assessed perceived cues, benefits, and barriers to exercising. Results indicated that the most helpful cue to physical activity for both female and male students was "having a friend to exercise with." The most commonly reported benefit of exercising among females was "to stay in shape," whereas the most commonly reported benefit to exercising among males was "to become strong." Among females, the most common barrier to exercising was "having no time to exercise," whereas males were most likely to report "wanting to do other things with my time." Multivariate analyses of covariance revealed that perceived cues, benefits, and barriers to physical activity differed significantly based on gender. Recommendations on specific strategies to increasing male and female adolescent physical activity levels are offered.     

Trends in Dietary Sodium from Food Sources in Australian Children and Adolescents from 2007 to 2011/12

Background

In western countries, most children eat more sodium than is recommended. In Australia in 2009, voluntary sodium reformulation targets were adopted for nine categories of processed foods, but the impact of this initiative on children’s sodium intake has not been assessed.

A Parental Health Education Model of Children’s Food Consumption: Influence on Children’s Attitudes,Intention, and Consumption of Healthy and Unhealthy Foods

This study proposes that parental mediation of television advertising and parental guidance of food consumption differentially influence children’s attitude, intention, and behavior toward the consumption of healthy and unhealthy foods. Structural equation modeling based on a survey of 1,119 children aged 9–12 supported our model, revealing that parental education strategies influence children’s food consumption in a complex manner that is highly context-dependent. Parental guidance of food consumption enhanced children’s healthy food attitude and intention to consume, while reducing the intention to consume unhealthy food. However, parental mediation of television advertising influenced unhealthy food attitude to a greater extent than healthy food attitude. Implications for health promotion and education, as well as parents and policy makers are discussed.     

Exploring Variations in North American Adults’ Attitudes,Interest, Experience,and Outcomes Related to Mixed-Gender Threesomes: A Replication and Extension

Mixed-gender threesomes (MGTs) are a type of consensually nonmonogamous sexual encounter involving three people of more than one gender. Little research has been conducted on MGTs, and what little work does exist is limited to college students, who may actually be less experienced with MGTs than older adults. The present study investigated attitudes toward, interest in, experiences with, and outcomes of MGTs in two samples (college N?=?231; online N?=?1342), comprised of 907 heterosexual and 666 sexual minority participants in total. Results indicated that participants reported neutral-to-positive attitudes toward and moderate-to-high levels of interest in MGTs (81% indicated some degree of interest). MGTs involving familiar others were preferred to those involving strangers. Men, sexual minority individuals, and participants from the online sample reported more favorable attitudes toward and greater interest in MGTs as compared to women, heterosexual individuals, and participants from the student sample. In addition, 30% of participants indicated having experience with a MGT. Sexual minority individuals reported more experience with MGTs and more positive outcomes than did heterosexual individuals. In addition, on average, participants reported that their MGT experiences “met expectations.” Overall, these results indicate that MGTs are a common sexual behavior that often results in positive outcomes, especially among sexual minority individuals. Additional research on this understudied topic is needed, particularly as it relates to outcomes and the role of MGTs in consensually nonmonogamous relationships.

     

Do Health Insurance Mandates Spillover to Education? Evidence from Michigan’s Autism Insurance Mandate

Social programs and mandates are usually studied in isolation, but unintended spillovers to other areas can impact individual behavior and social welfare. We examine the presence of spillovers from health care policy to the education sector by studying how health insurance coverage affects the education of students with Autism Spectrum Disorder (ASD). We leverage a state mandate that increased insurance coverage of ASD-related services, which often are provided by both the private sector and within public schools. The mandate primarily affected coverage for children with private health insurance, so we proxy for private insurance coverage with students’ economic disadvantage status and estimate effects via triple-differences. While we find little change in ASD identification, the mandate crowds-out special education supports for students with ASD. A lack of short-run impact on achievement supports our crowd-out interpretation and indicates that the mandate had little net effect on the academic achievement of ASD students.     

Do hospitals respond to changing incentive structures? Evidence from Medicare’s 2007 DRG restructuring

In 2007, the Centers for Medicare and Medicaid restructured the diagnosis related group (DRG) system by expanding the number of categories within a DRG to account for complications present within certain conditions. This change allows for differential reimbursement depending on the severity of the case. We examine whether this change incentivized hospitals to upcode patients as sicker to increase their reimbursements. Using the National Inpatient Survey data from HCUP from 2005 to 2010 and three methods to detect the presence of upcoding, our most conservative estimate is an additional three percent of reimbursement is attributable to upcoding. We find evidence of upcoding in government, non-profit, and for-profit hospitals. We find spillover effects of upcoding impacting not only Medicare payers, but also private insurance companies as well.     

Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children’s Brand Recognition,Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level

BackgroundLimitations in current Australian regulatory provisions may be identified by demonstrating the effect of different marketing methods on children’s recognition and attitudes toward unhealthy food brands.ObjectiveTo investigate how exposure to different marketing techniques from television (TV) and online food advertising affects children’s brand recall, recognition, and attitudinal responses toward brands and brand consumers and children’s desire to eat the advertised products.DesignSecondary analysis of data from a crossover experimental-control study.Participants/settingIn all, 154 children (7 to 12 years) completed the study, conducted at four 6-day holiday camps from April 2016 to January 2017 in New South Wales, Australia. Children were assigned to a single-media (n=76) or multiple-media (n=78) condition.InterventionAll children viewed 10 TV food advertisements in a cartoon on three occasions. For one of the brands, one set of children additionally played online “advergames” featuring the brand.Main outcome measuresChildren’s recognition and attitudes toward brands and brand consumers and children’s desire to eat the product were reported via a brand recognition and attitude survey pre- and postintervention. Marketing techniques were categorized.Statistical analysisPre- and postintervention brand recognition and relationships between brand recognition and attitudes by media condition and desire to eat the product were examined using generalized linear mixed models and linear mixed models.ResultsThere was a significant increase in the number of brands recognized postexposure by children in both media groups (mean difference=3.8, P<0.0001). The majority of brands appealed to children. Children who reported wanting to eat the advertised products rated brands more positively than children who did not express a desire to eat the products. A larger proportion of children who played the advergames (36%) rated brand consumers as “cool” than children who viewed the TV advertisements only (19%) (P<0.001). Anti-adult themes, fun and humor, and parent pleasing were techniques unique to some of the most recognized and favored advertisements.ConclusionsThe marketing communications increased children’s brand recognition and elicited positive attitudinal responses. These findings indicate a need for policy makers to consider additional regulations to protect children from the persuasive influence of unhealthy food advertising.     

Do Mother’s Metacognitions,Beliefs, and Behaviors Predict Child Anxiety-Related Metacognitions?

Background

Recent research suggests that adults and children with anxiety disorders have a particular set of metacognitive beliefs and strategies. Knowing whether parents’ metacognitions, beliefs and behaviors are associated with their children’s metacognitions is important for understanding how anxiety-related metacognitions and clinical anxiety develop.

Objective

We hypothesized that there are positive relationships between mother and corresponding child anxiety-related metacognitions even after controlling for maternal depression, anxiety and stress symptoms. We also hypothesized that maternal beliefs about child anxiety and maternal controlling behavior would be positively related to child metacognitions and would account for any associations between mother and child metacognitions.

Methods

The study employed a cross-sectional design in a community sample of 7–12 year old children and their mothers. Mothers and children completed questionnaires to assess anxiety-related metacognitions and an interaction task to assess mothers’ overinvolvement. Mothers also completed questionnaires regarding their beliefs about child anxiety and controlling rearing behavior. We examined correlations between variables before investigating which maternal variables made unique contributions to the variation in children’s metacognitions in a series of multiple regressions and mediation analyses.

Results

Mothers’ positive worry beliefs and cognitive confidence contributed a modest amount of unique variance in the corresponding beliefs in children. Mothers’ and children’s metacognitions were positively associated.

Conclusions

The unique contributions of mothers’ anxiety-related metacognitions on children’s anxiety-related metacognitions found in our study indicate that a metacognitive-parental intervention for preventing and treating child anxiety is worth investigation. Our findings place anxious metacognitions in a developmental context.

     

Provider Advice and Women’s Intentions to Meet Weight Gain,Physical Activity,and Nutrition Guidelines During Pregnancy

Objectives

To determine the prevalence and accuracy of patient-reported provider advice on weight gain, physical activity, and nutrition during prenatal visits and to examine the associations of provider advice with women’s behavioral intentions toward weight gain, physical activity, and nutrition.

Methods

A mixed-methods study design was used to assess patient-report of provider advice and health intentions in women between 20 and 30 weeks gestation (n = 188). Bivariate analyses examined patient-reported provider advice on weight gain, physical activity, and nutrition with women’s behavioral intentions. Linear and logistic regression models examined associations of provider weight gain recommendations with women’s intended weight gain.

Results

Approximately 52 % of women reported provider advice on weight gain, 63 % on physical activity, and 56 % on nutrition. Of those who reported weight gain advice, 79 % cited provider recommendations within the Institute of Medicine guidelines, 9 % below, and 11 % above. Patient-report of provider advice on physical activity and nutrition were consistent with guidelines, but limited in scope. Provider advice (yes/no) was significantly associated with women’s intentions to meet physical activity (p = 0.01) and nutrition (p = 0.02), but not weight gain guidelines (p = 0.86). Provider recommended weight gain (pounds) was significantly associated with women’s intended weight gain in linear and logistic regression models.

Conclusions for Practice

A large percentage of women report receiving no advice from providers on weight gain, physical activity or nutrition during pregnancy. Of those who receive advice, most report recommendations consistent with current guidelines. Provider advice was associated with women’s weight gain, physical activity, and nutrition intentions in pregnancy.

     

Correlates of Overweight and Obesity Among American Indian/Alaska Native and Non-Hispanic White Children and Adolescents: National Survey of Children’s Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children’s Health, behavioral (child’s sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child’s bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child’s age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10–17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5–2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1–3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3–5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.     

Let’s Get Physical: Sexual Orientation Disparities in Physical Activity,Sports Involvement,and Obesity Among a Population-Based Sample of Adolescents

Objectives. We examined sexual orientation disparities in physical activity, sports involvement, and obesity among a population-based adolescent sample.Methods. We analyzed data from the 2012 Dane County Youth Assessment for 13 933 students in grades 9 through 12 in 22 Wisconsin high schools. We conducted logistic regressions to examine sexual orientation disparities in physical activity, sports involvement, and body mass index among male and female adolescents.Results. When we accounted for several covariates, compared with heterosexual females, sexual minority females were less likely to participate in team sports (adjusted odds ratio [AOR] = 0.44; 95% confidence interval [CI] = 0.37, 0.53) and more likely to be overweight (AOR = 1.28; 95% CI = 1.02, 1.62) or obese (AOR = 1.88; 95% CI = 1.43, 2.48). Sexual minority males were less likely than heterosexual males to be physically active (AOR = 0.62; 95% CI = 0.46, 0.83) or to participate in team sports (AOR = 0.26; 95% CI = 0.20, 0.32), but the 2 groups did not differ in their risk of obesity.Conclusions. Sexual orientation health disparities in physical activity and obesity are evident during adolescence. Culturally affirming research, interventions, and policies are needed for sexual minority youths.Obesity is an increasing and serious health problem among adolescents.1,2 This is of major concern because obesity has many health and social consequences and it affects adolescents’ overall well-being.3,4 Obesity among adolescents also has a high likelihood of continuing into adulthood.5 Recent population-based and longitudinal research has demonstrated that there are disparities in obesity between sexual minority and heterosexual adolescents.6–8 Research has also documented sexual orientation disparities in physical activity and sports involvement in adolescence.9,10 Despite this increased attention, the overall empirical base remains limited, and findings also suggest some gender nuances that need further exploration. More population-based research is needed to investigate these disparities, consistent with federal health priorities.7,11There are sexual orientation–based disparities in physical activity and sports involvement among adolescents; however, there are mixed findings for females. One study reported that sexual minority females are less likely than heterosexual females to participate in moderate to vigorous physical activity and team sports,9 whereas another study found no such differences in physical activity.10 Findings are more consistent for sexual minority male adolescents, who are less likely than heterosexual males to engage in moderate to vigorous physical activity, to engage in recommended levels of physical activity, and to participate in team sports.9,10 More research is needed because of the paucity of studies and mixed results. This is especially important given that adolescents’ physical activity has been shown to relieve stress and protect against many mental and physical health conditions, including obesity,12,13 for which sexual minority adolescents are at greater risk.Research on sexual orientation disparities in obesity suggests that there are some gender nuances. Many studies have found that sexual minority female adolescents have higher risk of obesity than heterosexual females (e.g., higher body mass index [BMI], defined as weight in kilograms divided by the square of height in meters).6,8,10,14 These sexual orientation disparities in obesity among adolescent females parallel those among sexual minority adult women.15,16Findings of elevated obesity risk among sexual minority male adolescents are mixed. Some studies show that sexual minority males, specifically bisexual males, have higher odds of obesity than heterosexuals,14 whereas other studies have documented no differences.10 By contrast, some studies have found that heterosexual males have increases in BMI during adolescence compared with sexual minority males.6,8 These mixed findings for sexual minority males might be attributed to physical maturation and developmental changes in adolescence that some of the cross-sectional studies could not examine.10,14 Specifically, one study found that sexual minority males had higher obesity risk than heterosexual males in early adolescence, but their risk of obesity became lower than for heterosexual males later in adolescence.6 The authors postulated that, compared with heterosexual males, sexual minority males reach puberty maturation earlier in adolescence but make less substantial weight gains later in adolescence.6Sexual orientation health disparities have been explained through the minority stress model: sexual minority youths experience unique stressors and stigma related to their sexual identity (e.g., homophobic bullying), which lead to poorer health.17 Sexual minority adolescents might therefore be less likely to be physically active or involved in team sports because of potential minority stressors that they often experience at school, especially bias and heightened discrimination experienced in the context of sports or in their communities.18–20 More recently, the negative effects of minority stress and stigma on physical health disparities have been documented,21,22 including their effects on obesity for sexual minority women.23 However, the minority stress model is not sufficient in explaining how sexual minority adolescent females, but not males, are at greater risk for obesity compared with their heterosexual peers.Another potential explanation of these obesity disparities is related to cultural norms and sexual minority females’ experiences of internalizing ideals for femininity and appearance8 and sexual minority males’ ideals for muscularity and body image.24 For instance, compared with heterosexual women, sexual minority women are more likely to be satisfied with their bodies and attracted to women with greater body mass,25,26 whereas sexual minority men are less likely to be satisfied with their bodies compared with heterosexual men and are more likely to be attracted to muscular men.25,27 Therefore, these 2 groups might engage (or not engage) in differing body weight management and dieting behaviors compared with their heterosexual peers; concomitantly, these behaviors might render differing risks for obesity.Sexual minority adolescents’ lack of physical activity and sports involvement might be influenced by traditional gender norms associated with athleticism and sports, which has implications for their athletic self-esteem and involvement. For adolescent males, team sports are a means to define masculinity28; however, adolescent males often engage in homophobic banter to prove their masculinity and heterosexuality and to enforce traditional gender norms.29,30 Sexual prejudice is pervasive in athletic settings,19,20 making sports contexts unwelcoming and unsafe for many sexual minority males. Traditional feminine gender norms and homophobia also affect sexual minority females’ involvement in sports.31 However, sexual minority adolescent females have unique gendered experiences in relation to sports. Because women’s athleticism can be a stereotype for being a lesbian,32 sexual minority females might avoid sports involvement. Expecting or experiencing exclusion in sports settings might also affect sexual minority adolescents’ athletic self-esteem, consequently preventing them from engaging in future sports or physical activity.9 In fact, athletic self-esteem has been found to contribute to sexual orientation disparities in sports involvement and physical activity.9Emerging evidence of sexual orientation disparities in physical activity, sports involvement, and obesity among adolescents, in addition to potential gender nuances in these disparities, points to the need for more population-based research in this area. We therefore examined sexual orientation disparities among a large adolescent population-based sample and tested for gender differences. While accounting for variables commonly associated with physical activity and obesity among adolescents,4,33 we hypothesized that sexual minority adolescents would be less likely to report physical activity and sports involvement than would their heterosexual peers. We also hypothesized that sexual minority females would be at higher risk for being overweight and obese than their heterosexual peers. Because of mixed findings in existing sexual orientation disparities research among adolescent males, we hypothesized that sexual minority males would be at equal risk for being overweight and obese than their heterosexual male peers.