Jennifer E. Pelletier

Interventions for weight gain prevention during the transition to young adulthood: a review of the literature.

PURPOSE To review studies examining weight gain prevention interventions among young adults. METHODS A snowball strategy was used to identify relevant studies, beginning with systematic PubMed, MEDLINE, PsychINFO, Education Resources Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) searches. INCLUDED STUDIES (a) were published from 1985 to 2011; (b) were completed in the United States or Canada; (c) focused on weight gain prevention among young adults aged 18-35 years, assessing weight, body mass index, body composition, diet, or physical activity as an outcome; and (d) comprised pre- and postintervention assessments. RESULTS Thirty-seven interventions were identified. Ten interventions assessed weight, body mass index, or body composition; 27 addressed other relevant outcomes (e.g., diet, physical activity). Of the studies examining weight or body composition, six evaluated university courses or seminar-based interventions. Overall, many studies focused on individual-level intervention delivery and changes in weight-related knowledge and/or skills, although some incorporated relatively unique aspects (e.g., focusing on eating disorders and obesity simultaneously, using online technology, providing personalized feedback on weight change). Most showed promising results as small-scale pilot studies but lacked data from fully powered randomized trials. CONCLUSIONS There is an urgent need to develop effective young adult-focused weight gain prevention strategies. This review identified promising areas for future work, although much additional research is needed.

Positive Attitudes toward Organic, Local, and Sustainable Foods Are Associated with Higher Dietary Quality among Young Adults

Scant evidence is available on the relationship between preferences for organic, local, sustainable, and nonprocessed foods (ie, alternative food production practices) and dietary quality. This cross-sectional study examined the characteristics and dietary behaviors (eg, consumption of fruits, vegetables, fast food) of young adults who reported placing low, moderate, or high importance on alternative food production practices. A diverse sample of 1,201 students at a 2-year community college and a 4-year public university in the Twin Cities, MN, completed the Student Health and Wellness Study survey in spring 2010. χ(2) tests examined differences in attitudes across demographic characteristics. Linear regression adjusted dietary intake across attitudes. About half (49%) of young adults placed moderate to high importance on alternative production practices, and few demographic differences across attitudes were found. Young adults who placed high importance on alternative production practices consumed 1.3 more servings of fruits and vegetables (P<0.001), more dietary fiber (P<0.001), fewer added sugars (P<0.001), fewer sugar-sweetened beverages (P=0.001), and less fat (P=0.025) than those who placed low importance on these practices. Young adults who placed high importance on alternative food production practices also consumed breakfast approximately 1 more day per week and fast food half as often as those who placed low importance on these practices (P<0.001). Study findings suggest that nutrition messaging around social and environmental implications of food production practices may be well received by this age group. Experimental studies are needed to investigate whether attitudes toward alternative production practices can be manipulated to improve dietary quality.

Access to and Use of Paid Sick Leave Among Low-Income Families With Children

OBJECTIVE. The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents’ leave taking to care for themselves or others. METHODS. We used a sample of low-income families (<200% of the federal poverty level) with children aged 0 to 17 years in the 2003 and 2004 Medical Expenditure Panel Survey to examine bivariate relationships between access to and use of paid leave and characteristics of children, families, and parents’ employer. RESULTS. Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without ≥1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. CONCLUSIONS. Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents’ leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.

Balancing Healthy Meals and Busy Lives: Associations between Work, School, and Family Responsibilities and Perceived Time Constraints among Young Adults

OBJECTIVE To characterize associations between perceived time constraints for healthy eating and work, school, and family responsibilities among young adults. DESIGN Cross-sectional survey. SETTING A large, Midwestern metropolitan region. PARTICIPANTS A diverse sample of community college (n = 598) and public university (n = 603) students. MAIN OUTCOME MEASURES Time constraints in general, as well as those specific to meal preparation/structure, and perceptions of a healthy life balance. ANALYSIS Chi-square tests and multivariate logistic regression (α = .005). RESULTS Women, 4-year students, and students with lower socioeconomic status perceived more time constraints (P < .001-.002); students with lower socioeconomic status were less likely to have a healthy balance (P ≤ .003). Having a heavy course load and working longer hours were important predictors of time constraints among men (P < .001-.004), whereas living situation and being in a relationship were more important among women (P = .002-.003). CONCLUSIONS AND IMPLICATIONS Most young adults perceive time constraints on healthy dietary behaviors, yet some young adults appear able to maintain a healthy life balance despite multiple time demands. Interventions focused on improved time management strategies and nutrition-related messaging to achieve healthy diets on a low time budget may be more successful if tailored to the factors that contribute to time constraints separately among men and women.

Differences in healthy food supply and stocking practices between small grocery stores, gas-marts, pharmacies and dollar stores

OBJECTIVE Little is known about the practices for stocking and procuring healthy food in non-traditional food retailers (e.g., gas-marts, pharmacies). The present study aimed to: (i) compare availability of healthy food items across small food store types; and (ii) examine owner/manager perceptions and stocking practices for healthy food across store types. DESIGN Descriptive analyses were conducted among corner/small grocery stores, gas-marts, pharmacies and dollar stores. Data from store inventories were used to examine availability of twelve healthy food types and an overall healthy food supply score. Interviews with managers assessed stocking practices and profitability. SETTING Small stores in Minneapolis and St. Paul, MN, USA, not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. SUBJECTS One hundred and nineteen small food retailers and seventy-one store managers. RESULTS Availability of specific items varied across store type. Only corner/small grocery stores commonly sold fresh vegetables (63% v. 8% of gas-marts, 0% of dollar stores and 23% of pharmacies). More than half of managers stocking produce relied on cash-and-carry practices to stock fresh fruit (53%) and vegetables (55%), instead of direct store delivery. Most healthy foods were perceived by managers to have at least average profitability. CONCLUSIONS Interventions to improve healthy food offerings in small stores should consider the diverse environments, stocking practices and supply mechanisms of small stores, particularly non-traditional food retailers. Improvements may require technical support, customer engagement and innovative distribution practices.

The Effects of Medicaid and CHIP Policy Changes on Receipt of Preventive Care among Children

OBJECTIVE To examine changes in childrens receipt of well-child and preventive dental care in Medicaid/Childrens Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt. DATA SOURCES The 2004-2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky. STUDY DESIGN Logistic and hazard pre-post regression models, controlling for age, gender, race/ethnicity, and eligibility category. DATA EXTRACTION METHODS Claims and enrollment data were de-identified and merged. PRINCIPAL FINDINGS Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care. CONCLUSIONS Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.

Stress, Health Risk Behaviors, and Weight Status Among Community College Students

The objective of this study was to describe the relationship between stress, weight-related health risk behaviors (e.g., eating behaviors, physical activity, sedentary behavior, sleep, cigarette smoking, and binge drinking), and weight status using cross-sectional data on 2-year community college students enrolled in a randomized controlled weight gain prevention trial. Modified Poisson regression and linear regression were used to examine crude and adjusted cross-sectional associations. Higher stress was associated with higher prevalence of overweight/obesity (crude prevalence ratio [PR] = 1.05; 95% confidence interval [CI: 1.01, 1.09]), though the relationship was no longer statistically significant after controlling for a wide range of weight-related health risk behaviors (adjusted PR = 1.04; 95% CI [1.00, 1.08]). Stress levels were significantly associated with meal skipping and being a current smoker. Future research should investigate the mechanisms through which stress is related to obesity risk and examine the causes of stress among this understudied population to inform the design of appropriate interventions.

Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality

OBJECTIVE To assess measures of Medicaid and Childrens Health Insurance Program (CHIP) coverage duration for potential inclusion in a core set of childrens health care quality measures as called for by the Childrens Health Insurance Program Reauthorization Act (CHIPRA) of 2009. METHODS We reviewed published and unpublished reports and spoke to researchers, analysts, and program officials at the federal level and in selected states. Measures available in administrative data were assessed with regard to the feasibility of implementation and their validity in terms of their association with child health outcomes and state policy choices. RESULTS Although many measures are feasible to construct using existing administrative data, prospective measures of duration that examine a cohort of new enrollees were found to be the most valid measures based on research linking their outcomes to program policies and their consistent interpretation across states with similar enrollment and renewal structures. However, the inability of some states to link together data from their Medicaid and CHIP enrollment files affects the interpretation of these and other measures across states. CONCLUSIONS Prospective and retrospective measures of duration were recommended for inclusion in the core set of quality measures. Although the prospective and retrospective measures were ranked high in terms of validity and importance by the Subcommittee on Quality Measures for Childrens Health Care in Medicaid and CHIP, concerns were raised about feasibility given that no state currently uses these measures to monitor program performance. Additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment, particularly in the areas of linking Medicaid and CHIP data files, improving reason for dis-enrollment codes, and improving race and ethnicity coding. Monitoring how well states are doing at enrolling and retaining children in Medicaid and CHIP is a critical component to assessing overall program performance and quality and for interpreting many of the other proposed quality measures.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.

OBJECTIVE Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. DESIGN Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. SETTING Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. SUBJECTS Customers (n 661) from 105 food retailers. RESULTS Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of

Pricing of Staple Foods at Supermarkets versus Small Food Stores

US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. CONCLUSIONS Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.