Kimberly B. Garza

Food Insecurity Is Associated with Poor Sleep Outcomes among US Adults

BACKGROUND Although food insecure (FI) adults are at risk of chronic conditions, little research attention is given to their health behaviors, such as sleep. OBJECTIVE We examined the associations between adult food security status and sleep duration, sleep latency, and sleep complaints reported to a health care professional. METHODS Our population-based sample included 5637 men and 5264 women (≥22 y) who participated in the NHANES 2005-2010. Food security status was assessed with USDAs 10-item adult Food Security Survey Module. Self-reported information about sleep duration, sleep latency, and sleep complaints to a health care professional were used as sleep outcomes. Multiple linear, stratified by sex, and logistic regression models were used to estimate the association between food security status and the 3 sleep outcomes. RESULTS Very low food secure (FS) women reported significantly shorter sleep duration than fully FS women (difference: -30 ± 5.2 min; P < 0.01); however, no relation to sleep duration was observed among men. Among men, participants who were marginally FS (4 ± 1.1 min), low FS (4 ± 1.7 min), and very low FS (5 ± 1.8 min) reported significantly longer sleep latency than fully FS men (P < 0.05), but no association with sleep latency was observed among women. The divergent patterns in sleep duration and latency were likely because of our reference groups reporting undesirable sleep outcomes; fully FS men reported inadequate sleep and fully FS women reported long sleep latency. Among both men and women, marginally FS (OR: 1.64; 95% CI: 1.24, 2.16), low FS (OR: 1.63; 95% CI: 1.16, 2.30), and very low FS (OR: 1.99; 95% CI: 1.36, 2.92) participants were more likely to report sleep complaints than their fully FS counterparts (P < 0.05). CONCLUSIONS Poor sleep quantity and quality may predispose FI adults to adverse health outcomes.

Impulsivity and Fast-Food Consumption: A Cross-Sectional Study among Working Adults

BACKGROUND Little is known about the decision-making process of adults who choose to eat at fast-food restaurants. Impulsivity is the concept that individuals value immediate rewards and disregard future costs. OBJECTIVE To determine the association between impulsivity and consumption of fast food among employed adults and to explore their reasons for eating fast food. DESIGN A cross-sectional, online survey was conducted; participants were recruited using a mass electronic mailing. PARTICIPANTS/SETTING Four hundred seventy-eight adults employed in a university setting completed the survey. MAIN OUTCOME MEASURES The association between frequency of fast-food consumption and impulsivity was assessed. Impulsivity is assessed by the area under the delay discounting curve (AUC). The AUC is estimated by using a binary choice delay discounting task incorporating hypothetical monetary rewards. Greater AUC reflects lower impulsivity. STATISTICAL ANALYSES PERFORMED Analysis of variance, Students t tests, and Pearson correlation coefficients were used to measure unadjusted associations among demographic variables, fast-food consumption, and AUC. Linear regression was used to assess whether AUC was a significant predictor of having consumed fast food in the past 7 days, controlling for age, total household income, and education. RESULTS The majority (67%) of the participants reported eating one or more meals from a fast-food restaurant or pizza place in the past 7 days. The mean number of meals was 2.8±2.5 per week among those who reported eating at a fast-food restaurant or pizza place. Both fast-food consumption and body mass index (BMI) were correlated with greater impulsivity. Controlling for age, total household income, and education level, fast-food consumption was negatively related to AUC (P=0.017). The most commonly reported reasons for consuming fast food were convenience and to socialize. CONCLUSIONS These findings indicate that greater impulsivity was associated with greater fast-food consumption. Successful efforts to encourage healthful dietary behaviors might emphasize methods to overcome impulsivity, such as reward substitution and precommitment.

Alcohol use, impulsivity, and the non-medical use of prescription stimulants among college students

The non-medical use of prescription drugs (NMUPD) is a growing public health concern. College students have been identified as a particularly at risk population for engagement in NMUPD. Across all prescription drug classes, stimulants show the highest ratio of illicit to medical use and are thus important to examine within this population. Emerging research has suggested a relationship between the non-medical use of prescription stimulants (NMUPS) and alcohol use within the college student population. Finally, the construct of impulsivity may serve as an additional indicator for students who engage in NMUPS as well as those who engage in NMUPS/alcohol co-ingestion. The purpose of this paper is to expand on previous prevalence data collected for the past year NMUPS and NMUPS/alcohol co-ingestion. Additionally, this paper examines whether those who engage in NMUPS or NMUPS/alcohol co-ingestion differ significantly from their non-using counterparts on measures of alcohol use, alcohol related negative consequences, binge drinking, and impulsivity. Finally, binary logistic regression models indicated that increased alcohol use, alcohol related negative consequences, and impulsivity all significantly increase the odds of an individual engaging in NMUPS or NMUPS/alcohol co-ingestion.

Undiagnosed prediabetes among food insecure adults.

OBJECTIVES To identify sub-populations at risk for diabetes based on having prediabetes. Although food insecurity has been linked to diabetes, to our knowledge, no studies have examined whether food insecure individuals are more likely than fully food secure individuals to have undiagnosed prediabetes. METHODS This study was based on a cross-sectional analysis of 6577 adults in the 2005-08 National Health and Nutrition Examination Survey. USDAs Food Security Survey Module, self-reported prediabetes status and clinical measures were examined. RESULTS Whereas men who were food insecure were more likely than fully food secure men to have undiagnosed prediabetes, no association was observed among women. CONCLUSION Prediabetes screening appears warranted for food insecure men.

Examination of value of the future and health beliefs to explain dietary and physical activity behaviors

BACKGROUND Studies have shown a negative association between value of the future (preference for long-term vs. short-term rewards) and harmful addictive behaviors; however, research in the area of preventive behaviors is limited and has shown conflicting results. OBJECTIVES The primary objectives were: (1) to examine the association among value of the future and diet and physical activity (PA) behaviors, and (2) to assess whether value of the future explained additional variance in behaviors after controlling for theory-based health beliefs related to coronary heart disease (CHD). METHODS An online survey was conducted in adults (N = 172) with no prior history of CHD. A delay discounting task was administered to measure value of the future. Questionnaire items were based on the Health Belief Model (HBM) and included CHD knowledge, perceived risk, perceived severity, perceived benefits of and barriers to behavior change, self-efficacy, cues to action, diet and PA behaviors and demographic variables. RESULTS High value of the future was associated with younger age, lower BMI, more healthful diet, and increased PA. After controlling for HBM components and demographics, value of the future did not explain any additional variance in diet or PA behaviors. Significant predictors of healthful diet included female gender (P = .013), increased age (P = .029), greater than high school education (P = .023), greater diet-related self-efficacy (P = .021), and not having received a healthcare provider recommendation to improve diet (P = .018). Significant predictors of PA level included income between

Pilot Study to Test the Effectiveness of Different Financial Incentives to Improve Medication Adherence

20,000 and

Modeling motivations for non-medical use of prescription drugs.

69,999 (P = .014), greater exercise-related self-efficacy (P < .001) and not having received a healthcare provider recommendation to increase levels of PA (P = .015). CONCLUSIONS Behaviors to prevent CHD may be associated with a persons outlook on the future; however, self-efficacy was a stronger predictor of behavior. These findings support recommendations for enhancement of diet- and PA-related self-efficacy and problem-solving to address myopia in terms of long-term health benefits.

Relationship between vancomycin dosage and serum trough vancomycin concentrations in pediatric patients with cystic fibrosis.

Background: Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence. Objective: To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence. Methods: This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received

Patterns of treatment modifications among newly treated hypertensive patients: Does choice of modification strategy affect likelihood of treatment discontinuation?

30 up-front in a virtual account, with

Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority?

0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly