Roni A. Neff

Periodic prompts and reminders in health promotion and health behavior interventions: systematic review.

Background Health behavior interventions using periodic prompts have utilized technology, such as the Internet, that allows messages to be sent to participants in cost-effective ways. To our knowledge, no comprehensive evidence review has been performed specifically to evaluate the effectiveness of communicating regular messages and to examine how characteristics of the prompts change the effectiveness of programs aimed at reminding people to adopt healthy behaviors, maintain those they already practice, and cease unhealthy behaviors. Objective A systematic literature review was performed to investigate the effectiveness of limited contact interventions targeting weight loss, physical activity, and/or diet that provided periodic prompts regarding behavior change for health promotion. The review sought to identify specific characteristics of these interventions that may be associated with superior results. Methods Electronic literature searches were performed between February and April, 2008. Articles were included if periodic prompts were used as an intervention or a component of an intervention, a behavioral or biological outcome measure was used, and an ongoing health promotion behavior was targeted. A rating system was applied to each study to provide a quantitative representation of the quality of the evidence provided by each article. Results There were 19 articles with a combined sample size of 15,655 that met the inclusion criteria, and 11 studies reported positive findings regarding the utility of periodic prompts. Several articles showed enhanced effectiveness when prompts were frequent and personal contact with a counselor was included. Long-term behavior change and health improvements were not examined by this review because of a lack of long-term follow-up in the literature. Conclusions In light of promising results of most studies, additional research on limited contact interventions targeting health behaviors including weight loss, physical activity, and/or diet is merited that utilizes rigorous methods including control groups; follow-up data collection; and testing of prompt frequencies, specific intervention components, or prompt characteristics. Future research would be especially valuable if it improves understanding of the most effective types of periodic prompts for fostering long-term behavior change in order to maximize use of this tool in limited contact health promotion programs. Specifically, various types of communication technology should be used and evaluated to expand and refine their use.

Food Systems and Public Health Disparities.

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

Veterinary drug residues in seafood inspected by the European Union, United States, Canada, and Japan from 2000 to 2009.

Veterinary drugs are used to treat or prevent a wide array of production-related diseases in aquaculture. Residues of these drugs in seafood products may pose risks to consumers, prompting governments to set drug residue tolerance levels and inspect seafood for violations of these standards. This study characterizes veterinary drug inspection policies and violations among four inspecting bodies (European Union (E.U.), United States (U.S.), Canada, and Japan), using government-collected veterinary drug violation data from 2000 to 2009. Most veterinary drug violations were detected in species that are commonly farm-raised. Asian seafood products, including shrimp and prawns, catfish (or fish sold as catfish), crab, tilapia, eel, and Chilean salmon were most frequently in violation of veterinary drug residue standards. Vietnam had the greatest number of violations among exporting countries. Concentrations of most veterinary drugs in seafood found in violation did not differ between inspecting bodies that reported drug concentrations. Transparency in seafood inspection reporting varied widely among inspecting bodies. Estimation of violations in the untested fraction of seafood was precluded by a lack of information from inspecting bodies regarding the distinction between targeted and random sampling. Increased transparency could facilitate a more rigorous characterization of public health risks from consuming imported seafood.

Wasted Food: U.S. Consumers' Reported Awareness, Attitudes, and Behaviors

The U.S. wastes 31 to 40% of its post-harvest food supply, with a substantial portion of this waste occurring at the consumer level. Globally, interventions to address wasted food have proliferated, but efforts are in their infancy in the U.S. To inform these efforts and provide baseline data to track change, we performed a survey of U.S. consumer awareness, attitudes and behaviors related to wasted food. The survey was administered online to members of a nationally representative panel (N=1010), and post-survey weights were applied. The survey found widespread (self-reported) awareness of wasted food as an issue, efforts to reduce it, and knowledge about how to do so, plus moderately frequent performance of waste-reducing behaviors. Three-quarters of respondents said they discard less food than the average American. The leading motivations for waste reduction were saving money and setting an example for children, with environmental concerns ranked last. The most common reasons given for discarding food were concern about foodborne illness and a desire to eat only the freshest food. In some cases there were modest differences based on age, parental status, and income, but no differences were found by race, education, rural/urban residence or other demographic factors. Respondents recommended ways retailers and restaurants could help reduce waste. This is the first nationally representative consumer survey focused on wasted food in the U.S. It provides insight into U.S. consumers’ perceptions related to wasted food, and comparisons to existing literature. The findings suggest approaches including recognizing that many consumers perceive themselves as being already-knowledgeable and engaged, framing messages to focus on budgets, and modifying existing messages about food freshness and aesthetics. This research also suggests opportunities to shift retail and restaurant practice, and identifies critical research gaps.

Peak oil, food systems, and public health.

Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Todays globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all.

Meat consumption and climate change: the role of non-governmental organizations

The contribution of livestock production to climate change is now widely acknowledged. Despite this, efforts to reduce meat consumption in light of climate change have been relatively limited. One potential avenue for encouraging consumption changes is via non-governmental organizations (NGOs). This study used a qualitative approach to understand how and to what extent environmental, food-focused, and animal protection NGOs in the U.S., Canada, and Sweden have worked to reduce or alter domestic meat consumption in light of climate change. While almost all of the NGOs examined had mentioned the issue on their websites, few had established formal campaigns to reduce meat consumption. Active public outreach was dominated by animal protection and food-focused groups, particularly in the U.S. and Canada. Animal protection organizations advocated for larger reductions in meat consumption than environmental groups. Few NGOs sought to promote national-level polices to reduce meat consumption. There is a continued need for public education campaigns with clear messages, particularly by environmental NGOs, as well as efforts to build support for policy measures that seek to reduce meat consumption.

Reducing Food Loss And Waste While Improving The Public’s Health

An estimated 30 percent of the global food supply is lost or wasted, as is about 40 percent of the US food supply. There are valuable synergies between efforts to reduce food loss and waste and those promoting public health. To demonstrate the potential impact of building upon these synergies, we present an analysis of policies and interventions addressing food loss and waste, food security, food safety, and nutrition. We characterize as opportunities the policies and interventions that promote synergistic relationships between goals in the fields of food loss and waste and of public health. We characterize as challenges the policies and interventions that may reduce food loss and waste but compromise public health, or improve public health but increase food loss and waste. Some interventions are both opportunities and challenges. With deliberate planning and action, challenges can often be addressed and turned into opportunities. In other cases, it may be necessary to strike a balance between potential benefit in one area and risk of harm in the other. To help policy makers make the best use of the opportunities while tackling the challenges, it is essential to consider public health in efforts to reduce food loss and waste.

No Meat, Less Meat, or Better Meat: Understanding NGO Messaging Choices Intended to Alter Meat Consumption in Light of Climate Change

This paper examines the factors shaping non-governmental organization (NGO) messaging decisions on how meat consumption should be altered in light of climate change. In particular, we sought to understand the relative absence of messages promoting meat-free diets and the decision of some NGOs to pair meat reduction messages with messages encouraging consumers to switch to meat from ruminant grass-fed animals. Interviews were conducted with 27 staff members from environmental, food-focused, and animal protection NGOs from the USA, Canada, and Sweden. While strategic considerations consistently led to the use of modest messages for meat reduction, NGO missions were also key to shaping the specifics of messaging goals. The relatively low personal comfort levels that some NGO staffers held toward meat-free diets also led to the use of more modest requests for meat reduction. Findings highlight the complex nature of the factors underlying the environmental communication messages of NGOs.

A comparative study of allowable pesticide residue levels on produce in the United States

BackgroundThe U.S. imports a substantial and increasing portion of its fruits and vegetables. The U.S. Food and Drug Administration currently inspects less than one percent of import shipments. While countries exporting to the U.S. are expected to comply with U.S. tolerances, including allowable pesticide residue levels, there is a low rate of import inspections and few other incentives for compliance.MethodsThis analysis estimates the quantity of excess pesticide residue that could enter the U.S. if exporters followed originating country requirements but not U.S. pesticide tolerances, for the top 20 imported produce items based on quantities imported and U.S. consumption levels. Pesticide health effects data are also shown.ResultsThe model estimates that for the identified items, 120 439 kg of pesticides in excess of U.S. tolerances could potentially be imported to the U.S., in cases where U.S. regulations are more protective than those of originating countries. This figure is in addition to residues allowed on domestic produce. In the modeling, the top produce item, market, and pesticide of concern were oranges, Chile, and Zeta-Cypermethrin. Pesticides in this review are associated with health effects on 13 body systems, and some are associated with carcinogenic effects.ConclusionsThere is a critical information gap regarding pesticide residues on produce imported to the U.S. Without a more thorough sampling program, it is not possible accurately to characterize risks introduced by produce importation. The scenario presented herein relies on assumptions, and should be considered illustrative. The analysis highlights the need for additional investigation and resources for monitoring, enforcement, and other interventions, to improve import food safety and reduce pesticide exposures in originating countries.

Public health nutrition and sustainability.

In public health nutrition, sustainability refers to the ability to maintain food system capacity to support the nutritional health needs of current and future populations while protecting the ecological systems that produce food. The FAO defines sustainable diets as those that are ‘protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources’.