Pester power and its consequences: do European children's food purchasing requests relate to diet and weight outcomes?

OBJECTIVE: Children may influence household spending through 'pester power'. The present study examined pestering through parent-child food shopping behaviours in relation to children's diet and weight status. DESIGN: Cross-sectional and prospective analyses drawn from the IDEFICS study, a cohort study of parents and their children. Children's height and weight were measured and their recent diets were reported by parental proxy based on the Children's Eating Habits Questionnaire-FFQ at baseline and 2-year follow-up. Parents also completed questionnaires at both time points about pestering, including whether the child goes grocery shopping with them, asks for items seen on television and is bought requested food items. SETTING: Participants were recruited from eight European countries for the IDEFICS study (non-nationally representative sample). SUBJECTS: Study participants were children aged 2-9 years at enrolment and their parents. A total of 13 217 parent-child dyads were included at baseline. Two years later, 7820 of the children were re-examined. RESULTS: Most parents (63 %) at baseline reported 'sometimes' acquiescing to their children's requests to purchase specific foods. Pestering was modestly associated with weight and diet. At baseline, children whose parents 'often' complied consumed more high-sugar and high-fat foods. Children who 'often' asked for items seen on television were likely to become overweight after 2 years (OR=1·31), whereas 'never' asking protected against overweight (OR=0·72). CONCLUSIONS: Pestering was modestly related to diet and weight in cross-sectional, but not longitudinal analyses. Asking for items seen on television had the most robust relationships across child outcomes and over time.

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.

Using a Grocery List Is Associated With a Healthier Diet and Lower BMI Among Very High-Risk Adults.

OBJECTIVE: Examine whether use of a grocery list is associated with healthier diet and weight among food desert residents. METHODS: Cross-sectional analysis of in-person interview data from randomly selected household food shoppers in 2 low-income, primarily African American urban neighborhoods in Pittsburgh, PA with limited access to healthy foods. RESULTS: Multivariate ordinary least-square regressions conducted among 1,372 participants and controlling for sociodemographic factors and other potential confounding variables indicated that although most of the sample (78%) was overweight or obese, consistently using a list was associated with lower body mass index (based on measured height and weight) (adjusted multivariant coefficient = 0.095) and higher dietary quality (based on the Healthy Eating Index-2005) (adjusted multivariant coefficient = 0.103) (P < .05). CONCLUSIONS AND IMPLICATIONS: Shopping with a list may be a useful tool for low-income individuals to improve diet or decrease body mass index.

Substance Use Treatment and Reentry (STAR) Program: Final Evaluation Report.

Substance use disorders are common among juvenile justice populations, and few resources exist to address this problem as young offenders transition into the community upon release. To address this need, in October 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), awarded three-year grants to community-based organizations to expand and/or enhance substance abuse treatment and recovery and reentry services to sentenced offenders returning to the community. Homeboy Industries, Inc., in collaboration with Behavioral Health Services, Inc., and the RAND Corporation, was awarded a grant to serve up to 220 16- to 25-year-olds recently released from juvenile detention to receive substance use treatment and recovery services at Homeboy Industries in downtown Los Angeles. This study represents the evaluation of that Substance Use Treatment and Reentry (STAR) Program. Ninety-four percent of the proposed population was enrolled into the program. Ninety percent of participants received at least one substance use treatment session, and 73 percent successfully completed the five-session treatment in six months. Analysis of the client outcome data following participation showed improvements or stability over time in housing and social connectedness. Over 70 percent of participants who completed a 12-month interview reported continued employment, and self-reported arrests were below 15 percent. Abstinence rates did not change much throughout the project (about 30 percent); however, those reporting use at intake showed reductions in use over time. These findings reveal a continued need among the population for substance use treatment and recovery support.

Workplace Wellness Programs Study: Final Report.

This article investigates the characteristics of workplace wellness programs, their prevalence, their impact on employee health and medical cost, facilitators of their success, and the role of incentives in such programs. The authors employ four data collection and analysis streams: a review of the scientific and trade literature, a national survey of employers, a longitudinal analysis of medical claims and wellness program data from a sample of employers, and five case studies of existing wellness programs in a diverse set of employers to gauge the effectiveness of wellness programs and employees' and employers' experiences.

Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys.

OBJECTIVE: To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases. DESIGN: Cross sectional surveys in spring 2007 and spring 2009 (one year before and nine months after full implementation of regulation requiring chain restaurants' menus to contain details of the energy content of all menu items). Setting 168 randomly selected locations of the top 11 fast food chains in New York City during lunchtime hours. PARTICIPANTS: 7309 adult customers interviewed in 2007 and 8489 in 2009. MAIN OUTCOME MEASURES: Energy content of individual purchases, based on customers' register receipts and on calorie information provided for all items in menus. RESULTS: For the full sample, mean calories purchased did not change from before to after regulation (828 v 846 kcal, P = 0.22), though a modest decrease was shown in a regression model adjusted for restaurant chain, poverty level for the store location, sex of customers, type of purchase, and inflation adjusted cost (847 v 827 kcal, P = 0.01). Three major chains, which accounted for 42% of customers surveyed, showed significant reductions in mean energy per purchase (McDonald's 829 v 785 kcal, P = 0.02; Au Bon Pain 555 v 475 kcal, P<0.001; KFC 927 v 868 kcal, P<0.01), while mean energy content increased for one chain (Subway 749 v 882 kcal, P<0.001). In the 2009 survey, 15% (1288/8489) of customers reported using the calorie information, and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information (757 v 863 kcal, P<0.001). CONCLUSION: Although no overall decline in calories purchased was observed for the full sample, several major chains saw significant reductions. After regulation, one in six lunchtime customers used the calorie information provided, and these customers made lower calorie choices.

Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation.

OBJECTIVES: We assessed consumer awareness of menu calorie information at fast-food chains after the introduction of New York City's health code regulation requiring these chains to display food-item calories on menus and menu boards. METHODS: At 45 restaurants representing the 15 largest fast-food chains in the city, we conducted cross-sectional surveys 3 months before and 3 months after enforcement began. At both time points, customers were asked if they had seen calorie information and, if so, whether it had affected their purchase. Data were weighted to the number of city locations for each chain. RESULTS: We collected 1188 surveys pre-enforcement and 1229 surveys postenforcement. Before enforcement, 25% of customers reported seeing calorie information; postenforcement, this figure rose to 64% (P < .001; 38% and 72%, weighted). Among customers who saw calorie information postenforcement, 27% said they used the information, which represents a 2-fold increase in the percentage of customers making calorie-informed choices (10% vs 20%, weighted; P < .001). CONCLUSIONS: Posting calorie information on menu boards increases the number of people who see and use this information. Since enforcement of New York's calorie labeling regulation began, approximately 1 million New York adults have seen calorie information each day.

What people buy from fast-food restaurants: caloric content and menu item selection, New York City 2007.

Fast-food restaurants provide a growing share of daily food intake, but little information is available in the public health literature about customer purchases. In order to establish baseline data on mean calorie intake, this study was completed in the Spring of 2007, before calorie labeling regulations went into effect in New York City. Receipts were collected from lunchtime customers, at randomly selected New York City fast-food chains. A supplementary survey was also administered to clarify receipt items. Calorie information was obtained through company websites and ascribed to purchases. Lunchtime purchases for 7,750 customers averaged 827 calories and were lowest for sandwich chains (734 calories); and highest for chicken chains (931 calories). Overall, one-third of purchases were over 1,000 calories, predominantly from hamburger chains (39%) and chicken chains (48%); sandwich chains were the lowest, with only 20% of purchases over 1,000 calories. "Combination meals" at hamburger chains accounted for 31% of all purchases and averaged over 1,200 calories; side orders accounted for almost one-third of these calories. Lunch meals at these fast-food chains are high in calorie content. Although calorie posting may help to raise awareness of the high calories in fast-food offerings, reducing portion sizes and changing popular combination meals to include lower calorie options could significantly reduce the average calorie content of purchases.