Chronic Disease Risk Typologies among Young Adults in Community College.

OBJECTIVES: To address chronic disease risk holistically from a behavioral perspective, insights are needed to refine understanding of the covariance of key health behaviors. This study aims to identify distinct typologies of young adults based on 4 modifiable risk factors of chronic disease using a latent class analysis approach, and to describe patterns of class membership based on demographic characteristics, living arrangements, and weight. METHODS: Overall, 441 young adults aged 18-35 attending community colleges in the Minnesota Twin Cities area completed a baseline questionnaire for the Choosing Healthy Options in College Environments and Settings study, a RCT. Behavioral items were used to create indicators for latent classes, and individuals were classified using maximum-probability assignment. RESULTS: Three latent classes were identified: 'active, binge-drinkers with a healthy dietary intake' (13.1%); 'non-active, moderate-smokers and non-drinkers with poor dietary intake' (38.2%); 'moderately active, non-smokers and non-drinkers with moderately healthy dietary intake' (48.7%). Classes exhibited unique demographic and weight-related profiles. CONCLUSIONS: This study may contribute to the literature on health behaviors among young adults and provides evidence that there are weight and age differences among subgroups. Understanding how behaviors cluster is important for identifying groups for targeted interventions in community colleges.

Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trial.

OBJECTIVE: Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. DESIGN: Factorial design randomized controlled trial. SETTING: Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. SUBJECTS: Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. RESULTS: All interventions showed significantly increased stock of promoted foods v. CONTROL: There was a significant treatment effect for daily unit sales of healthy snacks (ß=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (ß=-0·49, 95 % CI -0·90, -0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. CONCLUSIONS: All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.

Understanding and Changing Food Consumption Behavior Among Children: The Comprehensive Child Consumption Patterns Model.

Current theoretical models attempting to explain diet-related weight status among children center around three individual-level theories. Alone, these theories fail to explain why children are engaging or not engaging in health-promoting eating behaviors. Our Comprehensive Child Consumption Patterns model takes a comprehensive approach and was developed specifically to help explain child food consumption behavior and addresses many of the theoretical gaps found in previous models, including integration of the life course trajectory, key influencers, perceived behavioral control, and self-regulation. Comprehensive Child Consumption Patterns model highlights multiple levels of the socioecological model to explain child food consumption, illustrating how negative influence at multiple levels can lead to caloric imbalance and contribute to child overweight and obesity. Recognizing the necessity for multi-level and system-based interventions, this model serves as a template for holistic, integrated interventions to improve child eating behavior, ultimately impacting life course health development.

Rural adults' perspectives on school food in a North Carolina county.

INTRODUCTION: To address alarming rates of youth obesity, multiple stakeholder perspectives must be understood and considered when developing nutrition interventions. The purpose of this qualitative study was to examine adults' perceptions of school food in rural North Carolina and their opinions about potential changes to encourage students to eat more fruits and vegetables in school meals. METHODS: We conducted semistructured key informant interviews by telephone from February through March 2013 to determine adult opinions regarding elementary school food and child health. Participants included parents, teachers, school administrators, and a cafeteria staff member. Interview transcripts were thematically analyzed using Dedoose qualitative analysis software. RESULTS: Four themes emerged from key informant interviews regarding school meals and increasing fruit and vegetable consumption: 1) schools are an appropriate place for nutritious food, 2) current school food is bland and unappealing, 3) school cafeterias can use simple strategies to increase fruit and vegetable intake, and 4) federal school meal guidelines are perceived as barriers to increased fruit and vegetable intake during school meals. CONCLUSION: Study findings suggest that training and support for cafeteria staff on healthy food preparation and presentation are critical and that there should be a "meeting in the middle" between child appeal and health. Nutritious and appealing school food options may have the potential to greatly increase fruit and vegetable consumption in rural elementary schools in North Carolina.

B'More Healthy: Retail Rewards--design of a multi-level communications and pricing intervention to improve the food environment in Baltimore City.

BACKGROUND: Low-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryland residents. Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets. This paper describes B'More Healthy: Retail Rewards (BHRR), an intervention that tests the effectiveness of performance-based pricing discounts and health communications, separately and combined, on healthy food purchasing and consumption among low-income small store customers. METHODS/DESIGN: BHRR is 2x2 factorial design randomized controlled trial. Fifteen regular customers recruited from each of 24 participating corner stores in Baltimore City were enrolled. Food stores were randomized to 1) pricing intervention, 2) communications intervention, 3) combined intervention, or 4) control. Pricing stores were given a 10-30% price discount on selected healthier food items, such as fresh fruits, frozen vegetables, and baked chips, at the point of purchase from two food wholesale stores during the 6-month trial. Storeowners agreed to pass on the discount to the consumer to increase demand for healthy food. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests, and refrigerators. Primary outcome measures include consumer food purchasing and associated psychosocial variables. Secondary outcome measures include consumer food consumption, store sales, and associated storeowner psychosocial factors. Process evaluation was monitored throughout the trial at wholesaler, small store, and consumer levels. DISCUSSION: This is the first study to test the impact of performance-based pricing and communications incentives in small food stores, an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking, promoting, and reducing costs of healthier foods in their stores. Local food wholesalers were involved in a top-down, participatory approach to develop and implement an effective and sustainable program. This study will provide evidence on the effectiveness of price incentives and health communications, separately and combined, among a low-income urban U.S. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02279849 (2/18/2014).

Preferences for healthy carryout meals in low-income neighborhoods of Baltimore city.

CONTEXT: The nutrition environment is associated with risk of obesity and other diet-related chronic diseases. In Baltimore's low-income areas, carryouts (locally prepared-food sources that offer food "to go") are a common source of food, but they lack a variety of healthy options for purchase. OBJECTIVE: To evaluate individuals' preferences of healthy combination meals sold at carryouts and to identify successful intervention methods to promote healthier foods in carryouts in low-income communities in Baltimore. METHOD: The study estimated the relationship between combinations of healthier entrées (turkey club, grilled chicken), beverages (diet coke, bottled water), side dishes (watermelon, side salad), price points ($5.00, $7.50), and labeling on consumers' combination meal decisions using a forced-choice conjoint analysis. Logistic regression analysis was used to determine how individuals value different features in combination meals sold in carryouts. RESULTS: There was a statistically significant difference between customer preference for the two entrées, with a turkey club sandwich being preferred over a grilled chicken sandwich (p = .02). Carryout customers (n = 50) preferred water to diet soda (p < .00). CONCLUSION: Results suggested specific foods to improve the bundling of healthy combination meals. The selection of preferred promotion foods is important in the success of environmental nutrition interventions.