Dietary patterns among U.S. food insecure cancer survivors and the risk of mortality: NHANES 1999-2018.

PURPOSE: Food insecurity-the lack of unabated access to nutritious foods-is a consequence many cancer survivors face. Food insecurity is associated with adverse health outcomes and lower diet quality in the general public. The goal of this analysis was to extract major and prevailing dietary patterns among food insecure cancer survivors from observed 24-h recall data and evaluate their relationship to survival after a cancer diagnosis. METHODS: We implemented two dietary patterns analysis approaches: penalized logistic regression and principal components analysis. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) study, we extracted three dietary patterns. Additionally, we evaluated the HEI-2015 for comparison. Cox proportional hazards models assessed the relationship between the diet quality indices and survival after a cancer diagnosis. RESULTS: There were 981 deaths from all causes and 343 cancer-related deaths. After multivariable adjustment, we found higher risks of all-cause mortality associated with higher adherence to Pattern #1 (HR 1.25; 95% CI 1.09-1.43) and Pattern #2 (HR 1.15; 95% CI 1.01-1.31) among cancer survivors. CONCLUSION: Among all cancer survivors, higher adherence to major and prevailing dietary patterns from the U.S. food insecure cancer survivor population may lead to worse survival outcomes.

A Test of Autonomy Restoration Postscripts to Mitigate Psychological Reactance to an Opt-Out Organ Donor Registry in the United States.

The organ shortage continues to present problems around the world including the United States. In response, some countries have switched from an opt-in organ donor registry to an opt-out registry. The United States currently utilizes an opt-in registry where an individual is not considered an organ donor until they register their intentions. In the current study, U.S. adults were randomly assigned to a 2 (message valence: promotional, refutational) x 2 (autonomy restoration postscript: present, not present) x 2 (social proof: high likes, low likes) posttest only control group design evaluating social media message regarding an opt-out organ donor registry for implementation in the U.S. Results revealed an interaction between message valence and autonomy on freedom threat perceptions toward the message. Consistent with psychological reactance theory, freedom threat perceptions were positively associated with reactance, which in turn was positively associated with an intention to sign a petition and call a representative to voice disapproval of the opt-out organ donor registry. The discussion is focused on pragmatic recommendations for organ donor practitioners and advocates as well as the theoretical contributions to reactance theory.

Informing State-Wide Coalition Efforts to Implement and Integrate Nutrition Best Practices in Early Care and Education: Focus Group Insights from Child Care Providers.

A healthy diet in early childhood is an important contributor to ensuring lifelong health and in reducing risk for obesity. The child care environment is critical to supporting nutrition as a majority of young children less than 5 years of age are enrolled in out-of-home care. In order to better understand barriers to implementing and integrating nutrition best practices, we conduced focus groups with child care providers (n = 25) in Illinois. Providers from low-income communities, rural communities, and communities of color were prioritized. Focus group participants reported several challenges including the high cost of nutritious food, picky eating, and their perception that parents did not set good examples at home. Many providers identified the Child and Adult Care Food Program (CACFP) as a critical resource in helping them implement best practices. Providers discussed needing and wanting more training, more money for food, and more parental support. These results indicate support for additional resources and sustained training and technical assistance to address perceived challenges. The evidence of the importance of CACFP in helping providers engage in nutrition best practices indicates support for expansion and strengthening of the program.

Oncology Registered Dietitian Nutritionists' Knowledge, Attitudes, and Practices Related to Food Insecurity among Cancer Survivors: A Qualitative Study.

BACKGROUND: Understanding the knowledge, attitudes, and practices pertaining to food insecurity among oncology registered dietitian nutritionists (RDNs) is critical to ensuring that cancer survivors have adequate nutrition-a fundamental component of successful treatment and recovery. OBJECTIVE: To qualitatively assess oncology RDNs' knowledge, attitudes, and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis. DESIGN: The qualitative cross-sectional study was conducted from September 2018 to January 2019. PARTICIPANTS AND SETTING: Forty-one oncology RDNs working with cancer survivors in various clinical settings across the United States participated. MAIN OUTCOME MEASURES: Participants completed a semistructured, in-depth interview via telephone, lasting an average of 49 minutes. STATISTICAL ANALYSES PERFORMED: Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program Dedoose was used to organize and analyze the data. RESULTS: Participants defined food insecurity (FI) as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the United Staes, has a greater influence on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs. CONCLUSIONS: Although Oncology RDNs have heard of FI, they do not routinely assess patients' food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs to enhance their ability to screen for and address FI with their patients.

Food-Focused Media Literacy for Remotely Acculturating Adolescents and Mothers: A Randomized Controlled Trial of the "JUS Media? Programme".

PURPOSE: Unhealthy eating is a major modifiable risk factor for noncommunicable diseases and obesity, and remote acculturation to U.S. culture is a recently identified cultural determinant of unhealthy eating among adolescents and families in low/middle-income countries. This small-scale randomized controlled trial evaluated the efficacy of the "JUS Media? Programme," a food-focused media literacy intervention promoting healthier eating among remotely acculturating adolescents and mothers in Jamaica. METHODS: Gender-stratified randomization of 184 eligible early adolescents and mothers in Kingston, Jamaica (i.e., 92 dyads: Madolescent.age = 12.79 years, 51% girls) determined 31 "Workshops-Only" dyads, 30 "Workshops + SMS/texting" dyads, and 31 "No-Intervention-Control" dyads. Nutrition knowledge (food group knowledge), nutrition attitudes (stage of nutritional change), and nutrition behavior (24-hour recall) were primary outcomes assessed at four time points (T1/baseline, T2, T3, T4) across 5 months using repeated measures analysis of covariances. RESULTS: Compared to control, families in one or both intervention groups demonstrated significantly higher nutrition knowledge (T3 adolescents, T4 mothers: mean differences .79-1.08 on a 0-6 scale, 95% confidence interval [CI] .12-1.95, Cohen's ds = .438-.630); were more prepared to eat fruit daily (T3 adolescents and mothers: .36-.41 on a 1-5 scale, 95% CI .02-.77, ds = .431-.493); and were eating more cooked vegetables (T4 adolescents and T2 and T4 mothers: .20-.26 on a 0-1 scale, 95% CI -.03-.50, ds = .406-.607). Postintervention focus groups (6-month-delay) revealed major positive impacts on participants' health and lives more broadly. CONCLUSIONS: A food-focused media literacy intervention for remotely acculturating adolescents and mothers can improve nutrition. Replication in Jamaica and extension to the Jamaican diaspora would be useful.

What Do Childcare Providers Know about Environmental Influences on Children's Health? Implications for Environmental Health Literacy Efforts.

Children are uniquely vulnerable to toxicant exposures in their environment, which can have long-lasting impacts on their health. Childcare providers are an important population to target for environmental health literacy, as most children in the United States under five years of age spend a significant number of waking hours in non-parental care. There is an increasing body of evidence that children are exposed to toxicants in the childcare environment, and yet little is known about what childcare providers know about environmental influences on the health of children in their care. We conducted semi-structured interviews with 36 home- and center-based Illinois childcare providers to better understand their knowledge, attitudes, and behaviors as they relate to environmental influences on children's health. We found that the majority of providers had a low level of understanding of potential sources of exposure in the childcare environment, and they did not feel that environmental exposures posed a significant risk to children. Future efforts to increase environmental health literacy should focus on raising awareness and knowledge of environmental health issues for childcare providers before addressing ways that providers can reduce or prevent toxicant exposures to children in their care.

The complexities of family mealtimes in the 21st century: A latent profile analysis.

The goal of the present study was to characterize more than 500 families regarding family mealtime organization patterns. Family profiles were developed based on patterns detected across a set of sociological and psychological variables. Latent profile analyses indicated three distinct subgroups of families: Food Secure and Organized (55% of the sample), Very Low Food Security and Disorganized (27%), and Low Food Security and Organized (18%). Examination of group membership correlates revealed significant differences related to family mealtime behaviors and food preparation strategies, but not food shopping location or areas of requested change around family mealtimes. Findings highlight homogenous subgroups of families on the basis of co-occurring psychological and sociological factors pertinent to family mealtimes, with those families possessing the highest levels of risk in multiple domains also reporting family mealtime organization patterns associated with less healthy eating. Findings provide a snapshot into the organization, and complexities, of family meals for the American family today, highlighting the need for researchers and practitioners interested in promoting healthy food intake within American families to consider both psychological and sociological factors that influence family mealtime organization.

U.S. Media Enjoyment without Strong Media Literacy Undermines Adolescents' and Mothers' Reported Efforts to Reduce Unhealthy Eating in Jamaica.

We investigate whether media literacy and media use can moderate the association between U.S. media enjoyment and unhealthy eating among remotely acculturating "Americanized" adolescents and their mothers in Jamaica (n = 164 individuals/82 dyads; Madolescent.age  = 12.83, SD = 0.48, 48% female; Mmother_age  = 39.25, SD = 5.71). Socioeconomically diverse participants completed questionnaires reporting their degree of enjoyment of U.S. media (i.e., remote acculturation), media literacy (i.e., critical thinking about food media/advertising), and adherence to national dietary guidelines to reduce sugar/fat. Multilevel modeling showed that enjoying U.S. media and consuming high levels of U.S. TV plus Jamaican TV are associated with lower efforts to reduce sugar and fat. However, high media literacy, whether one's own or a close family member's, weakens or nullifies that association.

Transdisciplinary Obesity Prevention Research Sciences (TOPRS) Curriculum Increases Knowledge About Complex Causes and Consequences of Obesity for Undergraduate Students.

Most researchers and public health officials would agree that the causes and consequences of obesity are complex and multi-faceted. However, curricula designed to address these complexities are limited and often guided by a single discipline. The purpose of the Transdisciplinary Obesity Prevention Research Sciences (TOPRS) program was to develop a "flip-the-classroom" curriculum on obesity prevention across multiple disciplines such that students would gain an appreciation of the complex origins of obesity. The curriculum is based on the 6 C's model (cell, child, clan, community, country, culture) that proposes a cell-to-society approach to obesity. Twenty video micro-lectures were developed and students were tested on content knowledge pre- and post-viewing. The curriculum was administered at three university sites to 74 undergraduate students across 23 declared majors from 2014-2016. There were significant gains in knowledge about the causes and consequences of obesity. Recommendations are offered to adopt this curriculum in undergraduate and other educational settings.

Sprouts Growing Healthy Habits: Curriculum Development and Pilot Study.

High rates of childhood obesity and the impact this has on children's health make it important to establish a healthy lifestyle during the early school years. This pilot study explored the impact of a newly developed healthy habits curriculum. The Sprouts: Growing Healthy Habits curriculum presents topics such as energy balance, healthy sleep habits, and food groups through short activities and interactive book-reading. A nonrandomized controlled experimental study design was used to assess impact. Fifty-seven children between 5 and 6 years of age participated from two elementary schools (36 from the intervention school, 21 from the control school). Knowledge was assessed pre- and post-intervention in five content areas (farm to table, bedtime routines, portion size, energy expenditure, sugar content of beverages) using card sorting, ranking, and sequence activities. Within- and between-school comparisons were conducted using differences between groups and mixed modeling approaches. Within the intervention school, significant increases in knowledge were observed for farm to table, sugar content of beverages, and bedtime routines. For the control school, there was a significant increase in knowledge of portion sizes. Considering between-schools, only change in knowledge of bedtime routines remained significant, with greater increases in the intervention school. Results seem promising given the short dosage of curriculum. Increases in knowledge of healthy habits in early childhood may help in promoting healthy behaviors and combatting the effects of obesity.

Get real: how current behavior influences perceptions of realism and behavioral intent for public service announcements.

This research examined how realism and current behavior influence message reception and processing for public service announcements (PSAs) designed to help parents with meal planning. Findings from 19 in-depth interviews revealed that the perceived realism of the message, the similarity, and the wishful identification with informants' lives influenced message acceptance, in line with the Message Interpretation Process (MIP) model. Results of an online survey with mothers show that realism matters more for those individuals who already engage in the featured behavior. In line with theory, "experts" (meal planners) show increased behavioral intent of the featured behaviors when viewing the more realistic PSA.

A formative evaluation of shared family mealtime for parents of toddlers and young children.

Shared family mealtime offers numerous health benefits for young children. Unfortunately, only a few studies examine the benefits and barriers to eating together as a family. The present study seeks to fill this gap in the literature by applying the health belief model to understand parents' perceptions about the challenges of preparing and executing family mealtime for toddlers and young children. Six focus groups were conducted with parents of toddlers and/or young children (n = 24). Results revealed that parents identified several benefits to shared family mealtime, including good teaching moments for their children, enhanced family connectedness, and encouraging nutritious meals. Parents also identified barriers to eating together as a family, including child behavioral issues, scheduling difficulties, and ill-prepared husbands. The risks associated with not eating together as a family were seldom mentioned; however, parents highlighted several issues related to self-efficacy, such as difficulty in selecting meals and challenges with cooking. Potential cues to action include print materials encouraging parents by emphasizing the benefits of eating together as a family. Results are discussed with an emphasis on message design strategies for health practitioners interested in advocating this important yet under-studied phenomenon.