Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial.

BACKGROUND: This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. METHODS: Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. RESULTS: Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01). CONCLUSIONS: Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02643576 .

Squeezing observational data for better causal inference: Methods and examples for prevention research.

Randomised controlled trials (RCTs) are typically viewed as the gold standard for causal inference. This is because effects of interest can be identified with the fewest assumptions, especially imbalance in background characteristics. Yet because conducting RCTs are expensive, time consuming and sometimes unethical, observational studies are frequently used to study causal associations. In these studies, imbalance, or confounding, is usually controlled with multiple regression, which entails strong assumptions. The purpose of this manuscript is to describe strengths and weaknesses of several methods to control for confounding in observational studies, and to demonstrate their use in cross-sectional dataset that use patient registration data from the Juan Pablo II Primary Care Clinic in La Pintana-Chile. The dataset contains responses from 5855 families who provided complete information on family socio-demographics, family functioning and health problems among their family members. We employ regression adjustment, stratification, restriction, matching, propensity score matching, standardisation and inverse probability weighting to illustrate the approaches to better causal inference in non-experimental data and compare results. By applying study design and data analysis techniques that control for confounding in different ways than regression adjustment, researchers may strengthen the scientific relevance of observational studies.

Nutritional quality at eight U.S. fast-food chains: 14-year trends.

BACKGROUND: Frequent consumption of fast-food menu items that are high in fat, sugar, and sodium contribute to poor dietary quality, increasing individuals' risk for diet-related chronic diseases. PURPOSE: To assess 14-year trends in the nutritional quality of menu offerings at eight fast-food restaurant chains in the U.S. METHODS: Data on menu items and food and nutrient composition were obtained in 2011 from archival versions of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database for eight fast-food restaurant chains. In this database, ingredient and nutrition information for all foods sold by the fast-food restaurants were updated biannually between 1997/1998 and 2009/2010. Healthy Eating Index (HEI)-2005 scores were calculated for each restaurant menu as a measure of the extent to which menu offerings were consistent with Dietary Guidelines for Americans and compared over time. RESULTS: Of a possible index total of 100 (healthiest), the HEI-2005 score across all eight fast-food restaurants was 45 in 1997/1998 and 48 in 2009/2010. Individually, restaurant scores in 1997/1998 ranged from 37 to 56 and in 2009/2010 ranged from 38 to 56. The greatest improvements in nutritional quality were seen in the increase of meat/beans, decrease in saturated fat, and decrease in the proportion of calories from solid fats and added sugars. The HEI-2005 score improved in six restaurants and decreased in two. CONCLUSIONS: The nutritional quality of menu offerings at fast-food restaurant chains included in this study increased over time, but further improvements are needed. Fast-food restaurants have an opportunity to contribute to a healthy diet for Americans by improving the nutritional quality of their menus.

The relationship between antenatal provider type and maternal care in rural Ghana: a cross-sectional study.

OBJECTIVES: To investigate the influence of antenatal provider type on maternity care in rural Ghana. METHODS: An analysis of maternal care by antenatal provider type using the 2008 Ghana Demographic and Health Survey. Study population included rural Ghanaian women aged 15-49 years with report of a live birth between 2003 and 2008. Bivariate chi-square analysis was performed to examine differences in maternal report of WHO Maternal Health Interventions. Multivariate linear and logistic regression were performed to assess differences in antenatal care (ANC) scales and maternal care packages. RESULTS: Thousand and three hundred and sixty-seven rural women reported a live birth. Provider distribution was: doctor, 15.6%; midwife, 70%; community health officer (CHO), 9.1%; no provider, 5.3%. Women from lower socio-demographic categories were more likely to report midwife or CHO. Report of CHO vs. no provider was positively associated with maternal services (P < 0.01). Report of doctor or midwife vs. CHO was significantly associated with maternal services (P < 0.01). CONCLUSION: There is a positive association between antenatal provider length of training and maternal specialization and report of maternal services. Community-based providers are associated with markedly increased report of maternal services compared with no provider. Structural factors appear to underlie some differences in service provision.

Characterization of Minnesota dairy herds participating in a Johne's disease control program and evaluation of the program risk assessment tool.

The objectives of this study were to: (1) characterize Minnesota dairy herds participating in a Johne's disease control program (JDCP) based on herd size, milk production, and clinical Johne's disease (JD) history, (2) evaluate if change in farm management practices, expressed in risk assessment (RA) total score, is associated with the change between the first and most recent ELISA test herd seroprevalence or change in clinical JD culling rate, and (3) identify farm factors associated with ELISA seroprevalence. A total of 1234 RA, performed between January 2000 and February 2004, were available for analysis from 714 dairy herds. ELISA test results from herd sampling between 2000 and 2004 were obtained from the Minnesota board of animal health (MBAH) database, and were available for 474 herds. Both the first and the most recent ELISA test results for herds with more than one RA were available for 262 herds. Mean herd size and mean annual milk production per cow was higher in JDCP dairy herds (161 milking cows) than either all Minnesota dairy herds or Minnesota dairy herd improvement association (DHIA) herds. For herds with more than one RA available, the most recent RA total score was significantly lower (mean 11% less) than the first. The change in RA total score (and any RA subtotal scores) between the first and most recent RA was not associated with the change between the first and the most recent ELISA within-herd seroprevalence or the change in JD culling rate between the first and most recent RA. The most recent ELISA test results were positively associated with postweaned heifer score and JD culling rate. The RA score was not found to be an effective tool for the prediction of ELISA seroprevalence.