Effects of a 2014 Statewide Policy Change on Cash-Value Voucher Redemptions for Fruits/Vegetables Among Participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Purpose In 2014, the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began requiring WIC-authorized stores to stock at least two fresh fruits and two fresh vegetables. We aimed to evaluate the effect of this policy change on fruit and vegetable purchases among WIC-participating households and to assess variation by household access to a healthy food store such as a supermarket or large grocery store. Description Households with continuous WIC enrollment from June 2013 to May 2015 were included (n = 16,415). Participants receive monthly cash-value vouchers (CVVs) to purchase fruits and vegetables. For each household, the CVV redemption proportion was calculated for the period before and after the policy by dividing the total dollar amount redeemed by the total dollar amount issued. Complete redemption was defined as a proportion ≥90% and the change in complete redemption odds was assessed after adjusting for Supplemental Nutrition Assistance Program participation. Assessment We observed a small increase following the policy change [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04-1.17]; however, the effect varied by healthy food access (p = 0.03). The odds increased for households with access to at least one healthy food store (OR 1.13, 95% CI 1.06-1.20) while no effect was observed for households without such access (OR 0.91, 95% CI 0.76-1.10). Conclusion Policy change was associated with a small increase in purchasing, but only among households with healthy food access. The state is addressing this gap through technical assistance interventions targeting WIC-authorized small stores in communities with limited access.

Evaluating Community Measures of Healthy Food Access.

Several community level measures of healthy food access exist, but evaluation efforts have been limited leaving uncertainty about how to prioritize communities for intervention. This study aimed to assess several existing measures to inform statewide public health planning efforts in New Jersey, USA. We assessed agreement between community measures of healthy food access and then evaluated the predictive validity of each measure by describing its association with complete fruit and vegetable cash-value voucher redemption (proportion redeemed ≥70, ≥80, ≥90%) among 30,078 low-income households participating in the New Jersey Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2013-2014. The United States Department of Agriculture's (USDA) food desert measure agreed with the Centers for Disease Control and Prevention's (CDC) no healthier food retailers (NHFR) measure for 76.5% of New Jersey census tracts, but the Kappa statistic was only 0.10. For urban households, the NHFR measure was negatively associated with complete redemption after adjusting for demographic factors and Supplemental Nutrition Assistance Program participation (≥70% odds ratio (OR) 0.68, 95% confidence interval (CI) 0.61-0.75; ≥80% OR 0.67, 95% CI 0.62-0.73; ≥90% OR 0.72, 95% CI 0.66-0.77). For rural households, a negative association was observed for the USDA's low-income/low-vehicle access measure (≥70% OR 0.48, 95% CI 0.26-0.90). The CDC's NHFR measure is more appropriate for prioritizing urban areas while the USDA's low-income/low-vehicle access measure may be better for rural areas.

Genetic testing preferences in families containing multiple individuals with epilepsy.

OBJECTIVE: To examine genetic testing preferences in families containing multiple individuals with epilepsy. METHODS: One hundred forty-three individuals with epilepsy and 165 biologic relatives without epilepsy from families containing multiple affected individuals were surveyed using a self-administered questionnaire. Four genetic testing scenarios were presented, defined by penetrance (100% vs. 50%) and presence or absence of clinical utility. Potential predictors of genetic testing preferences were evaluated using generalized estimating equations with robust Poisson regression models. The influence of 21 potential testing motivations was also assessed. RESULTS: For the scenario with 100% penetrance and clinical utility, 85% of individuals with epilepsy and 74% of unaffected relatives responded that they would definitely or probably want genetic testing. For the scenario with 100% penetrance but without clinical utility, the proportions who responded that they would want testing were significantly lower in both affected individuals (69%) and unaffected relatives (57%). Penetrance (100% vs. 50%) was not a significant predictor of genetic testing interest. The highest-ranking motivations for genetic testing were the following: the possibility that the results could improve health or health care, the potential to know if epilepsy in the family is caused by a gene, and the possibility of changing behavior or lifestyle to prevent seizures. SIGNIFICANCE: Interest in epilepsy genetic testing may be high in affected and unaffected individuals in families containing multiple individuals with epilepsy, especially when testing has implications for improving clinical care.

An exploration of religion and spirituality among young, HIV-infected gay and bisexual men in the USA.

Although religion and spirituality can promote healthy behaviours and mental well-being, negative religious experiences may harm sexual minority men's health. Despite increasing vulnerability to HIV infection among young gay and bisexual men, few studies examine how religion and spirituality might affect them. To this end, we interviewed young gay and bisexual men who were diagnosed with HIV infection during January 2006-June 2009. Questionnaires assessed religious service attendance, disclosure of sexuality within religious communities, and beliefs about homosexuality being sinful. A subset described religious and spiritual experiences in qualitative interviews. We calculated the prevalence of religion- and spirituality-related factors and identified themes within qualitative interviews. Among men completing questionnaires, 66% currently attended religious services, 16% believed they could disclose their sexuality at church, and 37% believed homosexuality was sinful. Participants who completed qualitative interviews commonly discussed religious attendance and negative experiences within religious settings. They often expressed their spirituality through prayer, and some used it to cope with adverse experiences. These data suggest that religion and spirituality are notable factors that shape young, HIV-infected gay and bisexual men's social contexts. Programmes and interventions that constructively engage with religious institutions and are sensitive to spiritual beliefs may promote these men's health.