How changes in menu quality associate with subsequent expenditure on (un)healthy foods and beverages in school cafeterias: A three-year longitudinal study.

Evidence of the association between the school food environment and children's and adolescents' diet is mostly cross-sectional, usually based on self-reported behavior, and often conducted in high-income countries. Also, relatively little is known about how variations in menu quality associate with the subsequent expenditure on food and beverages of the same- (vs. cross-) nutritional value. Based on a three-year longitudinal dataset comprised of 4,268,457 purchases made by 20,333 children and adolescents from 54 private schools in Brazil, we unobtrusively assess how changes in (un)healthy product availability associate with students' subsequent purchase behavior. Our results reveal that, on average, only 11.6% of the products offered in the school cafeterias were of high nutritional value (HNV). Critically, expenditure on HNV products increased following both the addition of one HNV product (ß = 0.18; 95% CI = 0.128, 0.240) and, to a lesser extent, the subtraction of one low nutritional value (LNV) product from the menu (ß = -0.03; 95% CI = -0.042, -0.016). Cross-nutritional value effects were stronger for beverages. The inclusion of one HNV beverage was associated not only with a subsequent increase in expenditure on HNV beverages (ß = 0.19; 95% CI = 0.115, 0.264), but also with a decrease in expenditure on LNV beverages (ß = -0.18; 95% CI = -0.352, -0.010).Although only a small percentage of foods and beverages consumed in private school cafeterias in Brazil are of high nutritional value, improvements to menu quality have the potential to increase the consumption of healthier products and decrease the consumption of unhealthy ones.

The impact of generic labels on the consumption of and adherence to medication: a randomized controlled trial.

Background: Although generic drugs are pharmacologically equivalent to their brand-name counterparts, prejudices against them remain strong. We assess the extent to which generic (versus brand-name) labels affect patients' consumption of and adherence to medication. Methods: One hundred one patients who received dental implants agreed to participate in a study. In a pre-surgery survey, most patients reported a positive view about generic drugs. After dental surgery, the patients were prescribed a once-daily analgesic regimen (50 mg tramadol hydrochloride) for up to 7 days. All the patients received at no cost the same brand-name medication with either a brand-name label (n = 51) or a generic label (n = 50) and were informed of the retail prices associated with both labels. Telephone follow-up was conducted 24 hours, four days, and seven days after surgery to assess the number of prescribed pills consumed and when their use was discontinued, the number of non-prescribed pills consumed, pain levels throughout the follow-up period, the perceived efficacy of the analgesic, and the willingness to recommend it to a friend. Results: The label manipulation impacted the participants' behaviour and subjective assessments. Discontinuation before the end of the 7-day period was more frequent under the generic (vs. brand-name) label condition. The patients in the generic label group were also more likely to consume non-prescribed pills (non-adherence). Additionally, the patients in the generic label group reported higher levels of pain. Conclusion: Generic labels may negatively affect adherence to treatment even if patients report ex ante positive evaluations of the quality of generics drugs.