B’More healthy: retail rewards - design of a multi-level communications and pricing intervention to improve the food environment in Baltimore City

BackgroundLow-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/designBHRR 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.DiscussionThis 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. population.Trial registrationClinicalTrials.gov: NCT02279849 (2/18/2014)

The relationships between the healthy nurse, Healthy Nation program, RN perceptions of their work system, and health-related quality of life

BACKGROUND: There is limited research on the effects of nationally oriented health care workforce interventions on RNs\u27 perceptions of their work systems and health-related quality of life (HRQOL). PURPOSE: Guided by a systems framework, we examined the association of being affiliated with an organization partnered with the American Nurses Association\u27s Healthy Nurse, Healthy Nation (HNHN) program on RNs\u27 perceptions of their work systems and HRQOL. METHODS: We performed a correlational, cross-sectional secondary analysis of a national RN sample (N = 2,166) with case-control matching. We used multiple linear and logistic regressions to evaluate our research questions. DISCUSSION: Affiliation with an HNHN partner organization was directly associated with more desirable work system perceptions, and indirectly associated with greater HRQOL. Organization-level workplace interventions hold promise to improve RN working conditions and well-being. CONCLUSION: There is an ongoing need to continue developing and evaluating scalable workplace well-being interventions for health care organizations

Trends in mental health indicators among nurses participating in healthy nurse, healthy nation from 2017 to 2021

BACKGROUND: American healthcare workers face unprecedented stress and trauma in the workplace during COVID-19, putting nurses at increased risk for poor mental health. Examining trends of mental health from before and during COVID-19 can illuminate the toll of the pandemic on nurses well-being. METHODS: Nurses enrolled in Healthy Nurse, Healthy Nation receive a prompt to take an annual survey (n = 24,289). Mental health was assessed by active diagnoses of anxiety and depressive disorder, and feeling sad, down or depressed for two or more weeks in the past year. Logistic regression models were used to calculate predictive probabilities of health outcomes in year 4 (May 1, 2020 - April 30, 2021) compared to years 1-3 (each from May 1 to April 30), controlling for age, sex, race/ethnicity, and nurse type. Models were also stratified by work setting and nurse type. RESULTS: In year 4, nurses had a 19.8% probability of anxiety disorder, significantly higher than year 3 (16.3%, p \u3c .001), year 2 (13.7%, p \u3c .001), and year 1 (14.0%, p \u3c .001). Similarly, nurses had a 16.7% probability of depression disorder in year 4, significantly higher than year 2 (12.9%, p \u3c .001) and year 1 (13.9%, p \u3c .01). Year 4 nurses had a 34.4% probability of feeling sad, down or depressed for two weeks, significantly higher than previous years (year 1 = 26.8%, year 2 = 25.9%, year 3 = 29.7%, p \u3c .001). Trends in probabilities of mental health indicators were similar among each nurse type and work setting. Nurses in medical/surgical work settings and those with licensed practical nurse and licensed vocational nurse titles consistently had the highest probability of poor mental health. LINKING ACTION TO EVIDENCE: In 2020-2021, nurses faced challenges unlike any experienced in previous years. Unsurprisingly, nurses reported increased instances of poor mental health indicators. Positive disruptive strategies are needed to systemically change organizational culture and policy to prioritize and support nurses\u27 well-being

Associations of e-cigarette industry beliefs and e-cigarette use and susceptibility among youth and young adults in the United States

Background: Anti-industry sentiments are protective against smoking, but the relationship between industry beliefs and e-cigarette use remains unknown. Methods: A nationally representative survey of U.S. youth and young adults in Fall 2019 (n = 9554) assessed knowledge that e-cigarette and cigarette companies are the same, belief that e-cigarette companies lie about harm, and belief that tobacco companies want young people to vape. Weighted multivariate logistic regression models estimated odds of current use and susceptibility to use (among ever and never users) by industry knowledge and beliefs. Additional models assess association between industry knowledge and industry beliefs. All models controlled for harm perceptions, friend use, sensation seeking, combustible use, and demographic characteristics. Results: Disagreement that companies lie about harm (adjusted odds ratio (aOR)= 1.94, 95% CI: 1.43–2.63) and companies want young people to vape (aOR=1.72, 95% CI: 1.36–2.17) was associated with increased odds of current use. Belief that e-cigarette and cigarette companies were different entities was associated with increased odds of current use (aOR=1.45, 95% CI: 1.12–1.88). Disagreement or not knowing that companies are the same was associated with lower odds of believing companies lie about harm (disagreement aOR=0.37, 95% CI: 0.27–0.52; don\u27t know aOR=0.47, 95% CI: 0.35–0.65) and belief that companies want young people to vape (disagreement aOR=0.36, 95% CI: 0.28–0.46; don\u27t know aOR=0.54, 95% CI: 0.42–0.68). Conclusion: Similar to cigarettes, e-cigarette industry beliefs were associated with current use among young people. Highlighting e-cigarettes’ connection to Big Tobacco may be an important strategy to prevent youth and young adult e-cigarette use

Relation between the Supplemental Nutritional Assistance Program cycle and dietary quality in low-income African Americans in Baltimore, Maryland

Background: There has been limited research regarding the Supplemental Nutritional Assistance Program (SNAP) and recipients' dietary quality during the days and weeks after benefit disbursement.Objective: We examined the relation between participants' stages in the SNAP cycle and their macronutrient consumption, Healthy Eating Index (HE!) scores, and fruit and vegetable intake.Design: in this cross-sectional study, we analyzed single 24-h dietary recalls collected from 244 African American SNAP participants recruited near 24 corner stores in Baltimore City. A multiple linear regression analysis and bootstrapping were used.Results: Among participants who received a SNAP benefit 15 d before being surveyed, energy intake (1.35%; 95% CI: 0.01%, 2.73%), energy intake adjusted for minimum energy requirements (3.86%; 95% CI: 0.06%. 7.96%), total fat intake (1.96%; 95% CI: 0.29%, 3.8%), saturated fat intake (2.02%; 95% Cl: 0.23%, 4.01%), and protein intake (2.09%; 95% Cl: 0.70%, 3.62%) were higher per each 1-d increase in the TSSD.Conclusions: These findings suggest that the relation between the TSSD and macronutrient intake might be U-shaped, with higher intake of calories, fat, and protein in individuals in the very early and late stages of their SNAP cycles. Foods high in these nutrients might be cheaper, more accessible, and have a longer shelf-life than healthier options, such as fruit, vegetables, and whole grains, for SNAP participants when their benefits run out. Additional efforts are needed to investigate the effect of the TSSD on dietary intake by using a longitudinal design and to improve the quality of dietary intake in African American SNAP participants.National Heart, Lung, and Blood InstituteKruse Family Publications AwardJohns Hopkins Sch Publ Health, Dept Int Hlth, Baltimore, MD USAJohns Hopkins Sch Publ Health, Dept Hlth Behav & Soc, Baltimore, MD USAUniversidade Federal de São Paulo, Dept Hlth Sci, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Hlth Sci, São Paulo, BrazilNational Heart, Lung, and Blood Institute: 1R21HL102812-01A1Web of Scienc