Food Security Status and Barriers to Fruit and Vegetable Consumption in Two Economically Deprived Communities of Oakland, California, 2013-2014.

IntroductionFood security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.MethodsWe surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.ResultsRespondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β(busyness) = -0.40; 95% confidence interval [CI], -0.52 to -0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β(taste) = -0.38; 95% CI, -0.60 to -0.15) and cost (β(cost) = -0.29; 95% CI, -0.44 to -0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.ConclusionPerceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions

Socioeconomic status and overweight: using a "fundamental cause" perspective to examine relationships across time and place

Historically, in lower income countries, women with lower socioeconomic status (SES) have had a lower risk of overweight compared to their higher SES counterparts. However, with increasing rates of overweight worldwide, contemporary data suggest that even in some developing countries, lower SES women now have a higher risk of overweight compared to higher SES women. We use data from women (n=556,352) in 41 lower income countries to determine whether the prevalence of overweight has increased disproportionately among low SES women compared to high SES women during the last two decades. We also assess whether the direction of the relationship between SES and overweight has changed for women in these countries. Furthermore, we examine whether there are country-level contextual features that are saliently associated with comparatively faster overweight prevalence gains among low SES women. We find that the relation between SES and overweight has changed direction from positive to inverse in only five countries. However, in approximately 30-50% of the countries, the increases in overweight prevalence over time have been faster in the lowest SES populations compared to the highest SES populations. Country-level economic development was positively associated with faster increases in overweight prevalence among the lower wealth women. The fastest gains in low SES populations were seen in countries that had relatively higher GDP and lower levels of income inequality. We then use longitudinal data from adults in China (1989-2006) to track trajectories of BMI and overweight according to SES. We find larger increases in BMI and overweight over time for the lowest SES women compared to the highest, resulting in the emergence of a socioeconomic disparity in overweight. Opposite findings are seen for men; high SES men (versus low) have higher odds of overweight by the end of the survey. Overall, this study indicates that, predominantly, in lower income countries, low SES women are still less likely to be overweight than high SES women. However, a shift in the burden of overweight also appears to be underway, as the rates of overweight prevalence gains among low SES women are currently outpacing those among high SES women in these contexts

COVID: decoded - A Website, Blog, and Social Media Page with Resources and Information for the Public

What\u27s the Problem? Information about COVID19 in the news and on social media platforms is overwhelming, confusing, riddled with jargon and sometimes straight up wrong. Makig it easy for the public to misinterpret facts or simply accept headlines and infographics at facevalue without checking with primary and/or reputable sources. The nature of social media also allows for a perpetuation of this misinformation without recourse. Recall the one article floating around Facebook reporting that gargling salt/vinegar water could help prevent COVID19. We needede a source of simplified, reliable information about the pandemic for people outside of the health professions. Medical students are in a unique position to translate the facts into easy to digest information since we have an arm in both the public and health professional worlds

Obesity and the food environment: income and ethnicity differences among people with diabetes: the Diabetes Study of Northern California (DISTANCE).

ObjectiveIt is unknown whether any association between neighborhood food environment and obesity varies according to individual income and/or race/ethnicity. The objectives of this study were to test whether there was an association between food environments and obesity among adults with diabetes and whether this relationship differed according to individual income or race/ethnicity.Research design and methodsSubjects (n = 16,057) were participants in the Diabetes Study of Northern California survey. Kernel density estimation was used to create a food environment score for each individual's residence address that reflected the mix of healthful and unhealthful food vendors nearby. Logistic regression models estimated the association between the modeled food environment and obesity, controlling for confounders, and testing for interactions between food environment and race/ethnicity and income.ResultsThe authors found that more healthful food environments were associated with lower obesity in the highest income groups (incomes 301-600% and >600% of U.S. poverty line) among whites, Latinos, and Asians. The association was negative, but smaller and not statistically significant, among high-income blacks. On the contrary, a more healthful food environment was associated with higher obesity among participants in the lowest-income group (<100% poverty threshold), which was statistically significant for black participants in this income category.ConclusionsThese findings suggest that the availability of healthful food environments may have different health implications when financial resources are severely constrained

Understanding community context and adult health changes in China: Development of an urbanicity scale

The classification of places as either urban or rural is typically based on an absolute threshold of population and/or population density. However, conceptual definitions of urbanization and urbanicity encompass dimensions beyond solely population size and population density. Multiple important distinguishing urban characteristics beyond population size have been described. The crude classification of places as urban or rural coupled with infrequent updates to this information create a measure that is prone to misclassification error. An improved measure of urbanicity would draw information from the domains that characterize urban and rural places, would be sensitive to changes over time, and would represent gradations on the continuum from rural to urban environments. The goal of the current study was to develop such a scale from existing data, test whether the scale was reliable and valid, and assess whether it provided information beyond what could be determined from the traditional urban/rural dichotomous variable. We utilized established scaling procedures from the psychometric literature to construct and evaluate a multicomponent scale to measure urban features on a continuum in China. We also provided an example of its potential contribution to health research by examining its relationship with the adult body mass index (BMI). Because the scale was constructed and tested using established scaling procedures and using a wide array of variables, it represents an improvement over previous attempts at such a scale and will provide a reliable and valid measurement tool for researchers in this arena. The scale was developed to predict the incidence of overweight/obesity populations in China, but it promises to be most useful for other economic, demographic, social welfare, and health outcomes

Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trial

Abstract Objective Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. Design Factorial design randomized controlled trial. Setting Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. Subjects Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. Results All interventions showed significantly increased stock of promoted foods v . control. There was a significant treatment effect for daily unit sales of healthy snacks ( β =6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods ( β =–0·49, 95 % CI –0·90, –0·03) for the combined group v . control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. Conclusions All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand

Food Store Environment Modifies Intervention Effect on Fruit and Vegetable Intake among Low-Income Women in North Carolina

Background. The aim of the study is to determine how the food store environment modifies the effects of an intervention on diet among low-income women. Study Design. A 16-week face-to-face behavioral weight loss intervention was delivered among low income midlife women. Methods. The retail food environment for all women was characterized by (1) the number and type of food stores within census tracts; (2) availability of healthy foods in stores where participants shop; (3) an aggregate score of self-reported availability of healthy foods in neighborhood and food stores. Statistical Analyses. Multivariable linear regression was used to model the food store environment as an effect modifier between the intervention effect of fruit and vegetable serving change. Results. Among intervention participants with a low perception of availability of healthy foods in stores, the intervention effect on fruit and vegetable serving change was greater [1.89, 95% CI (0.48, 3.31)] compared to controls. Among intervention participants residing in neighborhoods with few super markets, the intervention effect on fruit and vegetable serving change was greater [1.62, 95% CI (1.27, 1.96)] compared to controls. Conclusion. Results point to how the food store environment may modify the success of an intervention on diet change among low-income women

Inflammatory bowel disease psychological support pilot reduces inflammatory bowel disease symptoms and improves psychological wellbeing

This prospective service evaluation aimed to determine if integrated psychological support for Inflammatory Bowel Disease (IBD) patients enhanced outcomes. 75 patients were assessed and treated by a specialist liaison psychiatric service between 2015 -2017; 43 received psychiatric intervention alone, 32 were referred for psychological intervention by clinical health psychologist; 26 completed this. Pre-post data (n=15 available) included: Global impression, quality of life, psychiatric and IBD symptom scores. Referrer/patient satisfaction and cost effectiveness were retrospectively calculated. Psychological intervention led to reductions in IBD symptoms (SIBD; p=0.003), alongside improvements in depression scores (PHQ-9, p=0.006) and global impression (CGI; p=0.046). Patient/referrer satisfaction was very high. Indicative data comparing service utilisation one year before and after engagement found reductions in outpatient appointments and in imaging. This small study suggests consideration of increased access to integrated psychological support services to improve outcomes and gather further evidence of efficacy

Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare

Abstract: Background: An implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap. Methods: The BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus. Results: The behavioural diagnosis identified healthcare professionals’ initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies. Conclusions: This study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals’ frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice

Concert recording 2013-04-14b

[Track 01]. Winter spirits for solo flute / Katherine Hoover -- [Track 02]. Il bacio / Luigi Arditi -- [Track 03]. Sonata for flute and piano. First movement / Otar Taktakishvili -- [Track 04]. Euphonium Concerto. Andante ; [Track 05]. Finale-Giocoso / Vladimir Cosma -- [Track 06]. Flute concerto in D, op. 283. Allegro molto moderato / Carl Reinecke -- [Track 07]. White knuckle stroll / Casey Cangelosi -- [Track 08]. Into the air / Ivan Trevino -- [Track 09]. Horn concerto no. 1 in E♭ major. Allegro / Richard Strauss -- [Track 10]. Pulsar / Augusta Read Thomas -- [Track 11]. Concerto in F minor. Movement one / Oskar Bohme -- [Track 12]. Fugue in G minor, Little Fugue / J.S. Bach