Traffic-Light Labels and Choice Architecture: Promoting Healthy Food Choices

Background: Preventing obesity requires maintenance of healthy eating behaviors over time. Food labels and strategies that increase visibility and convenience of healthy foods (choice architecture) promote healthier choices, but long-term effectiveness is unknown. Purpose: Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months. Design: Longitudinal pre–post cohort follow-up study between December 2009 and February 2012. Data were analyzed in 2012. Setting/participants: Large hospital cafeteria with a mean of 6511 transactions daily. Cafeteria sales were analyzed for (1) all cafeteria customers and (2) a longitudinal cohort of 2285 hospital employees who used the cafeteria regularly. Intervention: After a 3-month baseline period, cafeteria items were labeled green (healthy); yellow (less healthy); or red (unhealthy) and rearranged to make healthy items more accessible. Main outcome measures: Proportion of cafeteria sales that were green or red during each 3-month period from baseline to 24 months. Changes in 12- and 24-month sales were compared to baseline for all transactions and transactions by the employee cohort. Results: The proportion of sales of red items decreased from 24% at baseline to 20% at 24 months (p\u3c0.001), and green sales increased from 41% to 46% (p\u3c0.001). Red beverages decreased from 26% of beverage sales at baseline to 17% at 24 months (p\u3c0.001); green beverages increased from 52% to 60% (p\u3c0.001). Similar patterns were observed for the cohort of employees, with the largest change for red beverages (23%–14%, p\u3c0.001). Conclusions: A traffic-light and choice architecture cafeteria intervention resulted in sustained healthier choices over 2 years, suggesting that food environment interventions can promote long-term changes in population eating behaviors

Effect of Personalized Incentives on Dietary Quality of Groceries Purchased A Randomized Crossover Trial

Importance Many factors are associated with food choice. Personalized interventions could help improve dietary intake by using individual purchasing preferences to promote healthier grocery purchases. Objective To test whether a healthy food incentive intervention using an algorithm incorporating customer preferences, purchase history, and baseline diet quality improves grocery purchase dietary quality and spending on healthy foods. Design, Setting, and Participants This was a 9-month randomized clinical crossover trial (AB–BA) with a 2- to 4-week washout period between 3-month intervention periods. Participants included 224 loyalty program members at an independent Rhode Island supermarket who completed baseline questionnaires and were randomized from July to September 2018 to group 1 (AB) or group 2 (BA). Data analysis was performed from September 2019 to May 2020. Intervention Participants received personalized weekly coupons with nutrition education during the intervention period (A) and occasional generic coupons with nutrition education during the control period (B). An automated study algorithm used customer data to allocate personalized healthy food incentives to participant loyalty cards. All participants received a 5% grocery discount. Main Outcomes and Measures Grocery Purchase Quality Index–2016 (GPQI-16) scores (range, 0-75, with higher scores denoting healthier purchases) and percentage spending on targeted foods were calculated from cumulative purchasing data. Participants in the top and bottom 1% of spending were excluded. Paired t tests examined between-group differences. Results The analytical sample included 209 participants (104 in group 1 and 105 in group 2), with a mean (SD) age of 55.4 (14.0) years. They were predominantly non-Hispanic White (193 of 206 participants [94.1%]) and female (187 of 207 participants [90.3%]). Of 161 participants with income data, 81 (50.3%) had annual household incomes greater than or equal to $100 000. Paired t tests showed that the intervention increased GPQI-16 scores (between-group difference, 1.06; 95% CI, 0.27-1.86; P = .01) and percentage spending on targeted foods (between-group difference, 1.38%; 95% CI, 0.08%-2.69%; P = .04). During the initial intervention period, group 1 (AB) and group 2 (BA) had similar mean (SD) GPQI-16 scores (41.2 [6.6] vs 41.0 [7.5]) and mean (SD) percentage spending on targeted healthy foods (32.0% [10.8%] vs 31.0% [10.5%]). During the crossover intervention period, group 2 had a higher mean (SD) GPQI-16 score than group 1 (42.9 [7.7] vs 41.0 [6.8]) and mean (SD) percentage spending on targeted foods (34.0% [12.1%] vs 32.0% [13.1%]). Conclusions and Relevance This pilot trial demonstrated preliminary evidence for the effectiveness of a novel personalized healthy food incentive algorithm to improve grocery purchase dietary quality. Trial Registration ClinicalTrials.gov Identifier: NCT0374805

A case of autism with an interstitial deletion on 4q leading to hemizygosity for genes encoding for glutamine and glycine neurotransmitter receptor sub-units (AMPA 2, GLRA3, GLRB) and neuropeptide receptors NPY1R, NPY5R

BACKGROUND: Autism is a pervasive developmental disorder characterized by a triad of deficits: qualitative impairments in social interactions, communication deficits, and repetitive and stereotyped patterns of behavior. Although autism is etiologically heterogeneous, family and twin studies have established a definite genetic basis. The inheritance of idiopathic autism is presumed to be complex, with many genes involved; environmental factors are also possibly contributory. The analysis of chromosome abnormalities associated with autism contributes greatly to the identification of autism candidate genes. CASE PRESENTATION: We describe a child with autistic disorder and an interstitial deletion on chromosome 4q. This child first presented at 12 months of age with developmental delay and minor dysmorphic features. At 4 years of age a diagnosis of Pervasive Developmental Disorder was made. At 11 years of age he met diagnostic criteria for autism. Cytogenetic studies revealed a chromosome 4q deletion. The karyotype was 46, XY del 4 (q31.3-q33). Here we report the clinical phenotype of the child and the molecular characterization of the deletion using molecular cytogenetic techniques and analysis of polymorphic markers. These studies revealed a 19 megabase deletion spanning 4q32 to 4q34. Analysis of existing polymorphic markers and new markers developed in this study revealed that the deletion arose on a paternally derived chromosome. To date 33 genes of known or inferred function are deleted as a consequence of the deletion. Among these are the AMPA 2 gene that encodes the glutamate receptor GluR2 sub-unit, GLRA3 and GLRB genes that encode glycine receptor subunits and neuropeptide Y receptor genes NPY1R and NPY5R. CONCLUSIONS: The deletion in this autistic subject serves to highlight specific autism candidate genes. He is hemizygous for AMPA 2, GLRA3, GLRB, NPY1R and NPY5R. GluR2 is the major determinant of AMPA receptor structure. Glutamate receptors maintain structural and functional plasticity of synapses. Neuropeptide Y and its receptors NPY1R and NPY5R play a role in hippocampal learning and memory. Glycine receptors are expressed in very early cortical development. Molecular cytogenetic studies and DNA sequence analysis in other patients with autism will be necessary to confirm that these genes are involved in autism

Rightward hemispheric asymmetries in auditory language cortex in children with autistic disorder: an MRI investigation

Purpose: determine if language disorder in children with autistic disorder (AD) corresponds to abnormalities in hemispheric asymmetries in auditory language cortex. Methods: MRI morphometric study in children with AD (n = 50) to assess hemispheric asymmetries in auditory language cortex. A key region of interest was the planum temporale (PT), which is larger in the left hemisphere in most healthy individuals. Results: (i) Heschl’s gyrus and planum polare showed typical hemisphere asymmetry patterns; (ii) posterior Superior Temporal Gyrus (pSTG) showed significant rightward asymmetry; and (iii) PT showed a trend for rightward asymmetry that was significant when constrained to right-handed boys (n = 30). For right-handed boys, symmetry indices for pSTG were significantly positively correlated with those for PT. PT asymmetry was age dependent, with greater rightward asymmetry with age. Conclusions: results provide evidence for rightward asymmetry in auditory association areas (pSTG and PT) known to subserve language processing. Cumulatively, our data provide evidence for a differing maturational path for PT for lower functioning children with AD, with both pre- and post-natal experience likely playing a role in PT asymmetry

Psychology and aggression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68264/2/10.1177_002200275900300301.pd

Workplace wellness program and short-term changes in health care expenditures

Workplace wellness programs are commonly offered by employers with the expectation that they will reduce health care costs. We previously reported that Be Fit, a 10-week wellness program offered to employees of a large teaching hospital and geared towards improving nutrition and physical activity, led to improvements in weight, serum cholesterol, and blood pressure at program completion and 1-year follow-up. In the present study we assessed whether Be Fit participation was associated with reduced health expenditures by employing a difference-in-differences analysis of claims data for 289 employees who participated in Be Fit between 2010 and 2014 and 194 controls from the same parent company matched on sex, age, health risk score, and baseline health expenditures. We compared changes in expenditures from the year prior to Be Fit participation to the year after initiating participation. We did not observe any inflection in health care expenditures at the time of Be Fit participation for participants or matched controls. After adjusting for matching characteristics, changes in quarterly health expenditures were $236 lower for participants compared to controls (95$640 to $168). We similarly found no evidence of reduced health expenditures when expenditures were capped at the 99th percentile (excluding the impact of outliers) or limited to expenditures for cardiovascular disease or diabetes. Despite improvements in clinical risk factors, we find no evidence that Be Fit was associated with reduced health expenditures over 1-year follow-up. Reducing health expenditures may require a longer time horizon and programs targeting a broader set of risk factors

The Treatment of Smoking by US Physicians During Ambulatory Visits: 1994–2003

Objectives. We sought to determine whether US physicians’ practice patterns in treating tobacco use at ambulatory visits improved over the past decade with the appearance of national clinical practice guidelines, new smoking cessation medications, and public reporting of physician performance in counseling smokers