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There is interest in reshaping the Supplemental Nutrition Assistance Program (SNAP) to better support family nutrition. The Grocery Assistance Program Study (GAPS) for Families evaluated the effects of prohibiting using program funds for the purchase of certain sugary foods on the nutritional quality of foods purchased and consumed by program participants. A randomized experimental trial was carried out with participants randomized to one of three food benefit conditions. Baseline and follow-up measures collected included interviewer-administered 24-hour dietary recalls, food purchase receipts, food security, height, and weight. Adult–child dyads in households eligible for SNAP but currently not enrolled were recruited from the Minneapolis/St Paul MN metropolitan area from May of 2018 through May of 2019. A total of 293 adult–child dyads received the intervention as allocated. Of these dyads, 233 adults completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 20.5%. A total of 224 children completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 23.5%. Participants were randomized to 1 of 3 conditions: restriction (not allowed to buy sugar-sweetened beverages [SSB], sweet baked goods, or candy with program funds); restriction paired with incentive (30% incentive for fruits and vegetables [FV] purchased with funds); and control (funds provided with no restrictions or incentives). Funds were provided on a 4-week cycle for 20 weeks via a study-provided debit card. The primary outcome was the Healthy Eating Index (HEI)-2015 total score. Additional outcomes included selected HEI-2015 component scores; energy intake; food security; body weight; and purchasing of SSB, sweet baked goods, candies, fruits, and vegetables. Linear regression analyses were conducted with change in the outcome regressed on treatment condition for the primary outcome analyses. No differences were observed between conditions in change in the nutrition and food security measures examined. Purchases of SSB and sweet baked goods and candies significantly differed by experimental condition. Purchase of restricted foods was lower at follow-up in the restriction and restriction paired with incentive conditions compared with the control condition. For example, spending on SSB at follow-up was significantly lower in the restriction ($2.66/week) and restriction paired with incentive ($2.06/week) conditions in comparison with control condition ($4.44/week) (P < 0.0003 and P < 0.0001, respectively). This study failed to find evidence in support of prohibiting the purchase of sugary foods with food program funds as a strategy to improve program participant nutrition, even when paired with an FV incentive. Research carried out in the context of the SNAP program is needed for a more robust evidence base. [ABSTRACT FROM AUTHOR]

Randomised controlled trials ( RCTs) are typically viewed as the gold standard for causal inference. This is because effects of interest can be identified with the fewest assumptions, especially imbalance in background characteristics. Yet because conducting RCTs are expensive, time consuming and sometimes unethical, observational studies are frequently used to study causal associations. In these studies, imbalance, or confounding, is usually controlled with multiple regression, which entails strong assumptions. The purpose of this manuscript is to describe strengths and weaknesses of several methods to control for confounding in observational studies, and to demonstrate their use in cross-sectional dataset that use patient registration data from the Juan Pablo II Primary Care Clinic in La Pintana-Chile. The dataset contains responses from 5855 families who provided complete information on family socio-demographics, family functioning and health problems among their family members. We employ regression adjustment, stratification, restriction, matching, propensity score matching, standardisation and inverse probability weighting to illustrate the approaches to better causal inference in non-experimental data and compare results. By applying study design and data analysis techniques that control for confounding in different ways than regression adjustment, researchers may strengthen the scientific relevance of observational studies. [ABSTRACT FROM AUTHOR]

Prevention and control of infectious diseases in livestock is dependent upon perceived risk and susceptibility, including the prevention of between-herd transmission of bovine tuberculosis through introductions of cattle to susceptible herds. To examine how perceived risk and susceptibility can help to inform policymaking in disease surveillance and control, we used factorial surveys to profile risk perceptions of cattle producers. We found that government indemnity and slaughtering policy did not impact the cattle purchasing behavior of producers who responded to our survey, but rather through other attributes such as the reliability or reputation of the seller. In addition, we identified significant production type and gender differences in purchasing behavior and risk perception. Finally, clustering analysis revealed a group of high-risk respondents characterized as experienced and very dedicated owners of established medium to large size herds. With the increasing availability of business data, assessment of producer's behavior, personalities and attitudes allows policymakers to understand the needs of cattle producers and develop tailored programs that will improve producer cooperation with government agencies. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiologists often seek a representative sample of particular persons from geographically bounded areas. However, it has become increasingly difficult to identify a sample frame that truly represents the underlying target population. We assessed the degree to which a clinic-based sample represents a target community. Methods: Our sample frame is from a large health care provider from the Minneapolis-Saint Paul, Minnesota, metropolitan area. We used U.S. Census data to examine the sociodemographic and geospatial distribution of the sampling frame and among those who did and did not respond. Results: Our study's overall response rate was 57%. The most impoverished areas of the target population were under-represented in our sample frame, but this under-representation was similar for both respondents and nonrespondents. In addition, our sampled population was slightly older compared to the target population. Using ecological-level census-derived markers of sociodemographic characteristics, members of the sample frame were similar to that of the target population except for being somewhat more highly educated. However, the distributions of available individual-level data such as race and education were different between respondents and the target population. Conclusions: Although the use of health care administrative records for identifying a sampling frame that represents a target population has limitations, our findings suggest that this method had strengths. More comparisons of methods for identifying and recruiting target populations are needed. [ABSTRACT FROM AUTHOR]

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine problem gambling. In this paper the authors describe part one of a two part, linked relapse process: the 'push' towards relapse. In this two-part process, factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behavioural events that ends with relapse when the 'push' overcomes 'pull' (part one); or as described in part two, continued abstinence when 'pull' overcomes 'push'. In the second paper, the authors describe how interacting factors 'pull' the problem gambler away from relapse. This study used four focus groups comprising thirty participants who were gamblers, gamblers' significant others, therapists and counsellors. The groups were recorded, recordings were then transcribed and analysed using thematic, textual analysis. With the large number of variables considered to be related to relapse in problem gamblers, five key factors emerged that 'push' the gambler towards relapse. These were urge, erroneous cognitions about the outcomes of gambling, negative affect, dysfunctional relationships and environmental gambling triggers. Two theories emerged: (1) each relapse episode comprised a sequence of mental and behavioural events, which evolves over time and was modified by factors that 'push' this sequence towards relapse and (2) a number of gamblers develop an altered state of consciousness during relapse described as the 'zone' which prolongs the relapse. [ABSTRACT FROM AUTHOR]

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine (EGM) problem gambling (PG) by describing the processes and factors that 'pull' the problem gambler away from relapse contrasted with the 'push' towards relapse. These conceptualisations describe two opposing, interacting emotional processes occurring within the problem gambler during any relapse episode. Each relapse episode comprises a complex set of psychological and social behaviours where many factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behaviour events that end (1) with relapse where 'push' overcomes 'pull' or (2) continued abstinence where 'pull' overcomes 'push'. Four focus groups comprising thirty participants who were EGM problem gamblers, gamblers' significant others, therapists and counsellors described their experiences and understanding of relapse. The groups were recorded, recordings were then transcribed and analysed using thematic textual analysis. It was established that vigilance, motivation to commit to change, positive social support, cognitive strategies such as remembering past gambling harms or distraction techniques to avoid thinking about gambling to enable gamblers to manage the urge to gamble and urge extinction were key factors that protected against relapse. Three complementary theories emerged from the analysis. Firstly, a process of reappraisal of personal gambling behaviour pulls the gambler away from relapse. This results in a commitment to change that develops over time and affects but is independent of each episode of relapse. Secondly, relapse may be halted by interacting factors that 'pull' the problem gambler away from the sequence of mental and behavioural events, which follow the triggering of the urge and cognitions to gamble. Thirdly, urge extinction and apparent 'cure' is possible for EGM gambling. This study provides a qualitative, empirical model for understanding protective factors against gambling relapse. [ABSTRACT FROM AUTHOR]

Background The prevalence of overweight and obesity in the US population has risen dramatically in recent years. To try to explain this, some studies have examined the association between the built environment and obesity (measured using the body mass index (BMI)). Most of these studies have not sought to identify causal effects, but rather correlations. Methods Data from the Twin Cities Walking Study were used to examine the effect of population density and block size on BMI. Although the Twin Cities Walking Study is a cross-sectional observational study, the matched-sampling design is novel in that it maximises environmental variance while minimising person variance to enhance exchangeability of subjects and more closely mimic an experimental study. Results Contrary to expectations, the hypothesised most walkable neighbourhood (high density, small block stratum) had the greatest mean and median BMI. After adjusting for demographic covariates, physical activity and clustering due to neighbourhood, no conclusive effect of population density by block size on BMI was found (β=1.024, 95% CI -2.408 to 0.359). Conclusion There is no evidence of an effect of population density by block size on BMI. [ABSTRACT FROM AUTHOR]

Background: Strategies to increase fruit and vegetable consumption of preschool aged children are needed. Objectives: Evaluate the independent effects of the following meal service strategies on intake of fruits and vegetables of preschool children: 1.) Serving fruits and vegetables in advance of other menu items as part of traditional family style meal service; and 2.) Serving meals portioned and plated by providers. Methods: Fifty-three preschool aged children completed a randomized crossover experiment conducted at a Head Start center in Minneapolis, MN. Over a six week trial period each of the experimental meal service strategies (serving fruits and vegetable first and serving meals portioned by providers) was implemented during lunch service for two one-week periods. Two one-week control periods (traditional family style meal service with all menu items served at once) were also included over the six week trial period. Children's lunch intake was observed as a measure of food and nutrient intake during each experimental condition. Results: Fruit intake was significantly higher (p<0.01) when fruits and vegetables were served in advance of other meal items (0.40 servings/meal) compared to the traditional family style meal service control condition when they were served in tandem with other menu items (0.32 servings/meal). Intakes of some nutrients found in fruits (vitamin A and folate) were concomitantly higher. In contrast, fruit and vegetable intakes were significantly lower and energy intake significantly higher during the provider portioned compared with control condition. Conclusions: Serving fruits in advance of other meal items may be a low cost easy to implement strategy for increasing fruit intake in young children. However, serving vegetables first does not appear to increase vegetable intake. Results provide support for current recommendations for traditional family style meal service in preschool settings. [ABSTRACT FROM AUTHOR]

Confounding associated with social stratification or other selection processes has been called structural confounding. In the presence of structural confounding, certain covariate strata will contain only subjects who could never be exposed, a violation of the positivity or experimental treatment effect assumption. Thus, structural confounding can prohibit the exchangeability necessary for meaningful causal contrasts across levels of exposure. The authors explored the presence and magnitude of structural confounding by estimating the independent effects of neighborhood deprivation and neighborhood racial composition (segregation) on rates of preterm birth in Wake and Durham counties, North Carolina (1999–2001). Tabular analyses and random-intercept fixed-slope multilevel logistic models portrayed different structural realities in these counties. The multilevel modeling results suggested some nonsignificant effect of residence in tracts with high levels of socioeconomic deprivation or racial residential segregation on adjusted odds of preterm birth for white and black women living in these counties, and the confidence limit ratios indicated fairly consistent levels of precision around the estimates. The results of the tabular analysis, however, suggested that many of these regression modeling findings were off-support and based on no actual data. The implications for statistical and public health inference, in the presence of no data, are considered. [ABSTRACT FROM PUBLISHER]

Research into the effects of neighborhood environments on social and behavioral characteristics is threatened by inattention to some methodological obstacles, including the recruitment of a representative sample of resident participants. Although sampling is relatively straightforward, actual recruitment is not. The authors present the recruitment experience of the Twin Cities Walking Study addressing two questions: (a) Are randomly selected participants different from those selected by convenience? and (b) How well does the realized sample match known demographic characteristics of target neighborhoods? Of 716 total participants nested in 36 neighborhoods, 74% were randomly recruited. Socioeconomic status was positively correlated with random recruitment; nonrandom volunteers were more likely to be non-White females of lower socioeconomic status. Multivariate analyses, using propensity scores, show randomly selected and volunteer participants to be similar. The final mixed sample represented the target neighborhoods well. Supplementing a random sample with volunteers may yield a representative sample exchangeable at the group level. [ABSTRACT FROM AUTHOR]

This paper considers the media research with children from a social epidemiological perspective. I am especially concerned with comparing the types of research designs, standard measures and modeling frameworks used in media studies to those used in (social) epidemiology and prevention research more generally. Overall, the state of research on the effect of various media on outcomes in children is robust and promises to be on par with the best epidemiological research. The principal measurement deficiency lies in the measurement of potential confounders and effect modifiers. With respect to research designs, the principal deficiencies include neglect of effectmodification by recognized social groupings, contextual influences and social interaction. Substantial practical benefits may come from the implementation and evaluation of intervention programs, especially group-randomized trials. As for analyses, the principal weakness appears to be in extending causal inference into observational field studies. [ABSTRACT FROM AUTHOR]

Abstract: We examine whether specific types of people are more sensitive to the built environment when making a decision to walk or engage in other physical activity. Over 700 participants from 36 environmentally diverse, but equivalent-sized neighborhoods or focus areas responded to a survey, kept a travel diary, and wore an accelerometer for seven days. Subgroups defined by demographic and socioeconomic variables, as well as self reported health and weight status demonstrate that most subgroups of people walk more for transportation in high density areas. However, only the less healthy walked more overall in high density areas after controlling for sociodemographic characteristics and physical activity was remarkably similar among the groups and across different kinds of environments. While environmental interventions may not increase physical activity population wide, some populations – including some for whom interventions may be important such as the less healthy and the unemployed or retired – are more affected by these neighborhood environmental characteristics. [Copyright &y& Elsevier]

Purpose: Poor living conditions are posited as an underlying cause of American Indian (AI) infant mortality, which is unusually high in the postneonatal period. We explore whether the effects of neighborhood poverty on AI infant death are identifiable by using observational data. Methods: Vital records for infants born between 1990 and 1999 to AI women in a metropolitan area (n = 4751) are linked with tract-level poverty data. A counterfactual framework, an explicit causal contrast study design, and propensity score matching methods were used. For each comparison, we created exchangeable groups by matching infants with the same probability of exposure to poverty when one was exposed and the other was not. Results: Our results suggest that neighborhood poverty has little effect on AI infant death outcomes. Importantly, the study design makes transparent the challenge of identifying appropriate analytic comparison groups in studies of neighborhood poverty and health. Conclusions: Collecting additional data will likely not overcome the fact that AIs with a high probability of living in poverty rarely reside in low-poverty neighborhoods. Yet, some of them must if a meaningful counterfactual comparison is to be made and the effects of neighborhood poverty on AI infant death are to be identified. [Copyright &y& Elsevier]

Many agree that increasing physical activity will improve public health. This paper reports on empirical findings on the relationship between the density of the residential environment, walking and total physical activity. Using multiple objective and self-reported measures for 715 participants in the US, and improved techniques for sampling and analysis, it finds that density is associated with the purpose of walking (travel, leisure) but not the amount of overall walking or overall physical activity, although there are sub-group differences by race/ethnicity. Overall, higher densities have many benefits in terms of efficient use of infrastructure, housing affordability, energy efficiency and possibly vibrant street life. But higher densities alone, like other built environment features, do not appear to be the silver bullet in the public health campaign to increase physical activity. [ABSTRACT FROM AUTHOR]

A growing body of health and policy research suggests residential neighborhood density and street connectivity affect walking and total physical activity, both of which are important risk factors for obesity and related chronic diseases. The authors report results from their methodologically novel Twin Cities Walking Study; a multilevel study which examined the relationship between built environments, walking behavior and total physical activity. In order to maximize neighborhood-level variation while maintaining the exchangeability of resident-subjects, investigators sampled 716 adult persons nested in 36 randomly selected neighborhoods across four strata defined on density and street-connectivity - a matched sampling design. Outcome measures include two types of self-reported walking (from surveys and diaries) and so-called objective 7-day accelerometry measures. While crude differences are evident across all outcomes, adjusted effects show increased odds of travel walking in higher-density areas and increased odds of leisure walking in low-connectivity areas, but neither density nor street connectivity are meaningfully related to overall mean miles walked per day or increased total physical activity. Contrary to prior research, the authors conclude that the effects of density and block size on total walking and physical activity are modest to non-existent, if not contrapositive to hypotheses. Divergent findings are attributed to this study's sampling design, which tends to mitigate residual confounding by socioeconomic status. [ABSTRACT FROM AUTHOR]

This article cites a study, determining the association of the timing of prognostic information delivery by physicians with care giver satisfaction with communication or decision making in intensive care units (ICUs). The objective of this longitudinal survey-based study was two-fold: first, to determine the congruity between surrogates' desired frequency of communication and the actual frequency, and second, to determine whether surrogates' comprehension of substituted judgment was associated with decision-making satisfaction. Subjects of the study were surrogate decision makers of patients in the Medical or Surgical ICU at Fairview University Medical Center or Methodist Hospital in Minnesota. A total of 57 caregivers received prognostic information during the ICU stay. The study suggests that the capacity of physicians and other ICU personnel to manage families' communication expectations may positively influence caregiver satisfaction.

Purpose: To estimate the prevalence of metabolic syndrome in persons with a history of cancer from a population-based sample of adults, and compare that prevalence to persons without a history of cancer. Methods: Data from the Third National Health and Nutrition Examination Survey were analyzed to compare prevalence and prevalence differences of the metabolic syndrome, as defined by Adult Treatment Panel III criteria, between 486 persons with a reported history of cancer and 12,526 persons with no reported history of cancer. Results: The prevalence of metabolic syndrome was 258/1000 persons for those with a cancer history and 184/1000 persons among those without, resulting in a prevalence difference of 74/1000 persons (95% CI, 38–110). Prevalence differences varied substantially by age at interview. The prevalence difference was highest among those aged 40 to 49 years (112/1000 persons) and 50 to 59 years (73/1000 persons), while those in younger (18–39 years) and older (: 60 years) age groups had a moderately higher prevalence among those without a cancer history. Conclusion: These results add to the emerging concern that metabolic syndrome and associated risks for cardiovascular disease and type 2 diabetes may be an adverse late effect of cancer and/or its treatment. [Copyright &y& Elsevier]

Objectives. We assessed long-term trends in ethylene oxide (EtO) worker exposures for the purposes of exposure surveillance and evaluation of the impacts of the Occupational Safety and Health Administration (OSHA) 1984 and 1988 EtO standards. Methods. We obtained exposure data from a large commercial vendor and processor of EtO passive dosimeters. Personal samples (87 582 workshift [8-hr] and 46097 short-term [15-min] samples) from 2265 US hospitals were analyzed for time trends from 1984 through 2001 and compared with OSHA enforcement data. Results. Exposures declined steadily for the first several years after the OSHA standards were set. Workshift exposures continued to taper off and have remained low and constant through 2001. However, since 1996, the probability of exceeding the short-term excursion limit has increased. This trend coincides with a decline in enforcement of the EtO standard. Conclusions. Results indicate the need for renewed intervention efforts to preserve gains made following the passage and implementation of the 1984 and 1988 EtO standards. (Am J Public Health. 2004;94:1614-1619). [ABSTRACT FROM AUTHOR]

The resurgence of interest in the effect of neighborhood contexts on health outcomes, motivated by advances in social epidemiology, multilevel theories and sophisticated statistical models, too often fails to confront the enormous methodological problems associated with causal inference. This paper employs the counterfactual causal framework to illuminate fundamental obstacles in the identification, explanation, and usefulness of multilevel neighborhood effect studies. We show that identifying useful independent neighborhood effect parameters, as currently conceptualized with observational data, to be impossible. Along with the development of a dependency-based methodology and theories of social interaction, randomized community trials are advocated as a superior research strategy, one that may help social epidemiology answer the causal questions necessary for remediating disparities and otherwise improving the public''s health. [Copyright &y& Elsevier]

The resurgence of social epidemiology has yet to induce corresponding research into basic measurement issues. This paper aims to motivate investigators to refocus attention on the measurement of socioeconomic status (SES). With a primarily American focus, we document striking paucity of basic research in SES, review the history of SES measurement, highlight the central limitations of current measurement approaches, sketch a new theoretical perspective, present new pilot results, and outline areas for future research. We argue (1) that lack of conceptual clarity and the bypassing of standard psychometric techniques have retarded SES measurement. And (2) social epidemiologists should revisit the measurement of SES and consider whether a richer, psychometrically induced, approach would be more useful. Our pilot study suggests a great deal of uniformity between existing SES measures and that a new approach may be worthy of pursuit. [Copyright &y& Elsevier]

Having an Institutional Review Board (IRB) review and monitor the use of human subjects is now fundamental to ethical research. Yet social scientists appear increasingly frustrated with the process. This article aims to assist evaluators struggling to understand and work with IRBs. The author theorizes why IRBs frustrate and insists there is only one remedy: We must accept the legitimacy of IRB review and (a) learn more about IRB regulations, imperatives, and the new pressures on them; and (b) educate IRBs about social scientific methodologies and empirically demonstrable risks. A research agenda and tips are offered. [ABSTRACT FROM AUTHOR]

Nonequivalent controlled pretest-posttest designs are central to evaluation science, yet no practical and unified approach for estimating power in the two most widely used analytic approaches to these designs exists. This article fills the gap by presenting and comparing useful, unified power formulas for ANCOVA and change-score analyses, indicating the implications of each on sample-size requirements. The authors close with practical recommendations for evaluators. Mathematical details and a simple spreadsheet approach are included in appendices. [ABSTRACT FROM AUTHOR]

Research on neighborhood effects faces enormous methodological challenges, with selection bias being near the top of the list. In this issue of the Journal (Am J Epidemiol. 2014;180(8):776–784), Professor Jokela addresses this issue with novel repeated measures data and models that decompose putative effects into those within and between persons. His contribution shows that within-person neighborhood effects are quite modest and that there is evidence of selection bias between persons. Like all research, the work rests on assumptions. Unfortunately, such assumptions are difficult to substantiate or validate in this context. A consequentialist epidemiologic perspective compels further innovation and a larger social epidemiologic imagination. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to examine psychosocial constructs targeted as potential mediators in a prior physical activity (PA) intervention study. This secondary analysis used data from 102 older adults randomized to one of four conditions—within a 2 (Interpersonal Strategies: yes, no) x 2 (Intrapersonal Strategies: yes, no) factorial design. We tested intervention effects on social support, self-efficacy, self-regulation, and goal attainment, and whether these constructs mediated intervention effects on PA. Participants who received interventions with interpersonal strategies, compared to those who did not, increased their readiness (post-intervention), the self-regulation subscale of self-assessment, and goal attainment (post-intervention, 6-months). Participants who received interventions with intrapersonal strategies, compared to those who did not, increased their social support from family (post-intervention). There was no statistically significant mediation. To understand mechanisms through which interventions increase older adults' PA and to improve intervention effectiveness, researchers should continue to examine potential psychosocial mediators. Clinical Trial Registry: NCT02433249. [ABSTRACT FROM AUTHOR]

The article by professors Galea and Link in this issue of the Journal (Am J Epidemiol. 2013;178(6):843-849) is an important contribution to the field of social epidemiology. Their 6 paths provide ample fodder for reflection, debate, and advancement. Although I agree with the thrust and spirit of their recommendations, I argue that if social epidemiology is to advance and become not just more popular but also more useful, we social epidemiologists need to first address our disciplinary pathologies. Among other things, we must embrace macro-to-micro transitions, understand and act on the principles of effect identification, conduct many more experiments, and train students to be not researchers but scientists. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Positivity in Practice," by D. Westreich and S. R. Cole in the 2010 issue of the "American Journal of Epidemiology."

Background: Little is known about which behavior change strategies motivate older adults to increase their physical activity.Purpose: The purpose of this study was to assess the relative effects of two sets of behavior change strategies to motivate increased physical activity among older adults: interpersonal and intrapersonal.Methods: Community-dwelling older adults (N = 102, mean age = 79) were randomized in a 2 × 2 factorial experiment to receive interpersonal (e.g., social support, friendly social comparison; no, yes) and /or intrapersonal (e.g., goal setting, barriers management; no, yes) behavior change strategies, combined with an evidence-based, physical activity protocol (Otago exercise program) and a physical activity monitor (Fitbit One™).Results: Based on monitor data, participants who received interpersonal strategies, compared to those who did not, increased their average minutes of total physical activity (light, moderate, vigorous) per week, immediately (p = .006) and 6 months (p = .048) post-intervention. Similar, increases were observed on measures of functional strength and balance, immediately (p = .012) and 6 months (p = .003) post-intervention. The intrapersonal strategies did not elicit a significant increase in physical activity or functional strength and balance.Conclusions: Findings suggest a set of interpersonally oriented behavior change strategies combined with an evidence-based physical activity protocol can elicit modest, but statistically and clinically significant, increases in older adults' physical activity and functional strength and balance. Future research should replicate these findings and investigate the sustained quantity of physical activity elicited by these strategies and their impact on older adults' quality of life and falls. Trial Registration The ClinicalTrials.gov registration identifier is NCT02433249. [ABSTRACT FROM AUTHOR]

Background: The majority of studies on youth violence have focused on factors that increase the risk for youth violence. Purpose: To assess whether determinants of violence operate as risk factors, direct protective factors, or both during adolescence and young adulthood. Methods: Data from participants in the National Longitudinal Study of Adolescent Health, aged 13 years at Wave 1, were analyzed. Individual, family, school, peer, and community factors during adolescence (Wave 1 [1995]; age 13 years) were examined as predictors of violence involvement during adolescence (Wave 2 [1996]; age 14 years) and in young adulthood (Wave 3 [2001–2002]; ages 18–20 years). Results: Twelve percent of participants aged 14 years and 8% of participants aged 18–20 years reported serious violence involvement during the past 12 months. Bivariate analyses revealed risk and direct protective factors for violence at both time points. Risk for violence at age 14 years was increased by earlier attention-deficit hyperactivity disorder (ADHD) symptoms, low school connectedness, low grade-point average, and high peer delinquency. Direct protective factors for youth violence at age 14 years included low ADHD symptoms, low emotional distress, high educational aspirations, and high grade-point averages. Bivariate analyses showed a lower risk of violence among youth aged 18–20 years who reported low peer delinquency at age 13 years. Multiple logistic regression analyses predicting violence involvement showed direct protective effects for low ADHD symptoms and low emotional distress at age 14 years, and a direct protective effect for low peer delinquency at ages 18–20 years, after controlling for demographic characteristics. Conclusions: Findings suggest that violence involvement remains difficult to predict but indicate the importance of assessing both risk and direct protective factors for understanding violent behavior. [ABSTRACT FROM AUTHOR]

Abstract: Progress in transdisciplinary research addressing the health effects of the food and physical activity environments appears hampered by several methodologic obstacles, including: (1) the absence of clear, testable conceptual models; (2) slow adoption of practicable, rigorous research designs; (3) improper use of analytic techniques; and (4) concerns about ubiquitous measurement error. The consequence of such obstacles is that data collected as part of the typical study are more complex than need be. We offer diagnoses and recommendations from an NIH-sponsored meeting that addressed core issues in food- and physical activity–environment research. Recommendations include improved conceptual models and more elaborate theories, experimental thinking and increased attention to causal effect estimation, adoption of cross-validation techniques, use of existing measurement-error models, and increased support for methodologic research. [Copyright &y& Elsevier]

Submission of vaginal samples collected at home could remove barriers that women face in getting screened for cervical cancer. From December 2013 to January 2014, women aged 21-30 years were recruited online to participate in either (1) self-collected testing for human papillomavirus (HPV) infection and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. Demographics, risk factors, testing perceptions, and satisfaction with self-collected testing were assessed with online questionnaires. Women who performed self-collection were sent a home sampling kit by US mail, which was returned via US mail for HPV testing. A total of 197 women were enrolled, with 130 completing the online survey and 67 participating in both the survey and self-collection. Of the 67 women who were sent kits, 62 (92.5 %) were returned for testing. Sixty kits contained a sample sufficient for testing. The overall prevalence of HPV infection was 17.8 %, however 6 women (9.7 %) were infected with >1 type of HPV. Women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey, including ease of sampling (87.1 vs. 18.9 %), no pain during sampling (72.6 vs. 5.6 %), and lack of embarrassment (67.7 vs. 12.9 %). A high prevalence of HPV infection was demonstrated among women recruited via the internet. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds. [ABSTRACT FROM AUTHOR]

Objective: To report perspectives of participants in a food benefit programme that includes foods high in added sugar (FAS) restrictions and FAS restrictions paired with fruits and vegetables (F/V) incentives.Design: Randomised experimental trial in which participant perspectives were an exploratory study outcome.Setting: Participants were randomised into one of three Supplemental Nutrition Assistance Program (SNAP)-like food benefit programme groups: (1) restriction: not allowed to buy FAS with benefits; (2) restriction paired with incentive: not allowed to buy FAS with benefits and 30 % financial incentive on eligible F/V purchased using benefits; or (3) control: same food purchasing rules as SNAP. Participants were asked questions to assess programme satisfaction.Participants: Adults in the Minneapolis-St. Paul, MN metropolitan area, eligible for but not currently participating in SNAP who completed baseline and follow-up study measures (n 254).Results: Among remaining households in each group, most found the programme helpful in buying nutritious foods (88·2 %-95·7 %) and were satisfied with the programme (89·1 %-93·0 %). Sensitivity analysis results indicate that reported helpfulness and satisfaction with the programme may in some instances be lower among the restriction and the restrictions paired with incentive groups in comparison to the control group.Conclusions: A food benefit programme that includes restriction on purchase of FAS or restriction paired with a financial incentive for F/V purchases may be acceptable to most SNAP-eligible households with children. [ABSTRACT FROM AUTHOR]

Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g. nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field. [ABSTRACT FROM AUTHOR]

Highlights: [•] We assessed price effects on black women's propensity to buy typical food products [•] Regular priced items were less likely to be purchased than lower priced items [•] Differences in calorie content/healthfulness were often more influential than price [•] Likelihood of paying the regular price was associated with nutrition consciousness [Copyright &y& Elsevier]

Schedule control and supervisor support for family and personal life may help employees manage the work-family interface. Existing data and research designs, however, have made it difficult to conclusively identify the effects of these work resources. This analysis utilizes a group-randomized trial in which some units in an information technology workplace were randomly assigned to participate in an initiative, called STAR, that targeted work practices, interactions, and expectations by (1) training supervisors on the value of demonstrating support for employees’ personal lives and (2) prompting employees to reconsider when and where they work. We find statistically significant, although modest, improvements in employees’ work-family conflict and family time adequacy, and larger changes in schedule control and supervisor support for family and personal life. We find no evidence that this intervention increased work hours or perceived job demands, as might have happened with increased permeability of work across time and space. Subgroup analyses suggest the intervention brought greater benefits to employees more vulnerable to work-family conflict. This study uses a rigorous design to investigate deliberate organizational changes and their effects on work resources and the work-family interface, advancing our understanding of the impact of social structures on individual lives. [ABSTRACT FROM PUBLISHER]

Purpose: To report a case of transvaginal small intestinal hernia following abdominal sacrocolpopexy and review this clinical presentation in the current literature. Methods: A review of our case and a literature review of vaginal evisceration were carried out. Results: The patient underwent sacrocolpopexy and a Burch procedure. Six months later, a recurrent enterocele through a 1 cm defect in the vaginal vault was diagnosed. Several weeks later she presented with an incarcerated and strangulated loop of small intestine extending beyond the introitus. This required an urgent exploratory laparotomy, ileocecal resection, and vaginal vault closure. Postoperatively, she experienced gradual prolapse recurrence and is currently successfully managed with a pessary. Risk factors that include vaginal atrophy, chronic constipation, and previous pelvic surgery may have contributed to the evisceration, mesh erosion, and may have caused the breakdown in the vaginal vault mucosa ultimately responsible for the evisceration. In addition, placement of the sacrocolpopexy mesh without tension, and utilization of an interposition graft to reinforce the weakened vaginal vault tissue, are aspects of the surgical procedure that may influence outcomes. At the time of evisceration repair, the best approach to resuspend the vaginal vault, and prevent recurrent prolapse or evisceration, is currently unknown. Conclusion: Vaginal evisceration is a potential complication of abdominal sacrocolpopexy. Early recognition and treatment of this complication is critical, and prolapse recurrence may occur even after surgical repair. [ABSTRACT FROM AUTHOR]

Abstract: A convenience sample of adolescents and adults who regularly eat at fast-food restaurants were recruited to participate in an experimental trial to examine the effect of nutrition labeling on meal choices. As part of this study, participants were asked to indicate how strongly they agreed or disagreed with 11 statements to assess reasons for eating at fast-food restaurants. Logistic regression was conducted to examine whether responses differed by demographic factors. The most frequently reported reasons for eating at fast-food restaurants were: fast food is quick (92%), restaurants are easy to get to (80%), and food tastes good (69%). The least frequently reported reasons were: eating fast food is a way of socializing with family and friends (33%), restaurants have nutritious foods to offer (21%), and restaurants are fun and entertaining (12%). Some differences were found with respect to the demographic factors examined. It appears that in order to reduce fast-food consumption, food and nutrition professionals need to identify alternative quick and convenient food sources. As motivation for eating at fast-food restaurants appears to differ somewhat by age, sex, education, employment status, and household size, tailored interventions could be considered. [Copyright &y& Elsevier]

Do people walk more, or less, depending on the physical character of their residential areas rather than merely their individual characteristics? This paper reports findings for the Twin Cities, Minnesota, about how walking and total physical activity are affected by street pattern, 'pedestrian-oriented' infrastructure and amenities, and mixed use or destinations—in shorthand, design and destinations. The effects of density are dealt with in less depth. Like earlier studies, it finds that walking for specific purposes (i.e. travel or leisure) varies in relation to the physical characteristics of places. However, this study using multiple measures of overall walking and physical activity suggests that socially similar people do the same total amount of physical activity in different kinds of places and that level of activity is, on average, low. [ABSTRACT FROM AUTHOR]

To assess youth's ability to purchase alcohol in a city previously not assessed—Chicago, Illinois—we hired individuals aged 21 and older who appeared to be aged 18-20 (i.e., pseudo-underage buyers) to make alcohol purchase attempts without age identification in off-premise licensed alcohol establishments. We conducted two purchase attempts at each establishment across 44 community areas, resulting in a total of 652 purchase attempts. Our dependent variable was purchase attempt outcome (purchase, no purchase) and we used four categories of independent variables: characteristics of sellers, establishments, purchase attempts, and community areas. We analyzed our data using a logistic regression model, with purchase attempt outcome regressed on the independent variables. The overall purchase rate was 35.1%, ranging from 0% to 72% across community areas. Buyers were less likely to purchase alcohol in community areas that had populations with higher percentages of Hispanics (OR = 0.99; CI = 0.98, 1.0), and more likely to purchase alcohol in establishments that had more expensive beer (OR = 2.0; CI = 1.50, 2.67) and in areas with higher percentages of unemployed individuals (OR = 1.1; CI = 1.07, 1.14). Although progress has been made since the early 1990s in reducing sales to underage youth, youth still have relatively easy access to alcohol from licensed establishments. We recommend increased use of compliance checks—underage youth attempt to purchase alcohol under the supervision of enforcement agents; if alcohol is sold, the server/seller and/or license holder are penalized-which scientific studies have shown to be the most effective strategy in reducing sales to minors. [ABSTRACT FROM AUTHOR]

Purpose: Medical late effects among cancer survivors may result in impairments that limit physical performance and activities necessary for normal participation in daily life. The aim of this analysis was to estimate the prevalence of physical performance limitations and participation restrictions among recent (< 5 years since diagnosis), and long-term (≥ 5 years) cancer survivors. Methods: Data from the 1999–2002 National Health and Nutrition Examination Survey were analyzed to compare the proportions of physical performance limitations and participation restrictions among 279 recent and 434 long-term cancer survivors, and among 9370 persons with no reported cancer history. Multivariable logistic regression was used to calculate adjusted prevalence odds ratios. Results: Physical performance limitations were 1.5–1.8 times (53% versus 21%) and participation restrictions 1.4–1.6 times (31% versus 13%) more prevalent in cancer survivors than in those with no cancer history. Recent cancer history was associated with increased prevalence of physical performance limitation and participation restriction, particularly in survivors aged 40–49 years. Conclusions: Over half of the cancer survivors reported physical performance limitations; one third reported participation restrictions. Deficits were present many years following cancer diagnosis, even among survivors who were not elderly. Cancer survivors may benefit from evaluation for rehabilitation services long after treatment for their original disease. [Copyright &y& Elsevier]

Purpose. To outline the design and present select findings front an evaluation of a statewide anti-tobacco industry youth organizing movement. Design. A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure. Setting. Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey. Subjects. The study comprised 852 youth, aged 15 to 17 years old, randomly selected front county-specific sampling frames constructed front a marketing research database. Measures. Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movements main messages,). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility. Results. Branding index scores were significantly correlated with taking action to get involved (p &iE; . 001) and spreading an anti-industry message (p &iE; . 001)). Messaging index scores were significantly correlated with all five attitudinal constructs (all associations, p &iE; .001), taking action to get involved (p &iE; .001), and spreading an anti-industry mess age (`p &iE; .01). The hypothesized association between messaging scores and susceptibility was not significant. conclusion. A youth organizing effort, in combination with an intensive counter marketing media campaign, can be an effective strategy for involving youth in tobacco prevention and generating negative attitudes about the industry. [ABSTRACT FROM AUTHOR]

Background: Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults.Methods: We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004-2006 and from the second in 2011-2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce.Results: Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3-5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3-5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3-5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence.Conclusions: For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs. [ABSTRACT FROM AUTHOR]

ABSTRACT: This study evaluated "All's Well That Eats Well," a theater production performed in 20 schools in the Twin Cities, Minn., metropolitan area in winter 2000. The production sought to change food-related knowledge and food choices concerning fruits and vegetables among children in grades 1-6. The study used a pretest-posttest design with two randomly-assigned, sequential intervention-control groups (N = 4,093). All students completed surveys prior to and then following the theater production and the classroom and home activities. No differences existed between the groups at pretest. Significant differences occurred in food-related knowledge, food choices, and food recall from pretest to posttest for all students. Significant differences also occurred between intervention groups in food-related knowledge and food choices. The study indicates that professional theater productions in schools can create at least a short-term effect on children's nutrition knowledge and behavior. (J Sch Health. 2002;72(6):256-261) [ABSTRACT FROM AUTHOR]