Search

This study examined the long-term impact of spouse caregiving on insomnia symptoms, compared to propensity-score matched non-caregivers. Health and Retirement Study data between 2006 and 2018 were used. Caregivers (n = 403) were respondents (aged 50+) who assisted their heterosexual spouses in performing (instrumental) activities of daily living at baseline. Non-caregivers were matched using a propensity score matching procedure based on baseline characteristics. Insomnia symptoms were measured every 4 years for both groups. Poisson mixed-effect models estimated the association between caregiver status and insomnia symptoms. Compared to matched non-caregivers, caregivers had similar severity of insomnia symptoms at baseline (${{\rm{\beta }}_{{\rm{caregiver}}}}$ β caregiver = 0.018, 95% CI = −0.089, 0.124) and reported a similar yearly change rate (${{\rm{\beta }}_{{\rm{caregiver}} \times {\rm{time}}}}$ β caregiver × time = −0.008, 95% CI = −0.017, 0.001). No moderation effects of care-recipients' dementia status and social support were significant. In this study sample, there is no evidence that spouse caregivers, specifically those who performed light duties, experience more severe insomnia symptoms than non-caregivers. Spouse caregiving, especially in a light-duty capacity, may not be detrimental to the caregivers' sleep health. More data are needed regarding insomnia in spouse caregivers with heavy duties of care to fully assess the health impact of the caregiving experience. [ABSTRACT FROM AUTHOR]

Background: Medical marijuana legalization (MML) has been widely implemented in the past decade. However, the debates regarding the consequences of MML persist, especially criminal behaviors. Objectives: We examined the association between MML and criminal behaviors among adults in the United States. The criminal behaviors measured three past-year offenses: whether the adult (1) have sold illegal drugs, (2) have stolen anything worth > $50 USD, or (3) have attacked someone. Methods: Using the 2015–2020 National Survey of Drug Use and Health, we included 214,505 adults in our primary analysis for 2015–2019 and 27,170 adults in 2020 for supplemental analysis (age > = 18). Weighted multivariable logistic regression models were used to examine the association between MML and three criminal behaviors. Results: In our primary analysis, we observed no statistically significant association between MML and the three outcomes of criminal behavior. Nevertheless, our supplemental analysis of the 2020 data showed MML was associated with increasing odds of the three criminal behaviors (have sold illegal drugs: AOR [adjusted odds ratio] = 1.7; have stolen anything worth > $50 USD: AOR = 1.9; have attacked someone: AOR = 1.8; all p < 0.05). Conclusion: Surveys from 2015 to 2019 did not suggest MML as a risk factor for higher incidence of criminal behaviors. However, 2020 data showed statistically significant association between MML and selected criminal behaviors. Issues related to the COVID-19 pandemic, such as the U.S. economic downturn, could potentially explain this discrepancy. Further research efforts may be warranted. [ABSTRACT FROM AUTHOR]

China is a large country with substantial urban-rural disparity. With the increasing concerns related to the rapid growth of the older adult population and problems related to smoking and alcohol consumption, this study aims to examine the potential urban-rural disparity associated with nicotine or alcohol dependence among Chinese older adults. We used three waves of the Chinese Longitudinal Healthy Longevity Survey and included older adults who were 65 years old or above (CLHLS; n = 18,207). The Heckman two-step selection procedure was applied to reduce potential selection bias. The first and the second steps of the Heckman two-step selection procedure all included multivariable logistic regressions. In the final study sample, approximately 8.1% and 4.0% of older adults reported nicotine and alcohol dependence, respectively. In the first step of the Heckman selection procedure, urban residents were less likely to become current smokers and alcohol users than rural residents (all p <.05). However, urban-rural disparity was not associated with either nicotine or alcohol dependence (all p >.05). We did not observe the urban-rural disparity in nicotine and alcohol dependence among Chinese older adults. Chinese policymakers should continue to strengthen national policy to combat smoking and alcohol consumption, especially older adults. [ABSTRACT FROM AUTHOR]

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011–2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013–2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples. [ABSTRACT FROM AUTHOR]

This study compared the associations of child–parent relationships with older adults' multidimensional health in the United States and China. Two waves of data from the US Health and Retirement Study and its sister study in China (2012–2015) were used (2174 non-Hispanic [NH] White Americans and 4467 Chinese). Linear regression models were conducted for cross-sectional and longitudinal comparisons. Results showed most child–parent relationships had nonsignificant associations with NH White Americans' health. In contrast, closer child–parent relationships were linked to fewer depressive symptoms and better cognitive function among Chinese. Co-residence was associated with poorer health among older Chinese. Over a 2-year period, living nearby was linked to poorer cognitive function among NH White Americans and fewer depressive symptoms among Chinese. Having weekly contact was predictive of better cognition among Chinese. This study revealed cross-cultural differences in the associations between child–parent relationships and older adults' health. Family relationships in accordance with Chinese culture could improve health. [ABSTRACT FROM AUTHOR]

China is a country with a large alcohol user population, but it also faces other public health challenges like the growth of older adult population and shift in dietary behaviors in the past few decades. We examined the associations of alcohol consumption and dietary behaviors with severe cognitive impairment among Chinese older men and women. We used panel data from three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) to examine this topic of interest. Older adults who answered three survey waves were analyzed (age ≥ 65), with a total of 7,950 observations (n = 7,950). In the panel logistic regression models, only former alcohol use was positively associated with severe cognitive impairment among older men (p <.05), but not in older women. Neither current light nor heavy alcohol consumption was associated with cognitive impairment. Older men and women who did not consume or rarely consume fruits and vegetables were more likely to develop severe cognitive impairment (all p <.01). Public health practitioners can use the empirical results from this research to identify what patterns of alcohol use and dietary behaviors can help prevent cognitive impairment among older adults. [ABSTRACT FROM AUTHOR]

Objectives: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory. Methods: Longitudinal data from the Health and Retirement Study (2004–2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory. Results: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p >.05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890). Discussion: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory. [ABSTRACT FROM AUTHOR]

China has faced challenges related to the rapid growth of its ageing population, and sleep is one of the public health challenges to this demographic group. This study examines the socio-demographic and behavioural factors associated with status change of sleeping patterns among Chinese older adults, using longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Socio-demographic factors were selected from the 2012 wave of the CLHLS to examine the sleep status change in the 2014 wave. Multivariable logistic and multinomial regressions were used to study older adults' changes of sleep quality and daily sleep duration. Older adults, 65 years old or above, were selected as study participants. A higher level of education was negatively associated with poor sleep quality and longer sleep duration (>8 hours). Increasing age was positively associated with both shorter and longer sleep duration. Being female was negatively associated with longer sleep duration. However, exercise status, smoking behaviour and alcohol use all were neither positively nor negatively associated with status change of sleeping patterns. Participants' education, age and gender might be important factors associated with sleep status change. However, the effects of behavioural factors should be studied further. Policy implications and further research directions are discussed based on empirical results. [ABSTRACT FROM AUTHOR]

(1) Background: Low-income rural residents in China are disadvantaged due to their financial vulnerability and insufficient access to resources, and this situation demands more research effort. This study examined the pattern of outpatient service satisfaction and its determinants among low-income adults in rural China. (2) Methods: Rural low-income respondents who used outpatient services in their local healthcare facilities in Jiangsu, China evaluated the access, cost, environment, doctor–patient interaction, and other topics during their outpatient visit (N = 662). Latent class analysis was used to identify the groups characterized by various dimensions of outpatient satisfaction. Multinomial logistic regression explored the determinants of class membership. (3) Results: Three latent classes were identified: 28.70% had low satisfaction, unsatisfied with every dimension; 20.69% reported medium satisfaction that valued doctor–patient relationships; and 50.60% had high satisfaction but thought that costs were high. Both low and medium satisfaction were associated with a higher proportion of self-paid fees. (4) Conclusions: Healthcare costs were an important determinant of outpatient service satisfaction. Medical social workers are suggested to be included in the medical team to help patients identify financial assistance. Special aid programs may be developed to help relieve rural low-income patients' medical cost-related burden. [ABSTRACT FROM AUTHOR]

Objective Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one's own and/or one's partner's cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context. Method Data from the Health and Retirement Study (2014–2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for health care (DPAHC). Structural equation models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife's and husband's AD, respectively. Results Moderate spousal interdependence was observed in living will (kappa coefficient, κ =.60) and DPAHC (κ =.53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife's higher level of cognitive function was associated with husband's AD completion. Contrarily, husband's lower level of cognitive function was associated with wife's AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband's AD completion. Discussion The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse's cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults. [ABSTRACT FROM AUTHOR]

Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period. Six waves of longitudinal data from the Health and Retirement Study (2006–2016) were used (n = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks. Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92, p < 0.001). Only men's emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03, p < 0.001). Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions. [ABSTRACT FROM AUTHOR]

Effective community food and nutrition programs are imperative for supporting older adults health and well-being. This three-part study examined to what extent the innovative congregate nutrition program (CNP), Encore Café, and targeted marketing campaign influenced CNP utilization, CNP program satisfaction, and overall CNP impact (e.g., nutritional risk, dietary practices, and loneliness). The Encore Café resulted in increases of 386% in meal distribution and 3,164% in CNP participants during a two-year period compared to a 20.8% reduction at traditional meal sites across the state. Total CNP satisfaction (food and dining) was high for both the Encore Café and Traditional CNP. Encore Café participants maintained their nutritional status and experienced significant reductions in emotional loneliness (p = 0.017) and dietary intake frequencies of processed meat (p = 0.027) compared to non-CNP participants. Utilizing a client-centered approach in marketing and programming for the Encore Café shows promising results for improving the utilization and effectiveness of the CNP. [ABSTRACT FROM AUTHOR]

Objective: This research investigates the associations between smoking frequency and body mass index (BMI) among older adults in China with and without the inclusion of food consumption behaviors. Method: Applying three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014), with 12,312 observations from 4,104 participants, gender-stratified panel ordered logistic regressions were performed. Food consumption included intake frequency and types of fruits, vegetables, staple food, cooking oil, and meat. Results: Among male older adults, more frequent smoking behavior was associated with lower BMI with the inclusion of food consumption behaviors. However, more frequent smoking behavior was not associated with BMI among female participants with the inclusion of food consumption behaviors. Former smoking status was not associated with BMI in all models. Discussion: The findings suggest the need of food consumption behaviors when researchers study the associations between smoking frequency and obesity. Gender gaps also should be considered. [ABSTRACT FROM AUTHOR]

Secondhand smoking (SHS) has become a critical challenge in Chinese society, and progress on SHS prevention remains unknown. There is little knowledge targeting Chinese older adults generally to investigate the associations between SHS exposure experiences during earlier life stages and health-related measurements. Using cross-sectional data from a nationally representative data set, the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 4,414), multilevel logistic regression models with random effects for Chinese provinces were used for analyses. Two health-related measurements included self-reported health status and life satisfaction. All regression models included the same set of predictors and covariates with socioeconomic factors and basic biological information. Approximately 40% and 47% of older adults reported SHS exposure in childhood and in younger adulthood at home, respectively. Older adults with SHS exposure in childhood had lower odds of reporting better health status, compared with those who did not have such exposure (adjusted odds ratio [AOR] = 0.69, 95% CI [0.55, 0.86], p <.01). However, life satisfaction was not associated with any SHS exposure experiences. Policy makers and public health practitioners should continue to investigate the long-term effect of SHS exposure on human health, including older adults. Policy regarding SHS prevention should be enhanced. [ABSTRACT FROM AUTHOR]

Background: This preliminary assessment evaluates the patterns of e-cigarette use and self-reported health outcomes in the United States. Methods: Multinomial logistic regressions were (baseline wave 2013-2014) performed by using  a nationally representative sample with self-reported health measures, including overall, physical, and mental health, and quality of life, as outcomes of interest. Measurements were based on “excellent,” “very good,” “good,” “fair,” and “poor” responses. Results: Among non-cigarette smokers, e-cigarette users had lower chance of reporting good mental health, compared with those non-users (RRR[Relative Risk Ratio] = 0.66). When the respondents used e-cigarette products containing nicotine, the risk for reporting poor mental health was higher (RRR = 1.87). Among cigarette smokers, more use of e-cigarette cartridges was associated with higher risk of mental health (RRR = 1.12). Poor quality of life was associated with regular e-cigarette use. If smokers used e-cigarette products with nicotine, the risk of reporting poor quality of life was lower than individuals who did not use such products (RRR = 0.49). Higher concentration of nicotine in e-cigarette cartridges was associated with higher risks of poor physical and poor overall health, and with lower chance of excellent mental health. Conclusions: Health practitioners should evaluate the benefits and harms of using e-cigarettes and the effects on human health. [ABSTRACT FROM AUTHOR]

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending communitybased nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p=.001) and vegetable (p=.021) DIF, age influenced processed meat DIF (p=.001), and gender influenced NR (p=.006), vegetable (p=.022), and processed meat (p=.033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and proteinrich foods to OA at NR. [ABSTRACT FROM AUTHOR]

This study examined the impact of the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program Fresh Conversations (FC) on the nutritional risk (NR) of older adults (OAs). A convenience sample of OAs (207 Treatment, 148 Control) completed questionnaires comprised of validated measures to assess NR, barriers to healthy eating self-efficacy (SE), food safety behaviors (FSB), and food security (FS) at three-time points over 9 months. Participants were mostly white (92.4%), older (age 81þ years, 40.1%), widowed (52.4%), and females (75.2%). Independent t-tests identified baseline differences among groups. Analysis of covariance assessed group changes at each time point for each measure. Block regression determined which variables influence baseline NR. Baseline NR risk was significantly predicted by SE (b=0.21), education (b=0.19) and age (b=0.14) (p<0.05). NR improvement was significantly higher for treatment group participants who attended four or more FC sessions than for the control group (p=.04) when controlling for the effects of gender (p=.061) and SE (p=.098). [ABSTRACT FROM AUTHOR]

Objectives: We determined relationships between food behaviors and health-risk factors by acculturation among limited-income Hispanic and non-Hispanic white women. Methods: Women aged 18-49 years were recruited from income-based programs in metro-Phoenix, Arizona. Self-administered surveys in English or Spanish included demographics, a 10-item food behavior checklist, health-risk factors, food security, and acculturation. Differences by 4 acculturation/ ethnicity categories were assessed with chi-square and analysis of variance (ANOVA). We created a food behavior scale. Results: Eighty-two percent self-identified as Hispanic (N = 358), with 45% Hispanic-dominant, 25% bicultural, 12% English-dominant, and 18% non-Hispanic white for acculturation status. Food behavior checklist results showed that English-dominant Hispanic and non-Hispanic white women were more likely to feed their children soon after waking, refrigerate meat/dairy promptly, not add salt to food, smoke cigarettes and be food insecure (p < .001). Education, not acculturation, was a significant predictor of the food behavior scale. BMI did not differ by acculturation, but 33% of Hispanic-dominant Latinas did not know their height and/or weight. These less acculturated Latinas had significantly greater food security, but lacked health insurance and years of education. Conclusions: Program outreach tailored by acculturation that considers educational level is needed to emphasize existing positive behaviors and address knowledge gaps among low socioeconomic women to improve health and reduce disparities. [ABSTRACT FROM AUTHOR]

Background. Cognitive impairments in Parkinson disease (PD) manifest as deficits in speed of processing, working memory, and executive function and attention abilities. The gait impairment in PD is well documented to include reduced speed, shortened step lengths, and increased step-to-step variability. However, there is a paucity of research examining the relationship between overground walking and cognitive performance in people with PD. Objective. This study sought to examine the relationship between both the mean and variability of gait spatiotemporal parameters and cognitive performance across a broad range of cognitive domains. Design. A cross-sectional design was used. Methods. Thirty-five participants with no dementia and diagnosed with idiopathic PD completed a battery of 12 cognitive tests that yielded 3 orthogonal factors: processing speed, working memory, and executive function and attention. Participants completed 10 trials of overground walking (single-task walking) and 5 trials of overground walking while counting backward by 3’s (dual-task walking). Results. All gait measures were impaired by the dual task. Cognitive processing speed correlated with stride length and walking speed. Executive function correlated with step width variability. There were no significant associations with working memory. Regression models relating speed of processing to gait spatiotemporal variables revealed that including dual-task costs in the model significantly improved the fit of the model. Limitations. Participants with PD were tested only in the on-medication state. Conclusions. Different characteristics of gait are related to distinct types of cognitive processing, which may be differentially affected by dual-task walking due to the pathology of PD. [ABSTRACT FROM AUTHOR]

At-risk older adults need community-based nutrition programs that improve nutritional status and practices. This 6-month study assessed the impact of the traditional Chef Charles (CC) program (Control) compared to a theory-based CC program (Treatment) on nutritional risk (NR), dietary intakes, self-efficacy (SE), food security (FS), and program satisfaction for congregate meal participants. Participants were mostly educated, single, “food secure” White females. NR change for the treatment group was significantly higher (P = 0.042) than the control group. No differences were noted for SE or FS change and program satisfaction between groups. The overall distribution classification levels of FS changed significantly (P < .001) from pre to post. Over half (n = 46, 76.7%) reported making dietary changes and the majority (n = 52, 86.7%) rated CC as good to excellent. Results suggest the theory-based CC program (treatment) is more effective in reducing NR and dietary practices than the traditional CC program (control). [ABSTRACT FROM AUTHOR]

To assess the prevalence of plant-based alternatives to meat consumption in students at a Midwest university, describe associations between demographics, environmental concern attitudes, and consumption, and determine variables statistically associated with trying the plant-based alternatives. Descriptive cross-sectional convenience sample; self-administered online surveys. College students at a Midwest university. Currently enrolled students aged 18–30 taking courses on campus as of March 2020. Plant-based alternative consumption; demographics; vegetarian status; environmental attitudes; influences on food choices; and trusted sources of food information. Bivariate comparisons for consumption of plant-based alternatives; logistic regression analysis. Fifty-five percent had tried a plant-based meat alternative. Top reasons were enjoying new foods and curiosity about the products. Out-of-state residency, vegetarian status, and 10 of 11 environmental attitude statements were significantly associated with plant-based alternative consumption (P < 0.05). About 30% of consumers indicated they wanted to eat less meat and that plant alternatives were better for the environment. Nonconsumers had less favorable views of meatless meals. This study supports that positive environmental attitudes were predictive of plant-based alternative consumption among college students. Increased awareness and familiarity could encourage consumption among this population. [ABSTRACT FROM AUTHOR]

It has been discussed previously that older adults' living arrangements are associated with mortality. This study investigated the relationships between older adults' living arrangements and sleep-related outcomes in China. The nationally representative sample included 4,731 participants who participated on two different occasions, with a total of 9,462 observations (2012 and 2014 waves). Panel logistic regression and panel ordinary least squares regression models were estimated with outcomes of sleep quality and average hours of sleep daily, respectively. Approximately 62% of individuals reported good quality of sleep. We observed that older adults who lived with family members had 17% greater odds of reporting good quality of sleep (adjusted odds ratio = 1.17, 95% confidence interval [1.03, 1.34], p <.05) and reported longer sleep duration daily (β =.334, standard error =.069, p <.01), compared with those who lived alone. Social support is needed to strengthen the residential relationship, especially with family members. [ABSTRACT FROM AUTHOR]

Background Evidence supports the use of social marketing campaigns to improve nutrition knowledge and reinforce the effects of nutrition education programs. However, the additional effects of parent-focused social marketing with nutrition education have received little attention. Objective Our aim was to assess the impact of the Iowa Nutrition Network’s school-based nutrition education program (Building and Strengthening Iowa Community Support for Nutrition and Physical Activity [BASICS]) and the benefits of adding a multichannel social marketing intervention (BASICS Plus) to increase parent-directed communication. Design and intervention A quasi-experimental design with three study conditions compared a school-based nutrition education program (BASICS) with a school-based and social marketing intervention (BASICS Plus) and a no-treatment comparison group. Participants/setting The study included 1,037 third-grade students attending 33 elementary schools and their parents. Main outcome measures Measures included parents’ reports of their children’s in-home consumption of fruits and vegetables (F/V) and use of low-fat/fat-free milk. Data on F/V were collected using a modified version of the University of California Cooperative Extension Food Behavior Checklist; and data on milk use were collected using two questions from the National Health and Nutrition Examination Survey. Statistical analyses Multilevel, mixed-effect regression models that account for correlation within repeated measures and children within school were used to compare the mean change over time in the outcome variable for one study group with the mean change over time for another study group. Results Children in BASICS increased mean consumption of fruit by 0.16 cups ( P =0.04) compared with children in the comparison group. Children in BASICS Plus increased mean consumption of fruit by 0.17 cups ( P =0.03) and mean consumption of vegetables by 0.13 cups ( P =0.02). Children in BASICS Plus were 1.3 times ( P =0.05) more likely to use low-fat/fat-free milk than children in either the BASICS group or the comparison group. Conclusions Gaining parents’ attention and engaging them in healthy eating practices for their children can be a useful way to increase the effectiveness of school-based nutrition education programs. This study demonstrates the benefits of incorporating a parent-focused social marketing campaign in nutrition education interventions. [ABSTRACT FROM AUTHOR]