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BACKGROUND: The health benefits related to intake of whole grain foods are well established. Consumption of whole grains in the US population is low, and whole grain content can vary greatly depending upon the specific products that are purchased. OBJECTIVES: To examine the proportion of products purchased by US households containing whole grain and refined grain ingredients using time-specific food composition data, and examine whether purchases differ between income, race or ethnicity, and household make-up. METHODS: Nationally representative Nielsen Homescan 2018 data were used. Each barcoded product captured in Nielsen Homescan 2018 was linked with ingredient information using commercial nutrition databases in a time-relevant manner. Packaged food products containing whole grain ingredients, refined grain ingredients, neither, or both were identified. The percentage of packaged food products containing whole grain and refined grain ingredients purchased by US households was determined overall, by demographic subgroup, and by food category. RESULTS: The proportion of packaged food purchases containing refined grain ingredients was significantly higher than whole grain ingredients (30.9% compared with 7.9%; P 90% of bread purchases contained refined grain ingredients, and the 5 categories with the largest proportion of whole grain ingredients contributed to

AtlantiCare Health System provides health care services to residents in Atlantic City, an urban food desert in southern New Jersey. The purpose of this study is to explore baseline data on the first four months of the program to better understand participants purchasing behaviors. To improve the health of Atlantic City seniors, AltantiCare established a Virtual Grocery Store Program (VGSP). The program covers fees associated with online grocery shopping for 300 residents in Jeffries Towers, a low-income housing complex. Over the course of 4 months, 28 participants placed a total of 151 orders, with a range from 1 to 14 orders each. Out of the 151 orders, that yielded 1,771 items, the top three types of food purchased were fruits and vegetables, dairy and eggs, and meat and fish; one-third of the items were prepared, two-thirds were perishable, and while almost half the items had no nutritional value, out the half that did, the majority had the high nutrition; and less than a third of participants used NJ SNAP funds to purchase their groceries online. Future efforts need to uncover the explanation for these purchases along with identifying potential strategies to increase consumption of healthier food options.

Objectives: Frontline essential workers face elevated risks of exposure to COVID-19 because of the interactive nature of their jobs, which require high levels of interaction with the general public and coworkers. The impact of these elevated risks on the mental health of essential workers, especially outside the health care sector, is not well studied. To address this knowledge gap, we examined correlations between perceptions of workplace risks and mental health distress among grocery store workers in Arizona. Methods: We collected the first statewide sample of essential workers outside the health care sector focused on mental health and well-being. A total of 3344 grocery store workers in Arizona completed an online survey in July 2020. We used multiple regression models to identify demographic and work-based correlates of mental health distress. Results: Levels of mental health distress among respondents were high: 557 of 3169 (17.6%) reported severe levels and 482 of 3168 (15.2%) reported moderate levels. Perceptions of workplace safety were strongly correlated with significantly reduced levels of mental health distress (ß = −1.44; SE = 0.20) and reduced perceived stress (ß = −0.97; SE = 0.16). Financially disadvantaged workers and employees aged Conclusions Lacking sufficient workplace protections, grocery store employees in Arizona experienced high levels of mental health distress during the COVID-19 pandemic. Providing clear federal and state policies to employers to guide implementation of workplace protections may help reduce sources of mental health distress.

The use of virtual reality (VR) technology has been suggested as a method to increase ecological validity in neuropsychological assessments. Although validity has been a focus in VR research, little attention has been paid to other psychometric properties such as test-retest reliability and practice effects. Practice effects are common on traditional neuropsychological tests and can be impacted by novelty. Because VR is not widely used it was expected that participants would demonstrate higher practice effects on VR as compared to paper-and-pencil testing.To compare test-retest reliability and practice effects in VR and traditional paper-and-pencil testing, the Virtual Environment Grocery Store (VEGS) and California Verbal Learning Test - Second Edition (CVLT-II) were used in healthy adults (n = 44). Participants received follow-up testing approximately 2 weeks after the initial visit.Significant practice effects of similar magnitude were seen on memory scores (i.e., total learning, long-delay free recall, and long-delay cued recall) on the VEGS and the CVLT-II. The VEGS and CVLT-II memory scores also demonstrated strong test-retest reliability (Results suggested similar test-retest reliability and practice effects of the VEGS and CVLT-II, although the VEGS has the benefit of being an immersive technology that simulates an everyday activity. The study replicated past findings that the VEGS is more difficult than the CVLT-II which may be a useful property for clinical assessment.

A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.

BACKGROUND Many lower-income communities in the United States lack a full-line grocery store. There is evidence that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increases the availability of healthy foods in stores. One national discount variety store chain (DVS) that is often located in low-income neighborhoods became an authorized WIC vendor in 8 pilot stores. OBJECTIVES The objective of this study was to evaluate how implementing WIC in DVS pilot stores affected sales of healthy, WIC-eligible foods. METHODS We used DVS sales data and difference-in-differences regression to evaluate how WIC authorization affected sales of WIC-eligible foods in 8 DVS pilot stores, compared with 8 matched comparison stores. RESULTS DVS added 18 new WIC-approved foods to become an authorized vendor. Results indicate that becoming a WIC vendor significantly increased sales of healthy, WIC-eligible foods that DVS carried before authorization. WIC implementation in DVS led to a 31-unit increase in sales of the original WIC foods per week on average (P

Objective:To determine whether residence in a US Department of Agriculture-designated food desert is associated with perceived access to healthy foods, grocery shopping behaviours, diet and BMI among a national sample of primary food shoppers.Design:Data for the present study came from a self-administered cross-sectional survey administered in 2015. Residential addresses of respondents were geocoded to determine whether their census tract of residence was a designated food desert or not. Inverse probability of treatment-weighted regression was used to assess whether residence in a food desert was associated with dependent variables of interest.Setting:USA.Participants:Of 4942 adult survey respondents, residential addresses of 75·0 % (n 3705) primary food shoppers were included in the analysis.Results:Residence in a food desert (11·1 %, n 411) was not significantly associated with perceived access to healthy foods, most grocery shopping behaviours or dietary behaviour, but was significantly associated with primarily shopping at a superstore or supercentre v. a large grocery store (OR = 1·32; 95 % CI 1·02, 1·71; P = 0·03) and higher BMI (b = 1·14; 95 % CI 0·36, 1·93; P = 0·004).Conclusions:Results suggest that food desert residents shop at different food stores and have higher BMI than non-food desert residents.

Background Nutrition labels show potential in increasing healthy food and beverage purchases, but their effectiveness seems to depend on the type of label, the targeted food category and the setting, and evidence on their impact in real-world settings is limited. The aim of this study was to evaluate the effectiveness of an industry-designed on-shelf sugar label on the sales of beverages with no, low, medium and high sugar content implemented within a real-world supermarket. Methods In week 17 of 2019, on-shelf sugar labels were implemented by a Dutch supermarket chain. Non-alcoholic beverages were classified using a traffic-light labeling system and included the beverage categories “green” for sugar free ( 13.5 g/250 ml). Store-level data on beverage sales and revenue from 41 randomly selected supermarkets for 13 weeks pre-implementation and 21 weeks post-implementation were used for analysis. In total, 30 stores implemented the on-shelf sugar labels by week 17, and the 11 stores that had not were used as comparisons. Outcome measures were differences in the number of beverages sold in the four label categories and the total revenue from beverage sales in implementation stores relative to comparison stores. Analyses were conducted using a multiple-group Interrupted Time Series Approach. Results of individual store data were combined using random effect meta-analyses. Results At the end of the intervention period, the changes in sales of beverages with green (B 3.4, 95%CI -0.3; 7.0), blue (B 0.0, 95%CI -0.6; 0.7), yellow (B 1.3, 95%CI -0.9; 3.5), and amber (B 0.9, 95%CI -5.5; 7.3) labels were not significantly different between intervention and comparison stores. The changes in total revenues for beverages at the end of the intervention period were also not significantly different between intervention and comparison stores. Conclusion The implementation of an on-shelf sugar labeling system did not significantly decrease unhealthy beverage sales or significantly increase healthier beverage sales. Nutrition labeling initiatives combined with complementary strategies, such as pricing strategies or other healthy food nudging approaches, should be considered to promote healthier beverage purchases.

Restaurant delivery services have gained in popularity among college students, however, students participating in the Supplemental Nutrition Assistance Program (SNAP) are not allowed to redeem their benefits via restaurant delivery services. This mixed-methods head-to-head crossover trial assessed whether college students experiencing marginal food security prefer benefits via a grocery store gift card (as a proxy for traditional SNAP benefits) or via a restaurant delivery service gift card of equivalent value, and which type of benefit is more effective at improving food security status. Thirty college students experiencing marginal food security were recruited to receive $80 in cash equivalent benefits to spend over a two-month period in the form of grocery store gift cards and restaurant delivery service gift cards. Participants completed surveys and interviews to measure their food security status and share their experiences with each benefit type. After four months of benefits, 48.3% of participants improved their food security status. However, neither type of benefit was statistically better at improving food security status. Most participants preferred grocery store benefits (89.7%) over restaurant delivery service benefits (10.3%). However, more research is needed to explore whether allowing SNAP recipients to redeem their benefits with restaurant delivery services is a viable mechanism to address food challenges among college students experiencing marginal food security.

The cognitive complexity of adults’ questions, particularly during shared book reading, supports children’s developing language skills. Questions can be described as having low cognitive demand (CD; e.g., labeling, matching) or high-CD (e.g., comparing, predicting). Little is known about the relation between different types of parental questioning and children’s math abilities. The current study examined the quantity of low- and high-CD and domain-specific math questions that parents posed to their 4-year-old children in three structured activities and how the frequency of those questions relates to children’s concurrent math and language skills. Parent–child dyads (n = 121) were observed interacting with a picture book, grocery store toys, and a puzzle for about 5 min each, and children completed math and spatial assessments. Although the frequency with which parents asked questions did not relate to children’s outcomes, parents’ use of high-CD questions was associated with children’s spatial skills, standardized math scores, and vocabulary skills after controlling for parental utterances, child utterances, child age, and family socioeconomic status. However, domain-specific math questions were not related to any child outcomes above and beyond parents’ total questions. This study suggests that domain-general questions that vary in CD (low and high) are differentially related to children’s math and language abilities, which can inform the ways in which parents engage in early learning opportunities with their children.

1. Sumathyuthee Kamalakannan, MD* 2. Irene P. Mathieu, MD* 1. *Department of Pediatrics, University of Virginia, Charlottesville, VA The demand for organic foods has grown substantially during the past several decades. Due to the widespread perception that organic food is healthier, parents may feel compelled to buy organic instead of conventional products to provide the most nutritious option available despite the cost of organic foods being on average 10% to 40% more expensive than conventionally produced foods. Furthermore, families may be concerned about the environmental impact of conventionally produced foods. Currently there is limited evidence for the nutritional superiority of organic foods. In this article we summarize the available evidence on the differences between organic and conventional food products and describe the limitations of the evidence currently available. In general, organic foods are defined as those that are grown or produced without the use of synthetic chemicals, hormones, antibiotic agents, genetic engineering, and irradiation. In the United States consumers may find product labeling at the grocery store misleading. For instance, processed products that contain mostly but not exclusively organic ingredients can use the phrase “made with organic ingredients.” Products can also be marked “natural” if no artificial ingredient or color has been added. These labels can lead consumers to incorrectly believe that such products meet the definition of organic. This heterogeneity, and the fact that few people eat an exclusively organic diet, complicate studies to assess the health impact of organic foods. For many people, the decision to buy organic produce is rooted in its perceived health benefits. Compared with conventionally grown produce, organic fruits and vegetables have been noted to contain more minerals such as iron, magnesium, phosphorus, vitamin C, and plant metabolites such as phenols and flavonoids. These metabolites function as defense agents for plants and may also have a role in preventing human disease. However, there is wide variation in the nutrient content of produce …

Objectives We investigated the effect of using smartphone-based calendars (Google and Outlook Calendar) on prospective memory in Alzheimer’s disease (AD). Methods we recruited two groups of participants with mild AD. In one group, prospective memory was cued by a paper-and-pencil calendar, whereas in the second group prospective memory was cued by a smartphone calendar application. After 2 weeks of training to familiarize the participants with calendar use, we invited participants to perform three prospective events per week (e.g., remembering to go to the grocery store) during a 3-week period. Events were cued either by the paper- or smartphone-based calendar. Results we observed fewer omissions of prospective events in the smartphone-based calendar group than in the paper-based calendar group. Conclusions our study suggests positive effects of smartphone calendar applications on prospective memory in AD.

A comprehensive review of the literature was performed on migration of substances from packaging materials into dry foods, specifically those with surfaces containing no free fats or oils. Historically, migration from food packaging to dry foods has been assumed to be minimal. However, several recent publications have reported concentrations of migrants into dry foods that are substantially higher than anticipated. The goal of this review is to provide a comprehensive summary of recent studies that examined migration to dry foods or dry food simulants, observe and assess common migrants, and report the highest migration values. Focusing on the packaging materials and migrants that exhibit the highest migration values, this review divided the studies into two categories: 1) analysis of food products in commercial packaging taken directly from grocery store shelves, and 2) analysis of food products and food simulants in contact with packaging or other material fortified with known quantities of a migrant. Discussions include the examination of migration testing methods, viability of different food simulants, and variables that affect migration behaviour. These include the physicochemical properties of both the migrant and food (i.e. volatility, molecular size, structure, food composition and particle size) and factors pertaining to the packaging material and the environment (i.e. temperature, humidity, and the presence of a secondary barrier). Information gaps and remaining questions are also identified and discussed.

Objectives: In this study, we tested for moderation by neighborhood food outlet presence on relationships between food outlet shopping or meal sources and dietary intake. Methods: We used generalized linear models to analyze parent-adolescent (12-17 years) dyad data from the 2014 Family Life, Activity, Sun, Health and Eating. Questions included food outlet presence in home (parent) and school (adolescent) neighborhoods (yes or no), shopping at food outlets (parent) (never, rarely, sometimes, often or always), and sources of food consumed away from and at home (weekly frequency). We captured food and beverage intakes via a dietary screener. Results: Relationships between adolescent added sugar intake and scratch cooked evening meals and meals away from home were found only when grocery stores and fast food restaurants, respectively, were present in adolescents' school neighborhoods. Shopping at fruit and vegetable (FV) markets and scratch cooked evening meals were associated with the largest increases in parent and adolescent FV intakes, respectively. Meals away from home at convenience stores were associated with the largest increases in parent and adolescent intakes of added sugars. Conclusions: Neighborhood grocery store and fast food restaurant presence moderated relationships between meal sources and dietary intake only in adolescents.

The 2018 Farm Bill was finalized in mid-December of 2018 after months of discussion and debate between policymakers. The Farm Bill has many implications for low-income and food-insecure populations in the United States. One program within the Farm Bill that helps bridge the nutrition gap for low-income Supplemental Nutrition Assistance Program participants is the Food Insecurity Nutrition Incentive Grant Program (FINI). This commentary explores the best practices and promising findings of FINI projects to inform future policy discussions and implementation of FINI. In addition, we discuss knowledge gaps and opportunities within the context of the extant literature. Stakeholders and FINI grantees reported positive impacts of FINI grants, describing outcomes across farmers, grocery store owners, local economies, and Supplemental Nutrition Assistance Program participants (eg, increased fruit and vegetable consumption). The 2018 Farm Bill was largely in alignment with the Academy's recommendations, and preserved the integrity of the Supplemental Nutrition Assistance Program as well as increased funding for FINI.

Introducing new grocery stores into low-income communities has been a focus of policy efforts to improve the food environment. Yet, evidence of the impact of this strategy on diet and health outcomes is inconsistent. In Baltimore, a not-for-profit grocery store was opened by the Salvation Army in March 2018 with the goal of improving healthy food access. Unfortunately, the store has so far failed to attract sufficient customers. This study explored the reasons for low usage from the perspective of community members and staff members. A qualitative, formative research study was conducted at the store, which included semi-structured interviews (n = 21), direct observations (n = 8), and sociodemographic surveys (n = 152). Reasons for low store usage included high prices, confusion regarding the nature of the store, and lack of product variety. Reducing prices, increasing community engagement, and using promotional materials were all recommended strategies to increase usage. The Salvation Army is interested in potentially opening other nonprofit grocery stores. The results of this study will be used to help the Salvation Army refine their nonprofit grocery store model and in their future planning.

Background Barriers to shopping for foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) have been reported. Online ordering options may improve the WIC shopping experience but are understudied. Objective The objective of this study was to test feasibility and acceptability of a “Click & Collect” model for WIC online ordering from the perspective of WIC participants. Design A Click & Collect online ordering model was adapted to the WIC program and implemented at 1 grocery store. In the Click & Collect model, WIC participants placed an online order (“click”), then completed payment and pickup at the store (“collect”). Participants/setting Twenty-five WIC participants in East Tennessee were included. Main outcome measures Feasibility was assessed by examining online order summaries and store receipts to determine whether WIC transactions were completed successfully. Acceptability was assessed by qualitative semi-structured interviews conducted with WIC participants after participating in the pilot. Analyses performed Descriptive statistics were used to analyze sociodemographic and purchase data in SPSS software, version 27. Qualitative interviews were transcribed and analyzed for themes using directed content analysis in NVivo, version 12.0. Results All WIC participants in the study placed an online order, and 96% picked up the order, indicating a high degree of feasibility. In follow-up qualitative interviews, WIC participants reported interest in the Click & Collect model, and provided suggestions to improve practicality across the following 4 primary themes: website experience, curbside pickup, online shopping fee, and shopping preferences. Conclusions The pilot was successfully implemented at 1 store. Click & Collect online ordering was feasible and acceptable to WIC participants, although additional work is needed to make it practical. Online shopping options for the WIC program should be further explored to expand access to nutritious WIC foods in families with low income.

We describe a patient who presented with subacute ascending numbness who we diagnosed with nitrous oxide toxicity from recreational drug abuse. Characteristic neuroimaging is presented and the diagnostic process for this condition is reviewed.

The relation between episodic and semantic memory was examined by testing how semantic knowledge influences children's episodic memory for events and their locations. Five-, six-, and seven-year-olds (N = 87) engaged in events in a children's museum designed as a town. Events were semantically congruent or incongruent with the spatial location (e.g., sorting mail at post office vs. grocery store). In addition to this experimental paradigm, a semantic interview assessed children's semantic knowledge about real-world locations. Accuracy in the experimental paradigm showed that children's semantic memory influenced memory for locations. Interviews revealed age-related improvements in children's semantic knowledge. Regression analyses examined factors that best supported episodic memory. These results provide novel insights and highlight the utility of research in naturalistic settings.

The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research, yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience, describes individual, interpersonal, and household characteristics that affect customer purchasing, highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave, and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.

Background Children are vulnerable to adverse health effects associated with phthalates, and food is one source of exposure. A comprehensive analysis investigating urinary phthalate metabolite concentrations in relation to food type and source has yet to be undertaken. Objectives We use reduced rank regression, a dimension reduction method, to identify dietary patterns associated with urinary phthalate metabolites in children in a large US study. Methods We used data from 2369 participants 6–19 years old from the 2011–2016 National Health and Nutrition Examination Survey who recalled their diet over the 24 h prior to urine collection. We used dietary data to estimate intake and source (i.e., prepared at a restaurant vs. purchased from a grocery store) of 136 food groups. We used reduced rank regression to identify dietary patterns explaining variation in overall urinary concentrations of ∑di-2-ethylhexyl phthalate and seven phthalate metabolites. We also examined pairwise associations between food groups and urinary phthalate metabolites. Results We identified eight dietary patterns that cumulatively explained 12.1% of variation in urinary phthalate metabolites, including a dietary pattern characterized by certain starchy vegetables (e.g., plantains and lima beans), quick breads, and citrus juice prepared at a restaurant. A one SD increase in this food pattern score was associated with a 37.2% higher monocarboxyoctyl phthalate (MCOP) concentration (95% CI: 30.3, 44.4). We also observed weak associations between certain food groups and urinary phthalate metabolites (e.g., a one SD increase in intake of certain starchy vegetables prepared at a restaurant was associated with a 1.8% [95% CI: 0.7, 2.8] higher MCOP). Conclusions Children whose diets were characterized by higher consumption of certain starchy vegetables, quick breads, and citrus juices prepared at a restaurant had higher urinary phthalate metabolites. More detailed information on the specific methods of food processing and details on packaging materials is needed.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the United States (U.S.). Participants in the program redeem their prescribed food benefits in WIC-authorized grocery stores. Online ordering is an innovative method being pilot-tested in some stores to facilitate WIC participants’ food benefit redemption, which has become especially important in the COVID-19 pandemic. The present research aimed to examine the online ordering (OO) behaviors among 726 WIC households who adopted WIC OO in a grocery chain, XYZ (anonymous) store, in Oklahoma (OK). These households represented approximately 5% of WIC households who redeemed WIC benefits in XYZ stores during the study period, which was 1 July to 31 December 2020. This period was during the COVID-19 pandemic but after the temporary lockdown in Oklahoma had been lifted. Descriptive statistics were estimated for WIC OO households’ adoption behaviors and their orders. The Cox proportional hazard model and zero-truncated negative binomial regression were applied to examine the relationship between participants’ socio-demographics and the length of time between 1 July 2020, and their first OO, as well as the number of WIC online orders. About 80% of these online orders were picked up without any changes. Minority households had a significantly longer time before adopting their first OO (hazard ratio (HR) < 1, p < 0.001), while households with a child or a woman participant, or more participants, had a shorter time before adopting OO (HR > 1, p < 0.05). Non-Hispanic black households had a fewer number of OOs than non-Hispanic white households (B = −0.374, p = 0.007). OO adoption varied across socio-demographics. More efforts are needed to ensure equal access and adoption of WIC OO.

Coronavirus disease 2019 (COVID-19) poses an occupational health risk to food system workers including farmers/producers, grocery store workers, emergency food system staff and volunteers (e.g., food pantry workers), and others. These food system workers have been pushed to the front-line of this pandemic, providing essential services that support food consumption for all Americans. Food system workers are some of the most economically vulnerable populations and are at risk of further financial disparities and contraction of COVID-19 during this pandemic. As we continue to grapple with the best strategies to support the food system and mitigate concerns around the spread of COVID-19, appropriate measures must be considered to better protect and support front-line food system workers that safeguard food access for all Americans.

Lack of food preparation knowledge, time to prepare meals and concerns about fruit and vegetable spoilage before consumption are the potential barriers to home cooking. These barriers may be addressed by meal kits (bundles of recipes and ingredients). We described home cooking barriers and evaluated acceptability of meal kits, using semi-structured focus groups with caregivers and adolescent patients of an outpatient paediatric weight management clinic. One meal kit per family, containing non-perishable food, a $20 gift card to a grocery store and recipes designed by clinic dietician for two meals, were given at clinic appointments. Two in-person semi-structured focus groups were conducted within 2 weeks of meal kit receipt. Four adolescent participants (75% female; 12.7 ± 0.9 years) and eight caregivers (88% female) participated in the focus groups. Four barriers to home cooking were identified: (a) healthy food cost, (b) preparation time, (c) food preparation knowledge and (d) picky eaters. Participants felt the meal kits addressed the time and lack of food preparation knowledge barriers to home cooking. A clinical meal kit programme was acceptable to a treatment-seeking adolescent population with obesity and their caregivers.

The objectives for this study were to examine the location and density of measured food outlets in five rural towns in the Lower Mississippi Delta, determine the spatial location of Delta Healthy Sprouts (DHS) participants&rsquo, homes in the food environment, and examine relationships between the spatial location of participants&rsquo, homes and their diet quality. Using a food desert/food swamp framework, food outlet geographic locations were analyzed in relation to one another, the distance between DHS participants&rsquo, residence and closest food outlets by class were computed, and associations among residents&rsquo, diet quality, hot spot status, and census tract classification were explored. Of 266 food outlets identified, 11 (4%), 86 (32%), 50 (19%), and 119 (45%) were classified as grocery stores (GS), convenience stores (CS), full-service restaurants (FS), or fast food restaurants (FF), respectively. A third of participants lived in CS hot spots, while 22% lived in FF hot spots. DHS participants lived closer in miles to CS (0.4) and FF (0.5) as compared to GS (1.6) and FS (1.1) outlets. Participants bought most groceries at national chain grocery stores rather than their closest grocery store. The food environments of the five towns and associated neighborhoods in which DHS participants resided were not supportive of healthful eating, containing both food deserts and food swamps, often in overlapping patterns.

Introduction The Lower Mississippi Delta is characterized by several factors associated with poor diet quality. Our objective was to measure local nutrition environments of pregnant women and their infants who participated in a nutrition and physical activity intervention to assess environmental exposures potentially influencing their dietary habits. Methods We measured the nutrition environments of 5 towns in which participants resided by using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full-service restaurants, and fast food restaurants. We used general linear models to test for differences in ratio scores, calculated by dividing each food outlet score by the maximum score possible, among food outlet classes and subclasses. Results Mean total ratio scores (expressed as percentages) for the Nutrition Environment Measures Survey among 4 classes of food outlets were significantly different from one another except for convenience stores and full-service restaurants. On average, grocery stores (n = 11) had 54% of maximum points possible, followed by full-service restaurants (21%; n = 50), convenience stores (16%; n = 86), and fast food restaurants (8%; n = 119). We found no significant differences in mean total ratio scores among convenience store subclasses. For fast food restaurant subclasses, stand-alone restaurants (n = 81) had 19% of maximum points possible, significantly higher than grocery store delicatessens (6%; n = 8), corner stores that sold fast food (3%; n = 5), and gas stations that sold fast food (4%; n = 25). Conclusion These 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating. Behavioral interventions designed to bring about positive changes in dietary habits of rural residents are needed; however, effects may be minimal if environmental factors supportive of healthful eating are not available.

Summary Grocery store is usually considered to be a healthy food outlet as it provides access to a variety of healthy food, such as fruits and vegetables, which may potentially improve overall dietary quality and protect against obesity. However, findings of the association between grocery store and childhood obesity are controversial. This study aimed to systematically review the evidence on the association between access to grocery stores and childhood obesity. A literature search was conducted in the PubMed, Embase, and Web of Science for articles published before January 1, 2019, using the combinations of three groups of keywords separately for grocery store, children and adolescents, and weight‐related behaviours and outcomes. A total of 27 cross‐sectional and eight longitudinal studies were identified. Controversial results existed among 24 studies, which examined the association between the access to grocery stores and weight‐related outcomes. A null association was observed in almost all meta‐analyses conducted by different measures of grocery stores and weight status, except the analysis between presence of grocery stores and overweight, which reached borderline significance. For weight‐related behaviours, mixed findings were reported between grocery stores and dietary behaviours, and no significant associations were found for physical activity. This systematic review and meta‐analysis suggested that access to grocery stores may have a rather small influence on child weight.

Emergence and dissemination of antimicrobial resistance (AMR) in food-borne bacteria is a public health issue. Retail meat is considered an important carrier for antimicrobial-resistant Escherichia coli. Currently, resistance of E. coli strains to third generation cephalosporins are of particular concern, with significant potential animal and public health consequences. Resistance to tetracyclines is also a concern, due to high prevalence of this resistance and important co-resistance patterns. However, the actual likelihood of exposure to antimicrobial-resistant bacteria via the consumption of retail meats, beyond the simple frequencies of resistance found in samples of meat at the grocery store, in Canada remains to be investigated. This study was conducted to estimate the potential human exposure to ceftriaxone- and tetracycline-resistant E.coli (CREC and TREC; the hazards of interest) through the consumption of ground beef in Western Canada. Our exposure assessment simulation model included five modules: 1) estimation of prevalence and concentration of the hazards of interest in retail ground beef samples collected by the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS), 2011–2014; 2) potential growth of the hazards during transportation from retail to home; 3) potential growth or reduction of the hazards during home storage; 4) thermal inactivation of the hazards due to cooking; and 5) consumption. The outputs of the model were presented as the probability of consumers' exposure to various threshold levels of the hazards [10 to 106 colony forming units (CFU)] in one serving of cooked ground beef. Overall, the probabilities of exposure to high threshold levels of the hazards (>4 log10 CFU/serving) were estimated to be lower than 0.12% in the study population (2011–2014). The mean probabilities of exposure to at least 1 log10 CFU CREC and TREC in a single meal containing cooked ground beef were 0.067% (SD: 0.001%) and 1.20% (SD: 0.02%), respectively. This probability substantially decreased as the threshold level of exposure increased to ≥6 log10 CFU. The probability of exposure to TREC was consistently greater than that for CREC. Cooking led to a prominent drop in the mean concentration of the hazards (4.7 log10 CFU/g). The findings from this research could inform the policy-making process and provide suggestions for adjustments in future retail surveillance plans. In addition, important knowledge gaps in this area have been highlighted.

This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada.We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences.Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%), Saskatchewan (83%) and Manitoba (72%). Respondents to the survey (n = 92) expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods.There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.Cet article porte sur l'environnement de la vente d’aliments dans les collectivités des Premières nations du nord des provinces, en particulier sur la concurrence éventuelle dans la vente au détail de la North West Company (NWC) ainsi que sur les expériences d'achats alimentaires de la population vivant dans le Nord canadien.Nous avons utilisé deux méthodologies pour évaluer l’environnement alimentaire de la vente au détail dans le Nord. D’abord, nous avons cartographié les détaillants en alimentation du Nord afin d’examiner le degré de concurrence au détail dans les régions nordiques, en prêtant une attention particulière aux collectivités qui ne sont pas accessibles à l’année par la route. Ensuite, nous avons enquêté auprès des personnes vivant dans les collectivités du Nord canadien à propos de leurs expériences d’achat au détail et de magasinage.Cinquante-quatre pour cent des collectivités du nord des provinces et du Grand Nord n’avaient aucune épicerie en concurrence avec la NWC. Les provinces comptant les plus fortes proportions de collectivités nordiques sans concurrence dans la vente au détail étaient l’Ontario (87 %), la Saskatchewan (83 %) et le Manitoba (72 %). Les participants au sondage (n = 92) ont fait état de leurs préoccupations quant à leurs expériences d'achat dans trois grands secteurs : le coût des aliments, la qualité et la fraîcheur des aliments et la disponibilité de certains aliments.La concurrence dans la vente au détail est limitée dans le nord des provinces. Au Manitoba, en Saskatchewan et en Ontario, la NWC ne fait face à aucune concurrence dans au moins 70 % des collectivités nordiques. Les consommateurs du Nord canadien considèrent que les aliments nutritifs sont peu abordables, et ils souhaitent avoir accès à un plus grand choix d’aliments périssables en bon état.

Foodborne salmonellosis causes an estimated 1 million illnesses and 400 deaths annually in the United States (1). In recent years, salmonellosis outbreaks have been caused by foods not typically associated with Salmonella. On May 2, 2017, PulseNet, CDC's national molecular subtyping network for foodborne disease surveillance, identified a cluster of 14 Salmonella Chailey isolates with a rare pulsed-field gel electrophoresis (PFGE) pattern. On May 29, Canadian health officials informed CDC that they were also investigating a cluster of five Salmonella Chailey infections in British Columbia with the same PFGE pattern. Nineteen cases were identified and investigated by CDC, U.S. state health departments, the Public Health Agency of Canada, and the British Columbia Centre for Disease Control. Isolates from all cases were highly related by whole genome sequencing (WGS). Illness onset dates ranged from March 10 to May 7, 2017. Initial interviews revealed that infected persons consumed various fresh foods and shopped at grocery chain A; focused questionnaires identified precut coconut pieces from grocery chain A as a common vehicle. The Canadian Food Inspection Agency (CFIA) and the U.S. Food and Drug Administration (FDA) conducted a traceback investigation that implicated a single lot of frozen, precut coconut as the outbreak source. Grocery chain A voluntarily removed precut coconut pieces from their stores. This action likely limited the size and scope of this outbreak.

Grocery store workers are essential workers, but often have not been provided with appropriate protection during the current pandemic. This report describes efforts made by one union local to protect workers, including negotiated paid sick leave and specific safety practices. Union representatives from 319 stores completed 1612 in-store surveys to assess compliance between 23 April 2020 and 31 August 2020. Employers provided the union with lists of workers confirmed to have COVID-19 infection through 31 December 2020. Worker infection rates were calculated using store employees represented by the union as the denominator and compared to cumulative county infection rates; outcome was dichotomized as rates higher or lower than background rates. Restrictions on reusable bags and management enforcement of customer mask usage were most strongly associated with COVID-19 rates lower than rates in the surrounding county. Stores that responded positively to worker complaints also had better outcomes. The union is currently engaging to promote improved ventilation and vaccination uptake.

Understanding how people assimilate different types of information for food choices is integral to improving knowledge about diet and human health. This study evaluates the impact that 10 information signals have on the perceived healthiness of gluten. Signals include non-social signals such as personal eating experiences, scientific studies, and advice from doctors, but also includes social signals such as recommendations from attractive people, social media, the layout of a grocery store, and celebrities. An online survey of over 1,000 Americans is administered using indirect questioning where subjects are presented with a hypothetical other person and asked how the various signals would impact that person’s opinion of gluten-free diets. Results show that advice from an attractive person is thought to have a slightly larger impact than reading about a new study regarding gluten, and seeing a grocery store develop a new gluten-free section has a larger impact than learning a celebrity consumes a gluten-free diet.

Children's involvement in beverage selection or purchase has seldom been investigated. The responsiveness dimension of parental feeding styles has been related to healthy maternal feeding practices. Assessing mothers' reports of responsiveness and demandingness in grocery stores may shed light on influences on purchases of sugar-sweetened beverages (SSB) and fruit juice (FJ). Study objectives were to explore whether (1) maternal responsiveness and demandingness were associated with preschoolers' a) help with selection of and b) influence on SSB and FJ purchases during grocery shopping and whether (2) preschoolers' a) help with selection of and b) influence on SSB and FJ purchases were associated with child intake of these beverages. Mothers of 3-to-5-year-old children (n=185) who co-shopped with the child completed the Caregiver Feeding Style Questionnaire, reported frequency of child help with selection and influence on beverage purchase via questionnaire, and provided a one-day weekend food recall for the child. In adjusted logistic regressions, responsiveness was associated with child help selecting FJ (OR=6.50, 95% CI[1.04, 40.75], p

Background Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits. Objective One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility. Methods To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels. Results Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff’s prior WIC participation and customers’ proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers. Conclusions These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina’s recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.

Objective:To examine the effectiveness of the Produce for Better Health Foundation grocery store tour programme as a nutrition education tool for changing consumers’ intention to consume various forms of fruits and vegetables (F&V).Design:Cross-sectional study.Setting:Ten grocery stores in a city in the Southeast USA.Participants:A total of 147 grocery shoppers in Alabama, who participated in a grocery store tour, completed a retrospective pre-/post-survey using the Theory of Planned Behaviour.Results:Results from independent-samples t tests indicated that mean values of attitude, subjective norm and perceived control were significantly increased after store tours (P < 0·01). Participants’ intentions to consume various types of F&V (fresh, dried, canned, juice and frozen), especially dried F&V, increased significantly after store tours. Results from structural equation modelling indicated that before store tours attitude (γ = 0·48, P < 0·01) was the most significant predictor of intention to consume F&V, followed by perceived behavioural control (γ = 0·24, P = 0·02) and subjective norm (γ = 0·21, P = 0·03). After store tours, attitude (γ = 0·51, P < 0·01) and perceived behavioural control (γ = 0·44, P < 0·01) were still strong predictors of intention to consume F&V, while subjective norm became an insignificant predictor of intention.Conclusions:Findings revealed positive changes in study participants’ attitude, subjective norm, perceived behavioural control and their intentions to consume various forms of F&V, which suggest potential benefits of providing grocery store tours as a tool to promote consumers’ F&V intake.

Background. Implementing food stores in deprived neighborhoods to improve access to healthy food is a debated topic. Aims. To uncover important contributors to the closure of grocery store interventions in urban food deserts. Method. We systematically reviewed both peer-reviewed and gray literature for publications on the failure of grocery store interventions. Results. We found nine articles on six different failed food stores. The reasons stated for closure included low sales, a lack of food retail experience, poor marketing, and difficulty in attracting and retaining a high volume of consumers from the local market. Discussion. Current literature on the topic of the closure of inner-city grocery stores does not have a concise rationale to explain why inner-city grocery store interventions were not successful. Conclusion. We must consider the most appropriate interventions to improve food environments in food deserts using local and national policies to address the social determinants of health.

Public health taxes on less healthy food and beverage products have been shown to be effective in various settings. However, it is unclear if observed reductions in the quantity of taxed products purchased is a result of price increases due to the tax or the accompanying messaging and if the effects are influenced by the level of support for such taxes within the population. 941 adults residing in Singapore were randomized and asked to shop in one of four versions of a fully functional on-line experimental grocery store: 1) no tax control; 2) implicit tax showing only post-tax prices (i.e., 20 % higher than control prices) on high-in-calorie products; 3) fake tax showing pre-tax prices and a label falsely indicating that the price includes a 20 % tax on high-in-calorie products; and 4) explicit tax showing the same label as in 3) and an actual 20 % price increase applied to the high-in-calorie products. The proportion of high-in-calorie products purchased was 14 % in the control arm. We were unable to reject the null hypothesis of no effect in the implicit tax arm compared to control (0.08, 95 % CI -3.31 to 1.77) or in the fake tax arm compared to the control (2.59, 95 % CI -5.04 to 0.00) but observed a statistically significant 3.35 percentage point decrease (95 % CI -6.01 to -0.5) in the explicit tax arm compared to control. We were unable to reject the null hypothesis of no effect in any of the outcomes related to diet quality. Individuals who support the tax showed greater responsiveness to the explicit and fake taxes compared to those who do not (price elasticities of demand of -1.38 and -0.51 respectively). Results suggest that reductions in the proportions of high-in-calorie products purchased may be largely attributable to explicit messaging rather than to price increases. However, even when effective, policymakers should recognize that changes in purchasing patterns may not improve diet quality and that results may not generalize to other areas where levels of support differ.

Disparities in healthy food access are well documented in cross-sectional studies in communities across the United States. However, longitudinal studies examining changes in food environments within various neighborhood contexts are scarce. In a sample of 142 census tracts in four low-income, high-minority cities in New Jersey, United States, we examined the availability of different types of food stores by census tract characteristics over time (2009&ndash, 2017). Outlets were classified as supermarkets, small grocery stores, convenience stores, and pharmacies using multiple sources of data and a rigorous protocol. Census tracts were categorized by median household income and race/ethnicity of the population each year. Significant declines were observed in convenience store prevalence in lower- and medium-income and majority black tracts (p for trend: 0.004, 0.031, and 0.006 respectively), while a slight increase was observed in the prevalence of supermarkets in medium-income tracts (p for trend: 0.059). The decline in prevalence of convenience stores in lower-income and minority neighborhoods is likely attributable to declining incomes in these already poor communities. Compared to non-Hispanic neighborhoods, Hispanic communities had a higher prevalence of small groceries and convenience stores. This higher prevalence of smaller stores, coupled with shopping practices of Hispanic consumers, suggests that efforts to upgrade smaller stores in Hispanic communities may be more sustainable.

This study examined the potential usability, relevance, and acceptability of V-Mart, a virtual reality grocery store as an assessment and intervention tool for veterans with mild traumatic brain injury.Six focus groups were conducted for a 2-yr period to assess perceptions from the following three key stakeholders: therapists, veterans with neither mild traumatic brain injury nor posttraumatic stress disorder, and veterans with mild traumatic brain injury with or without posttraumatic stress disorder (mild traumatic brain injury/posttraumatic stress disorder). The System Usability Scale was applied as an objective measure of usability. Transcripts from the six focus groups were subjected to thematic analyses using the constant, comparative method.The focus groups indicated that V-Mart was perceived as highly usable, relevant, and acceptable. Early technical problems were resolved satisfactorily. Therapists indicated that they would use an application such as V-Mart if it were available. The veterans with neither mild traumatic brain injury nor posttraumatic stress disorder felt that it was realistic and likely to be useful, as did the veterans with mild traumatic brain injury/posttraumatic stress disorder. The System Usability Scale mean follow-up scores ranged from 71.4 to 86.0, surpassing the threshold for acceptable usability in health care settings.Focus group and System Usability Scale data indicate that the V-Mart has great potential as an assessment tool and intervention for veterans with mild traumatic brain injury/posttraumatic stress disorder. Further development and clinical trials are warranted.

Objectives To assess levonorgestrel (LNG) and ulipristal acetate (UPA) availability in pharmacies in a metropolitan area. Methods A cross-sectional survey was conducted of all identified pharmacies within 25 miles of an urban medical center in Kansas City, KS. We categorized the pharmacies as dedicated commercial (national chains), store-associated (affiliated with a general merchandise or grocery store), or independent. We assessed LNG and UPA availability or time to availability if not currently stocked. Results We contacted 165 pharmacies. Of the 165 pharmacies, few stocked UPA (12/165, 7%) whereas the majority stocked oral LNG (128/165, 78%). Dedicated commercial pharmacies were more likely to carry UPA than store-associated and independent pharmacies (11/84 [13%] vs. 1/61 [1%] vs. 0/20, respectively; P = 0.016). Most pharmacies that did not stock UPA reported that they could obtain it within 24 hours (94/153, 62%). Dedicated commercial pharmacies were most likely report the ability to obtain UPA in 24 hours (P = 0.016). Conclusion Few pharmacies stock UPA, the most effective form of oral emergency contraception. Enhanced communication between medical providers and pharmacists within current laws and regulations could enhance patient access to UPA.

CONTEXT Volunteer-led out-of-school-time (OST) programs, such as 4-H, scouting, and youth sports, reach a large population of children and are positioned to offer opportunities for healthy eating. However, cost is a barrier to providing healthy snacks such as fruits and vegetables (FVs) during OST. OBJECTIVE Offering discounts through grocery store partnerships has shown promise in addressing this barrier in structured, staff-led after-school programs. We tested this model in volunteer-led OST programs and evaluated it using mixed methods. DESIGN/SETTING The Snack It Up (SIU) intervention was designed to promote FV snacks to volunteer-led OST programs through weekly $5 grocery store discounts. Participation was limited to 1 leader per program. PARTICIPANTS Thirty-five of 36 recruited OST program leaders completed the study; 16 were enrolled in SIU and 19 in a comparison group. MAIN OUTCOME MEASURES We assessed the following: (1) discount redemption among SIU leaders; (2) snacks served by SIU and comparison group leaders via photographs from 3 to 4 OST program sessions during SIU implementation; and (3) SIU leader perspectives using key informant interviews before and after implementation. RESULTS SIU leaders saved an average of $48.75 on FV snacks throughout the intervention ($2.90 per week, more than one-fifth of typical self-reported spending on snacks). SIU leaders also served a greater frequency (100% of sessions vs 75%, P < .001) and variety of FVs (an average of 3.5 types per session vs 1.3, P < .001) and fewer salty/sweet snacks (0.0 vs 1.3 types per session, P < .001) than those in the comparison group and expressed positive impressions of SIU. CONCLUSIONS Partnerships between OST programs and grocery stores are a promising avenue for promoting healthier snacks during OST.

Introduction Open airway reconstruction is a highly specialized skill. Simulation affords the opportunity to practice surgical skills in a low stakes environment which is particularly important for a high acuity, low frequency operation. Although animal models have been described, these present ethical and financial barriers, and therefore are not ideal to expose residents to airway reconstruction techniques. To our knowledge there is not a commercially available simulator for laryngotracheal reconstruction. Objectives This study describes a novel, low-fidelity simulation technique for laryngotracheal reconstruction using a cartilage graft. Methods We designed a low-fidelity simulator to represent the trachea, esophagus, and cartilage graft using tubing from a Luken’s trap, vinyl backwash hose, and pig’s ears from a non-specialty grocery store. The model was evaluated with a Likert scale (1= strongly disagree to 5= strongly agree). Results Twelve participants attended simulation sessions. Participants reported a mean score (+/-SD) 4.25+/-0.75 that the tissue characteristics were adequate and 4.50+/-0.79 that sutures could be placed. There was universal strong agreement that the tissue could be manipulated appropriately (5+/-0). The cost per resident was less than 4 dollars. Conclusion We present a readily available, easy to construct, and low cost simulation model for open airway reconstruction that can be used as a stand-alone simulator or in preparation for an animal dissection course. Our participants reported that the model had acceptable tissue characteristics to practice performing laryngotracheal reconstruction with a cartilage graft.

The objective of the current study was to evaluate young Canadians&rsquo, exposure to caffeinated energy drink marketing and educational messages that warn about the potential health risks of energy drinks. An online survey was conducted in 2015 with youth and young adults aged 12&ndash, 24 years recruited from a national online panel (n = 2023). Respondents were asked about their exposure to energy drink marketing and educational messages that warn about the potential health risks of energy drinks. Regression models were fitted to examine correlates of exposure to marketing and to educational messages. Over 80% of respondents reported ever seeing energy drink marketing through at least one channel, most commonly television (58.8%), posters or signs in a convenience or grocery store (48.5%), and online ads (45.7%). The mean number of marketing channels selected was 3.4 (SD = 2.9) out of ten. Respondents aged 18&ndash, 19 (vs. 12&ndash, 14 and 15&ndash, 17) and 20&ndash, 24 (vs. 12&ndash, 17) reported significantly more channels of exposure to marketing. Overall, 32% of respondents reporting ever seeing an educational message about energy drinks. The most frequently reported sources of exposure were at school (16.2%), online (15.0%), and on television (12.6%). Respondents aged 18&ndash, 14, 15&ndash, 17 and 20&ndash, 24) and 20&ndash, 24 (vs. 15&ndash, 17) were significantly more likely to report having seen an educational message. Exposure to energy drink marketing was common among youth and young adults and was significantly more prevalent than exposure to educational messages that warn about the potential health risks of energy drinks. A comprehensive policy approach, including enforcing responsible marketing and increasing education surrounding the risks of consuming energy drinks, may be an effective approach in promoting lower-risk consumption of CEDs.

In light of calls for improving people’s skill in collaboration, this paper examines strengths in processes of collaboration of Mexican immigrant children. Sibling pairs (6–10 years old) in California were asked to collaborate in planning the shortest route through a model grocery store. On average, 14 sibling pairs with Mexican Indigenous-heritage backgrounds engaged together collaboratively as an ensemble, making decisions in common and fluidly building on each other’s ideas, more often than 16 middle-class European American sibling pairs, who on average more often divided decision making into a solo activity (often ignoring the other or simply bossing the other). Siblings who spent more time collaborating fluidly as an ensemble in the shared planning task were also more likely to collaborate with initiative at home, according to their mothers, which suggests that family socialization practices may contribute to cultural differences in collaboration.

Research has examined how the food environment affects the risk of cardiovascular disease (CVD). Many studies have focused on residential neighbourhoods, neglecting the activity spaces of individuals. The objective of this study was to investigate whether food environments in both residential and global positioning system (GPS)-defined activity space buffers are associated with body mass index (BMI) and blood pressure (BP) among low-income adults. Data came from the New York City Low Income Housing, Neighborhoods and Health Study, including BMI and BP data (n=102, age=39.3±14.1 years), and one week of GPS data. Five food environment variables around residential and GPS buffers included: fast-food restaurants, wait-service restaurants, corner stores, grocery stores, and supermarkets. We examined associations between food environments and BMI, systolic and diastolic BP, controlling for individual- and neighbourhood-level sociodemographics and population density. Within residential buffers, a higher grocery store density was associated with lower BMI (β=- 0.20 kg/m2, P

Background In developed countries, adolescent and young adult diets have been found to be nutritionally poor. The aim of this study was to examine whether a choice architecture intervention, re-arrangement of produce within a grocery store to increase the accessibility of fruit and vegetables, affected purchasing behaviour on a university campus. Methods A database of daily sales data from January 2012 to July 2017 was obtained from a campus grocery store. Two changes to the layout were made during this time period. In January 2015, fruit and vegetables were moved from the back of the store, furthest from the entrance, to the aisle closest to the entrance and an entrance-facing display increasing their accessibility. In April 2016, the entrance-facing display of fruit and vegetables was replaced with a chiller cabinet so that fruit and vegetables remained more accessible than during the baseline period, but less accessible than in the period immediately previously. A retrospective interrupted time series analysis using dynamic regression was used to model the data and to examine the effect of the store re-arrangements on purchasing. All analyses were carried out both for sales-by-quantity and for sales-by-money. Results The first shop re-arrangement which made fruit and vegetables more prominent, increased the percentage of total sales that were fruit and vegetables, when analysed by either items purchased or money spent. The second rearrangement also had a positive effect on the percentage of total sales that were fruit and vegetables compared to baseline, however this was not significant at the 5% level. Over the five year period, the percentage of sales that were fruit and vegetables declined both in terms of items purchased, and money spent. Conclusions Increasing accessibility of fruit and vegetables in a grocery store is a feasible way to improve the diet of students in tertiary education. There is evidence of declining fruit and vegetable consumption among the studied population, which should be further investigated. Electronic supplementary material The online version of this article (10.1186/s12889-018-6063-8) contains supplementary material, which is available to authorized users.

Background Positive front-of-pack (FOP) labels, including Singapore’s Healthier Choice Symbol (HCS), target a subset of healthier products whose consumption is to be encouraged. However, this may inadvertently lead to excess caloric intake, which could be addressed by including an additional label identifying calories per serving. We test this hypothesis by adding a Physical Activity Equivalent (PAE) label, an indicator of calorie content, to all products available in an on-line grocery store. Methods We conducted a randomized controlled trial using a 3 arm within-subject crossover design in adult Singapore residents recruited online. Participants shopped once in each condition in an experimental online grocery store in random order: 1) no FOP label (Control); 2) Select products displaying HCS labels (HCS-only); 3) Condition 2 with additional information displaying PAEs per serving on every product (HCS+PAE). 117 participants were recruited and data from 317 shops were analyzed. We used first-differenced regressions to assess the impact of the conditions on calories per serving (primary) and on other measures of diet quality. Results The HCS-only condition led to a statistically significant five-percentage point increase in the proportion of HCS products purchased (95% CI, 1%: 9%). However, neither the HCS-only (3.45; 95% CI, −12.52: 19.43) nor HCS + PAE (8.14; 95% CI, −5.25: 21.54) condition led to a change in the number of calories per serving purchased or changes in other measures of diet quality. Conclusions Positive labels, like the HCS, are likely to increase purchases of labelled products. However, these changes may not lead to improvements in diet quality or calorie intake. Combining positive labels with additional PAE information does not appear to address this concern.