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Poor diets are responsible for a large burden of noncommunicable disease (NCD). The prevalence of modifiable dietary risk factors is rising in lower-income countries such as Haiti, along with increasing urbanization and shifts to diets high in sugar, salt, and fat. We describe self-reported dietary patterns (intake of fruits, vegetables, fried food, sugar-sweetened beverages, and added salt and oil) among a population-based cohort of low-income adults in Port-au-Prince and assess for associated sociodemographic factors (age, sex, income, education, body mass index). Among 2989 participants, the median age was 40 years, and 58.0% were women. Less than 1% met the World Health Organization recommendation of at least five servings/day of fruits and vegetables. Participants consumed fried food on average 1.6 days/week and sugar-sweetened beverages on average 4.7 days/week; young males of low socioeconomic status were the most likely to consume these dietary risk factors. The vast majority of participants reported usually or often consuming salt (87.1%) and oil (86.5%) added to their meals eaten at home. Our findings underscore the need for public health campaigns, particularly those targeting young males and household cooks preparing family meals at home, to improve dietary patterns in Haiti in order to address the growing NCD burden.

Suboptimal diets drive the multiple burdens of malnutrition among women living in informal settlements. Women's food choices have important implications for their health, as well as that of their families. The purpose of this study was to examine how food choice decisions might differ across different age groups of women living in informal settlements in Nairobi, Kenya. Using in-depth interviews which incorporated a free-listing task, we determined the factors influencing food choice decisions in women in two informal settlements, Kibera and Mukuru. Among women in all age groups, we found income and food price to be the most salient factors influencing food choice decisions. Differences across age groups regarding food choice considerations included individual preference and quality being more salient factors amongst younger women while household preferences were more salient among older women. Women also reported making trade-offs between food affordability and other factors including time and nutrition, which led to sub-optimal diets. Our findings suggest that interventions in these settings may need to be tailored to specific age groups. Additionally, interventions may need to target both individual factors and the external food environment to help women overcome the trade-offs they often find themselves making in food choice decisions.

Adam and Galinsky (2012) motivated their theory of enclothed cognition using experimental results showing that wearing a doctor's coat improved selective attention by reducing errors on incongruent Stroop trials. While many other studies have pursued extensions of this idea, there have been no published replications of this influence on the Stroop effect. This preregistered, direct replication attempt uses equivalence testing and the small telescopes framework from Simonsohn (2015) to argue that such an effect, if it exists, is too small to have been reliably detected under the original design. Theoretically predicted sequential effects as small as 7 ms were successfully detected at α = .05, indicating that the failure to find an effect of lab coat is likely not due to power limitations or poor experimental technique.

The food environments that people have access to shape their food choices. The purpose of this study was to use mixed methods to characterize the external food environment in informal settlements in Nairobi, Kenya and to examine the individual factors that influence the way in which women interact with those environments to make food choices. We used a combination of food environment assessments (vendor mapping, collection of food prices, food quality assessments) and five focus group discussions with women (n = 26) in four villages within two informal settlements in Nairobi (Mukuru and Kibera) to better understand the drivers of food choice. We found a large number (n = 1163) of vendors selling a variety of food within the settlements. The highest number of vendors were selling fruits and/or vegetables; however, there was limited diversity of fruits available. Animal-source foods were considered relatively expensive as compared to plant-based foods, including prepared fried snacks. We found that the way women interacted with their food environments was influenced by individual factors such as income, time, convenience, and preferences. Our findings suggest that interventions targeting both the external food environment as well as individual factors such as income will be necessary to support healthy diets among low-income populations living in informal settlements in Kenya.

Objective We proposed and demonstrate a theory-driven, quantitative, individual-level estimate of the degree to which cognitive processes are degraded or enhanced when multiple tasks are simultaneously completed. Background To evaluate multitasking, we used a performance-based cognitive model to predict efficient performance. The model controls for single-task performance at the individual level and does not depend on parametric assumptions, such as normality, which do not apply to many performance evaluations. Methods Twenty participants attempted to maintain their isolated task performance in combination for three dual-task and one triple-task scenarios. We utilized a computational model of multiple resource theory to form hypotheses for how performance in each environment would compare, relative to the other multitask contexts. We assessed if and to what extent multitask performance diverged from the model of efficient multitasking in each combination of tasks across multiple sessions. Results Across the two sessions, we found variable individual task performances but consistent patterns of multitask efficiency such that deficits were evident in all task combinations. All participants exhibited decrements in performing the triple-task condition. Conclusions We demonstrate a modeling framework that characterizes multitasking efficiency with a single score. Because it controls for single-task differences and makes no parametric assumptions, the measure enables researchers and system designers to directly compare efficiency across various individuals and complex situations. Application Multitask efficiency scores offer practical implications for the design of adaptive automation and training regimes. Furthermore, a system may be tailored for individuals or suggest task combinations that support productivity and minimize performance costs.

In a 2015 paper published in the Journal of Bioethical Inquiry, bioethicist Henk ten Have identifies vulnerability as a “controversial topic in bioethics” and argues that bioethical attention to vulnerability comes at the expense of sufficient attention to the social structures that shape human life. In this paper, we situate ten Have’s argument within the broader bioethical literature, emphasizing how critiques of vulnerability can enrich approaches in clinical settings, including in nutrition, where the concept of vulnerability is not foreign (eg, children are often labeled members of a vulnerable group). We use an example of food (in)security to show how reframing vulnerability to capture “layers of marginalization” can help clinicians and organizations more clearly identify who is most in need, develop solutions for what should be done, and determine how and by whom those solutions should be implemented.

The type and amount of task demands that humans must simultaneously process and respond to influences how efficient they are in completing the tasks. Capturing how and to what degree human efficiency changes in different task environments is crucial to inform an appropriate system design. An individual-based analytic approach is necessary to accurately capture performance changes and lend practical suggestions. We can provide designers with the amount and type of task demands that we expect a person to sustain adequate performance given their unique underlying cognitive properties. We develop a metric, multi-tasking throughput (MT), that provides the extent to which a person processes tasks more efficiently, the same, or less efficiently when required to complete several different types of tasks at once. This is a cognitive-based, standardized metric; meaning it yields the relative degree of change from a baseline model that is created to accommodate to unique individual differences, numbers of tasks, and task characteristics. We quantify MT by using transformations of RTs to predict the extent that external demands of multi-tasking exceeds what the cognitive system can accommodate to thereby hindering performance. We use a real world dual-task application to highlight the apparent differences in strategy and ability across individuals and alternative task environments.

In nearly all situations, a person’s performance varies across time (i.e., trials), for example due to vigilance decrements or training. When the performance depends on multiple sources of information, the variation could be either due to changes in processing each source or the efficiency of combining the sources. The capacity coefficient is a frequently used statistic for measuring the efficiency of combining multiple sources of information, but in most applications the analyses assume stationary performance across trials. A trial-varying capacity measure would be valuable in determining the nature of the change over trials but dropping the stationarity assumption results in a severe loss in power. In this work, we develop a Bayesian trial-varying model of the capacity coefficient to estimate the efficiency of an individual processing multiple sources of information. This model is based on the Weibull distribution to approximately characterize the processing time of each source, with an inverse gamma distribution prior for the scale parameter and a known shape. This approach provided us a tractable way to update prior estimates for real-time estimation of capacity across trials. We demonstrate the approach with both simulated and human data.

An assessment of global inequality in agriculture, food and health indicators between 1970–2010 reveals that significant progress has been made in some countries, but more is needed to achieve a truly equitable food system that delivers for the diets, nutrition and health of all people.

In this paper, we conducted a narrative review to describe age-specific characteristics that inform how children and adolescents interact with their food systems and how that relationship influences their diets. Children of all ages are active agents in determining the foods they eat. Numerous intrapersonal, interpersonal, and environmental characteristics influence their diets, and these shift over time. Some of these characteristics make children and adolescents susceptible to features across the food system that present challenges to the attainment of healthy diets during childhood and adolescence, and that lead to suboptimal nutrition outcomes. Special attention is needed to protect children's and adolescents' abilities to secure diets that are desirable, nutritious, safe, affordable, and sustainable.

Current food systems are failing to guide children towards healthy diets. This paper presents a tool to identify the actions needed to reorient food systems to become more child-centred from a nutrition perspective. To connect the dots between children's lives, their food environments and food supply systems, the tool takes a child-centred, food systems approach. Comprising six methodological steps, the tool starts by measuring and understanding children's realities and then working back up into the system to identify how food environments and supply systems could make relevant foods more or less available, affordable, appealing and aspirational in the contexts of children's lives. The paper spells out the mix of methods needed to make this assessment, gives examples of the data and studies already available and type of insights they provide, and discusses the methodological challenges and gaps. It presents a worked example that shows how following these steps in sequence enables the identification of a package of actions that can act coherently to reorient food systems in the way most likely to have impact on child malnutrition.

Transforming food systems is essential to ensuring nutritious, safe, affordable, and sustainable diets for all, including children and adolescents. This paper proposes a new conceptual framework (the ‘Innocenti Framework’) to better articulate how the diets of children and adolescents are shaped by food systems. The framework is comprised of a set of food system drivers, determinants (namely, food supply chains, external food environments, personal food environments, and behaviors of caregivers, children and adolescents), influencers, and interactions, which together determine children's and adolescents' diets. The conceptual framework conceptualizes the dynamic linkages between the elements of food systems, and highlights the importance of continuously shaping food systems to deliver nutritious, safe, affordable, and sustainable diets to children and adolescents.

Nutrition interventions that target mothers alone inadequately address women's needs across their lives: during adolescence, preconception, and in later years of life. They also fail to capture nulliparous women. The extent to which nutrition interventions effectively reach women throughout the life course is not well documented. In this comprehensive narrative review, we summarized the impact and delivery platforms of nutrition-specific and nutrition-sensitive interventions targeting adolescent girls, women of reproductive age (nonpregnant, nonlactating), pregnant and lactating women, women with young children

Worldwide, mothers with young children receive many messages about infant feeding. Some messages are generated by health providers and others by the households, communities, and social contexts in which women live. We aimed to determine the scope of infant feeding messages in urban Haiti and to examine intracultural differences in salience of these messages and their alignment with international guidelines. We applied the method of free listing with 13 health workers and 15 human immunodeficiency virus (HIV)-infected and 15 HIV-uninfected mothers with infants 0-6 months old at Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port-au-Prince, Haiti. Participants listed all messages women receive about infant feeding and specifically about HIV and infant feeding. Message salience was determined by frequency of mention and recall order; messages were coded for key themes. For all groups, the World Health Organization infant feeding recommendations were salient, especially those related to exclusive breastfeeding. Messages across all groups focused on infant health outcomes, with less emphasis on maternal outcomes. Cultural beliefs were also elicited and showed higher salience for mothers than health workers, particularly for consequences of poor maternal nutrition. Health workers' free lists were poorly correlated to those of mothers, whereas those of mothers were highly correlated, regardless of HIV status. Inasmuch as many salient messages were culturally generated, and differences existed between mothers and health workers, we conclude that it is important for health workers to acknowledge the broader infant feeding message environment, and discrepancies within that environment, to address successes and failures in the messages reaching mothers, given potential consequences for mothers' breastfeeding behaviours.

Systems factorial technology (SFT) is a powerful framework for examining how people use multiple sources of information together. Unfortunately, it is often difficult to apply. Appropriate manipulation of the salience of each source of information is critical to assessing processing characteristics so a significant amount of time can be spent piloting to determine the correct levels. Even with piloting, some participants’ data ends up unusable due to individual differences. We first examine the use of an accuracy-only adaptation for stimulus levels, based on the Psi method. In some cases a focus entirely on accuracy may be insufficient, particularly given that response time (RT) is the primary measure with SFT. Hence, we also introduce an approach to adapting stimulus levels for each individual participant’s joint accuracy and RT. This will increase the likelihood that salience manipulations will be effective and that a participant’s data will be usable.

Multi-spectral imagery can enhance decision-making by supplying multiple complementary sources of information. However, overloading an observer with information can deter decision-making. Hence, it is critical to assess multi-spectral image displays using human performance. Accuracy and response times (RTs) are fundamental for assessment, although without sophisticated empirical designs, they offer little information about why performance is better or worse. Systems factorial technology (SFT) is a framework for study design and analysis that examines observers’ processing mechanisms, not just overall performance. In the current work, we use SFT to compare a display with two sensor images alongside each another with a display in which there is a single composite image. In our first experiment, the SFT results indicated that both display approaches suffered from limited workload capacity and more so for the composite imagery. In the second experiment, we examined the change in observer performance over the course of multiple days of practice. Participants’ accuracy and RTs improved with training, but their capacity limitations were unaffected. Using SFT, we found that the capacity limitation was not due to an inefficient serial examination of the imagery by the participants. There are two clear implications of these results: Observers are less efficient with multi-spectral images than single images and the side-by-side display of source images is a viable alternative to composite imagery. SFT was necessary for these conclusions because it provided an appropriate mechanism for comparing single-source images to multi-spectral images and because it ruled out serial processing as the source of the capacity limitation.

Background The cognitive processes involved in individuals’ perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers’ perceptions over the course of their early breastfeeding experiences. Objective The aim of this study was to identify HIV-infected breastfeeding mothers’ cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. Methods With the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. Results At all 3 visits, we found consistency in women's cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers’ cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. Conclusions We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.

Objective We assessed the association between gender and mortality on antiretroviral therapy (ART) using identical models with and without sex-specific categories for weight and hemoglobin. Design Cohort study of adult patients on ART. Setting GHESKIO Clinic in Port-au-Prince, Haiti. Participants 4,717 ART-naïve adult patients consecutively enrolled on ART at GHESKIO from 2003 to 2008. Main Outcome Measure Mortality on ART; multivariable analyses were conducted with and without sex-specific categories for weight and hemoglobin. Results In Haiti, male gender was associated with mortality (OR 1.61; 95% CI: 1.30–2.00) in multivariable analyses with hemoglobin and weight included as control variables, but not when sex-specific interactions with hemoglobin and weight were used. Conclusions If sex-specific categories are omitted, multivariable analyses indicate a higher risk of mortality for males vs. females of the same weight and hemoglobin. However, because males have higher normal values for weight and hemoglobin, the males in this comparison would generally have poorer health status than the females. This may explain why gender differences in mortality are sometimes observed after controlling for differences in baseline variables when gender-specific interactions with weight and hemoglobin are omitted.

1. Unhealthy and unsustainably produced food poses a global risk to people and the planet. More than 820 million people have insufficient food and many more consume an unhealthy diet that contributes to premature death and morbidity. Moreover, global food production is the largest pressure caused by humans on Earth, threatening local ecosystems and the stability of the Earth system. 2. Current dietary trends, combined with projected population growth to about 10 billion by 2050, will exacerbate risks to people and planet. The global burden of non-communicable diseases is predicted to worsen and the effects of food production on greenhouse-gas emissions, nitrogen and phosphorus pollution, biodiversity loss, and water and land use will reduce the stability of the Earth system. 3. Transformation to healthy diets from sustainable food systems is necessary to achieve the UN Sustainable Development Goals and the Paris Agreement, and scientific targets for healthy diets and sustainable food production are needed to guide a Great Food Transformation. 4. Healthy diets have an appropriate caloric intake and consist of a diversity of plant-based foods, low amounts of animal source foods, unsaturated rather than saturated fats, and small amounts of refined grains, highly processed foods, and added sugars. 5. Transformation to healthy diets by 2050 will require substantial dietary shifts, including a greater than 50% reduction in global consumption of unhealthy foods, such as red meat and sugar, and a greater than 100% increase in consumption of healthy foods, such as nuts, fruits, vegetables, and legumes. However, the changes needed differ greatly by region. 6. Dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10·8–11·6 million deaths per year, a reduction of 19·0–23·6%. 7. With food production causing major global environmental risks, sustainable food production needs to operate within the safe operating space for food systems at all scales on Earth. Therefore, sustainable food production for about 10 billion people should use no additional land, safeguard existing biodiversity, reduce consumptive water use and manage water responsibly, substantially reduce nitrogen and phosphorus pollution, produce zero carbon dioxide emissions, and cause no further increase in methane and nitrous oxide emissions. 8. Transformation to sustainable food production by 2050 will require at least a 75% reduction of yield gaps, global redistribution of nitrogen and phosphorus fertiliser use, recycling of phosphorus, radical improvements in efficiency of fertiliser and water use, rapid implementation of agricultural mitigation options to reduce greenhouse-gas emissions, adoption of land management practices that shift agriculture from a carbon source to sink, and a fundamental shift in production priorities. 9. The scientific targets for healthy diets from sustainable food systems are intertwined with all UN Sustainable Development Goals. For example, achieving these targets will depend on providing high-quality primary health care that integrates family planning and education on healthy diets. These targets and the Sustainable Development Goals on freshwater, climate, land, oceans, and biodiversity will be achieved through strong commitment to global partnerships and actions. 10. Achieving healthy diets from sustainable food systems for everyone will require substantial shifts towards healthy dietary patterns, large reductions in food losses and waste, and major improvements in food production practices. This universal goal for all humans is within reach but will require adoption of scientific targets by all sectors to stimulate a range of actions from individuals and organisations working in all sectors and at all scales.