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ImportanceStrategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers.ObjectiveTo evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants' diets.Design, setting, and participantsLower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period.Main outcomes and measuresPrimary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality.ResultsA number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (-96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (-64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (-0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms.Conclusions and relevanceA food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions.Clinical trial registrationclinicaltrials.gov Identifier: NCT02643576.

The Irvine Minnesota Inventory (IMI) was designed to measure environmental features that may be associated with physical activity and particularly walking. This study assesses how well the IMI predicts physical activity and walking behavior and develops shortened, validated audit tools. A version of the IMI was used in the Twin Cities Walking Study, a research project measuring how density, street pattern, mixed use, pedestrian infrastructure, and a variety of social and economic factors affect walking. Both bivariate and multivariate analyses were used to assess the predictive value of the IMI. We find that while this inventory provides reliable measurement of urban design features, only some of these features present associations with increased or decreased walking. This article presents two versions of shortened scales--a prudent scale, requiring association with two separate measures of a physical activity or walking behavior, and a moderate scale, requiring association with one measure of physical activity or walking. The shortened scales provide built environment audit instruments that have been tested both for inter-rater reliability and for associations with physical activity and walking. The results are also useful in showing which built environment variables are more reliably associated with walking for travel--characteristics of the sidewalk infrastructure, street crossings and traffic speeds, and land use are more strongly associated with walking for travel, while factors that measure aesthetics are typically less strongly associated with walking for travel. (Contains 9 notes and 6 tables.)

Describes and compares useful and unified power formulas for analysis of covariance and change-score analyses, indicating the implications of each for sample size requirements. Contains practical recommendations for evaluations and outlines a simple spreadsheet approach. (SLD)

Examines factors that influence the prompt seeking of care for symptoms of acute myocardial infarction (AMI). Survey of adults in 20 communities in 10 states confirmed the importance of attrition and perceived self-confidence in symptom recognition in care seeking. Concludes that the lack of a significant role of health history and clinician contact highlighted missed opportunities for patient education. (Author/JDM)

BackgroundFederally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys. ObjectiveOur goal was to use Facebook-based recruitment and online surveys to estimate local variation in HPV vaccine uptake among young men and women in Minnesota. MethodsFrom November 2012 to January 2013, men and women were recruited via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. The Facebook advertisements were targeted to recruit men and women by location (25 mile radius of Minneapolis, Minnesota, United States), age (18-30 years), and language (English). ResultsOf the 2079 men and women who responded to the Facebook advertisements and visited the study website, 1003 (48.2%) enrolled in the study and completed the survey. The average advertising cost per completed survey was US $1.36. Among those who reported their postal code, 90.6% (881/972) of the participants lived within the previously defined geographic study area. Receipt of 1 dose or more of HPV vaccine was reported by 65.6% women (351/535), and 13.0% (45/347) of men. These results differ from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men). ConclusionsThis study shows that recruiting a representative sample of young men and women based on county and postal code location to complete a survey on HPV vaccination uptake via the Internet is a cost-effective and feasible strategy. This study also highlights the need for local estimates to assess the variation in HPV vaccine uptake, as these estimates differ considerably from those obtained using survey data that are aggregated to the state or federal level.