Food prices and food shopping decisions of black women.

Identifying food pricing strategies to encourage purchases of lower-calorie food products may be particularly important for black Americans. Black children and adults have higher than average obesity prevalence and disproportionate exposure to food marketing environments in which high calorie foods are readily available and heavily promoted. The main objective of this study was to characterize effects of price on food purchases of black female household shoppers in conjunction with other key decision attributes (calorie content/healthfulness, package size, and convenience). Factorial discrete choice experiments were conducted with 65 low- and middle-/higher-income black women. The within-subject study design assessed responses to hypothetical scenarios for purchasing frozen vegetables, bread, chips, soda, fruit drinks, chicken, and cheese. Linear models were used to estimate the effects of price, calorie level (or healthfulness for bread), package size, and convenience on the propensity to purchase items. Moderating effects of demographic and personal characteristics were assessed. Compared with a price that was 35% lower, the regular price was associated with a lesser propensity to purchase foods in all categories (ß = -0.33 to -0.82 points on a 1 to 5 scale). Other attributes, primarily calorie content/healthfulness, were more influential than price for four of seven foods. The moderating variable most often associated with propensity to pay the regular versus lower price was the reported use of nutrition labels. Price reductions alone may increase purchases of certain lower-calorie or more healthful foods by black female shoppers. In other cases, effects may depend on combining price changes with nutrition education or improvements in other valued attributes.

Assessing Increases in Cannabis-Related Diagnoses in US Hospitals by Regional Policy Status.

Cannabis policy is rapidly changing and more individuals are using cannabis nationally. Despite increased use and known adverse outcomes to cannabis use, there is a lack of understanding of health care utilization for cannabis-related conditions. The objectives of this study were: (1) To understand the change in the incidence of cannabis-related diagnoses from 2012 to 2015 nationally and (2) to describe the relationship between regional cannabis policies and changes in the incidence of cannabis-related diagnoses from 2012 to 2015. National Inpatient Sample (NIS) data from the Healthcare Cost and Utilization Project for 2012 and 2015 were analyzed using SPSS software for incidence of cannabis diagnoses. Previously defined NIS regions were assigned a policy status related to medical and recreational cannabis laws. Comparisons were made at the national and regional levels to better understand change in incidence of diagnoses. From 2012 to 2015, there was a 26.7% increase in cannabis-related diagnoses in the inpatient setting nationally. All 9 regions showed increases in the incidence of cannabis-related diagnoses ranging from 15.5% to 41.9% regardless of cannabis policy. As cannabis policy increased legal access, cannabis-related diagnoses increased nationally and regionally across the United States from 2012 to 2015 regardless of cannabis policy. Continued tracking of cannabis-related diagnoses is needed to identify where interventions are necessary to reduce negative impacts of increased cannabis use.

Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle?

BACKGROUND: Behavioral mechanisms that contribute to the association between breastfeeding and reduced obesity risk are poorly understood. The purpose of this study was to evaluate the hypothesis that feeding human milk from the breast (direct breastfeeding) has a more optimal association with subsequent child appetite regulation behaviors and growth, when compared to bottle-feeding. METHODS: Children (n = 109) aged 3- to 6- years were retrospectively classified as directly breastfed (fed exclusively at the breast), bottle-fed human milk, or bottle-fed formula in the first three months of life. Young children's appetite regulation was examined by measuring three constructs (satiety response, food responsiveness, enjoyment of food) associated with obesity risk, using the Child Eating Behavior Questionnaire. Multinomial logistic regression analyses were used to test whether children bottle-fed either human milk or formula had reduced odds of high satiety and increased odds of high food responsiveness and high enjoyment of food compared to children fed directly from the breast. Current child weight status and growth trends from 6-36 months were also examined for their relation to direct breastfeeding and appetite regulation behaviors in early childhood. RESULTS: Children fed human milk in a bottle were 67% less likely to have high satiety responsiveness compared to directly breastfed children, after controlling for child age, child weight status, maternal race/ethnicity, and maternal education. There was no association of bottle-feeding (either human milk or formula) with young children's food responsiveness and enjoyment of food. There was neither an association of direct breastfeeding with current child weight status, nor was there a clear difference between directly breastfed and bottle-fed children in growth trajectories from 6- to 36-months. More rapid infant changes in weight-for-age score were associated with lower satiety responsiveness, higher food responsiveness and higher enjoyment of food in later childhood CONCLUSION: While direct breastfeeding was not found to differentially affect growth trajectories from infancy to childhood compared to bottle-feeding, results suggest direct breastfeeding during early infancy is associated with greater appetite regulation later in childhood. A better understanding of such behavioral distinctions between direct breastfeeding and bottle-feeding may identify new pathways to reduce the pediatric obesity epidemic.

A Mixed Methods Case Study of Food Shopping in a Community with High Infant Mortality.

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment (n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores' nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.

The Impact of a Non-profit Market on Food Store Choice and Shopping Experience: A Community Case Study.

Research evaluating the impact of new food stores in "food deserts" have reported limited impact on eating and health outcomes of residents who live nearby. Few studies have reported on shoppers' food store choices and experiences in these new stores. This study focused on residents' experience with a new non-profit food market in Chester, PA and analyzes spatial patterns regarding who did and did not choose to shop at the new store. Phone surveys (n = 135) and in-person interviews (n = 13) were conducted with the primary food shopper for households living in Chester 1-2 years, respectively, after the opening of a store. Participants who shopped at the new market reported positive experiences in regard to convenience, customer service, food quality, and prices and believed that the new market had a positive impact on the community. But most participants had not shopped at the new market, citing many of the same factors in their decision to shop at supermarkets outside the city. Our findings underscore the need to combine new food retail strategies with community engagement and other interventions, such as in-store promotions and health education programs, to maximize the number of people who shop at new food outlets designed to improve access to healthful foods.

Plate size and children's appetite: effects of larger dishware on self-served portions and intake.

OBJECTIVES: Dishware size is thought to influence eating behaviors, but effects on children's self-served portion sizes and intakes have not been studied. We aimed to evaluate whether larger dishware increased children's self-served portion sizes and intake during meals. METHODS: A within-subjects experimental design was used to test the effects of dishware size (ie, plates and bowls) on children's self-served portion sizes and intakes in a naturalistic setting. Subjects were predominantly African American elementary school-aged children (n = 42) observed on repeated occasions during school lunch. Children served themselves an entree and side dishes using either child- or adult-size dishware, which represented a 100% increase in the surface area of plates and volume of bowls across conditions. Condition order was randomly assigned and counterbalanced across 2 first-grade classrooms. Entrées of amorphous and unit form were evaluated on separate days. Fruit and vegetable side dishes were evaluated at each meal. Fixed portions of milk and bread were provided at each meal. RESULTS: Children served more energy (mean = 90.1 kcal, SE = 29.4 kcal) when using adult-size dishware. Adult-size dishware promoted energy intake indirectly, where every additional calorie served resulted in a 0.43-kcal increase in total energy intakes at lunch (t = 7.72, P = .001). CONCLUSIONS: Children served themselves more with larger plates and bowls and consumed nearly 50% of the calories that they served. This provides new evidence that children's self-served portion sizes are influenced by size-related facets of their eating environments, which, in turn, may influence children's energy intake.