Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey.

BACKGROUND: Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions. METHODS: We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points. RESULTS: A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points. CONCLUSIONS: Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.

Perceptions of a food benefit programme that includes financial incentives for the purchase of fruits and vegetables and restrictions on the purchase of foods high in added sugar.

OBJECTIVE: To report perspectives of participants in a food benefit programme that includes foods high in added sugar (FAS) restrictions and FAS restrictions paired with fruits and vegetables (F/V) incentives. DESIGN: Randomised experimental trial in which participant perspectives were an exploratory study outcome. SETTING: Participants were randomised into one of three Supplemental Nutrition Assistance Program (SNAP)-like food benefit programme groups: (1) restriction: not allowed to buy FAS with benefits; (2) restriction paired with incentive: not allowed to buy FAS with benefits and 30 % financial incentive on eligible F/V purchased using benefits; or (3) control: same food purchasing rules as SNAP. Participants were asked questions to assess programme satisfaction. PARTICIPANTS: Adults in the Minneapolis-St. Paul, MN metropolitan area, eligible for but not currently participating in SNAP who completed baseline and follow-up study measures (n 254). RESULTS: Among remaining households in each group, most found the programme helpful in buying nutritious foods (88·2 %-95·7 %) and were satisfied with the programme (89·1 %-93·0 %). Sensitivity analysis results indicate that reported helpfulness and satisfaction with the programme may in some instances be lower among the restriction and the restrictions paired with incentive groups in comparison to the control group. CONCLUSIONS: A food benefit programme that includes restriction on purchase of FAS or restriction paired with a financial incentive for F/V purchases may be acceptable to most SNAP-eligible households with children.

Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction intervention.

BACKGROUND: Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery personnel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach to examine potential explanatory factors that could distinguish higher from lower performing worksites based on reduced sedentary time. METHODS: We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12 worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services framework, we created an indicator of intervention fidelity related to adherence to the protocol and competence of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table containing implementation construct presence or absence), and used to examine differences between higher and lower performing worksites. RESULTS: There were substantive differences in the magnitude of change in sedentary time between higher (-75.2 min/8 h workday, CI95: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI95: -38.3, -22.7) performing worksites. Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in some of the lower performing sites suggesting we were unable to identify sufficient conditions to predict program success. CONCLUSIONS: Higher intervention adherence and implementer competence is necessary for greater program success. These findings illustrate the need for future research to identify what factors may influence intervention fidelity, and in turn, effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Efficacy of the 'Stand and Move at Work' multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial.

BACKGROUND: Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk. METHODS: Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months. RESULTS: Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was - 59.2 (CI: - 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (- 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat. CONCLUSIONS: Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

A yoga-based therapy program designed to improve body image among an outpatient eating disordered population: program description and results from a mixed-methods pilot study.

Poor body image is a critical barrier to eating disorder recovery. This pilot project was designed as a feasibility study to examine a novel group-based, therapeutic yoga and body image program (YBI) for addressing negative body image in those clinically diagnosed with an eating disorder (anorexia, bulimia nervosa, and other specified feeding or eating disorder) receiving outpatient level treatment at an eating disorder treatment center located in Minneapolis-St. Paul, Minnesota. Self-administered questionnaires were completed by 67 participants at the beginning and end of the 8-week series, to better understand the acceptability of the YBI program and its potential effects on body image and self-worth during outpatient eating disorder treatment. Quantitative survey questions assessed participants' body image concerns, while open-ended questions probed participants' experiences and the perceived impact of the yoga program on their body image. After completion of the yoga program, mean item scores on the body image concern survey improved: increases ranged from 0.3 to 0.8 points on a 5-point scale. In open-ended questions, participants described many positive changes to their body image. Participants reported that the yoga program improved their self-acceptance, self-awareness, confidence, emotional and physical strength, and was a positive form of release. Participants also discussed physical and emotional challenges of the yoga program and how they contributed to self-judgment, vulnerability, and confrontation of uncomfortable feelings. The results of this pilot study are promising and warrant consideration of more rigorous study designs to explore the potential of a body image specific therapeutic yoga program to aid those in eating disorder treatment to improve body image disturbances.

Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia.

INTRODUCTION: Vulvodynia is a debilitating, chronic vulvar pain condition. Community-based case-control studies have consistently shown associations between early-life chronic stressors and vulvodynia onset. AIM: We examined rumination as a specific stress response involved in the psychobiological mechanism of vulvodynia. METHODS: A psychosocial survey with questions specific to early-life traumatic events and rumination were administered to 185 matched case-control pairs of women with and without vulvodynia. Conditional logistic regression was used to examine associations between rumination constructs (ie, total rumination, emotion-focused, instrumental, and searching for meaning) and vulvodynia onset. Conditional logistic regression was also used to determine whether these associations depended on early-life stressors (ie, severity of childhood abuse and of self-reported antecedent traumatic events). Age at interview, antecedent pain disorders, any childhood abuse, and antecedent psychiatric morbidity were included as covariates. MAIN OUTCOME MEASURES: We estimated the odds of rumination in relation to the onset of vulvodynia within a community-based and clinically confirmed sample of women with and without vulvodynia. RESULTS: Vulvodynia was associated with the highest tertile of emotion-focused (odds ratio [OR] = 2.1; 95% CI = 1.2, 3.2) and instrumental (OR = 2.1; 95% CI = 1.1, 4.0) rumination. These associations were attenuated after additional adjustment for antecedent psychiatric morbidity. Among women who reported rumination about early-life stressors before vulvar pain in cases or matched reference age in control subjects, those with vulvodynia were >2 times more likely to report the highest tertile of total rumination (OR = 2.3; 95% CI = 1.1, 5.0) compared with those without vulvodynia. CLINICAL IMPLICATIONS: Healthcare providers may be able to identify subsets of women who could benefit from preventive measures before the development of vulvodynia. STRENGTH & LIMITATIONS: This is the first study to use a community-based and clinically confirmed sample of women with and without vulvodynia to examine the associations between rumination about early-life trauma and the onset of vulvodynia. However, as with all retrospective studies, the reporting of information (eg, traumatic events) was subject to recall bias and misclassification. CONCLUSION: Our findings indicate that a prolonged cognitive stress response (ie, rumination) may be 1 important mechanism by which early-life chronic stressors contribute to the onset vulvodynia. Prospective studies are recommended to examine whether and how cognitive, affective, and physiological components of prolonged stress responses interact to influence the development of vulvodynia. Understanding both the psychobiological and behavioral mechanisms may help in addressing and treating individuals to potentially reverse the development of vulvodynia. Khandker M, Brady SS, Rydell SA, et al. Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia. J Sex Med 2019;16:880-890.

Yoga's potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study.

BACKGROUND: A regular yoga practice may have benefits for young adult health, however, there is limited evidence available to guide yoga interventions targeting weight-related health. The present study explored the relationship between participation in yoga, healthy eating behaviors and physical activity among young adults. METHODS: The present mixed-methods study used data collected as part of wave 4 of Project EAT (Eating and Activity in Teens and Young Adults), a population-based cohort study in Minneapolis-St. Paul, Minnesota. Young adults (n = 1820) completed the Project EAT survey and a food frequency questionnaire, and a subset who reported practicing yoga additionally participated in semi-structured interviews (n = 46). Analyses of survey data were used to examine cross-sectional associations between the frequency of yoga practice, dietary behaviors (servings of fruits and vegetables (FV), sugar-sweetened beverages (SSBs) and snack foods and frequency of fast food consumption), and moderate-to-vigorous physical activity (MVPA). Thematic analysis of interview discussions further explored yoga's perceived influence on eating and activity behaviors among interview participants. RESULTS: Regular yoga practice was associated with more servings of FV, fewer servings of SSBs and snack foods, less frequent fast food consumption, and more hours of MVPA. Interviews revealed that yoga supported healthy eating through motivation to eat healthfully, greater mindfulness, management of emotional eating, more healthy food cravings, and the influence of the yoga community. Yoga supported physical activity through activity as part of yoga practice, motivation to do other forms of activity, increased capacity to be active, and by complementing an active lifestyle. CONCLUSIONS: Young adult yoga practitioners reported healthier eating behaviors and higher levels of physical activity than non-practitioners. Yoga should be investigated as an intervention for young adult health promotion and healthy weight management.

Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial.

BACKGROUND: This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. METHODS: Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. RESULTS: Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01). CONCLUSIONS: Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02643576 .

Social ecological correlates of workplace sedentary behavior.

BACKGROUND: To identify social ecological correlates of objectively measured workplace sedentary behavior. METHODS: Participants from 24 worksites - across academic, industrial, and government sectors - wore an activPAL-micro accelerometer for 7-days (Jan-Nov 2016). Work time was segmented using daily logs. Sedentary behavior outcomes included time spent sitting, standing, in light intensity physical activity (LPA, stepping cadence <100 steps/min), and in prolonged sitting bouts (>30 min). Outcomes were standardized to an 8 h work day. Two electronic surveys were completed to derive individual (job type and work engagement), cultural (lunch away from the desk, walking at lunch and face-to-face interaction), physical (personal printer and office type) and organizational (sector) factors. Mixed-model analyses with worksite-level clustering were performed to examine multi-level associations. Secondary analyses examined job type and sector as moderators of these associations. All models were adjusted for age, race/ethnicity and gender. RESULTS: Participants (N = 478; 72% female; age: 45.0 ± 11.3 years; 77.8% non-Hispanic white) wore the activPAL-micro for 90.2 ± 15.5% of the reported workday. Walking at lunch was positively associated with LPA (5.0 ± 0.5 min/8 h, P < 0.001). Regular face-to-face interaction was negatively associated with prolonged sitting (-11.3 ± 4.8 min/8 h, P < 0.05). Individuals in private offices sat more (20.1 ± 9.1 min/8 h, P < 0.05), stood less (-21.5 ± 8.8 min/8 h, P < 0.05), and engaged in more prolonged sitting (40.9 ± 11.2 min/8 h, P < 0.001) than those in public office space. These associations were further modified by job type and sector. CONCLUSIONS: Work-specific individual, cultural, physical and organizational factors are associated with workplace sedentary behavior. Associations vary by job type and sector and should be considered in the design of workplace interventions to reduce sedentary behavior. TRIAL REGISTRATION: Clinical trial No. NCT02566317 ; Registered Sept 22nd 2015.

Parental control and overconsumption of snack foods in overweight and obese children.

The associations between snack food consumption, parent feeding practices and general parenting in overweight in obese children are largely unknown. Therefore, we examined these relationships in 117 treatment-seeking overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± .39). Children consumed a dinner meal, completed an Eating in the Absence of Hunger (EAH) free access paradigm (total EAH intake = EAH%-total; sweet food intake = EAH%-sweet), and completed the Child Report of Parent Behavior Inventory. Parents completed the Child Feeding Questionnaire. Child EAH%-total and EAH%-sweet were positively associated with dinner consumption (p's < .01). Girls had significantly higher EAH%-total compared to boys (p < .05). In separate models, higher EAH%-total was associated with greater use of maternal psychological control (p < .05) and EAH%-sweet was positively associated with parent monitoring (p < .05). In analyses examining factors associated with the consumption of specific foods, EAH snack food, parent restriction, pressure to eat, monitoring, and maternal psychological control were positively correlated with intake of Hershey's(®) chocolate bars (p's < .05). In summary, parental monitoring is associated with child sweet snack food intake and maternal psychological control is associated with child total snack food consumption. Future research should evaluate the complex relationship between child eating and parenting, especially with regard to subgroups of foods.

The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children.

OBJECTIVE: To examine differences in parent feeding behaviors and general parenting of overweight children with and without loss of control (LOC) eating. METHOD: One-hundred-and-eighteen overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± 0.39) and their parents (42.42 ± 6.20 years; 91% female; 70% Caucasian; BMI: 31.74 ± 6.96 kg/m(2) ) were seen at a baseline assessment visit for a behavioral intervention that targeted overeating. The Eating Disorder Examination, adapted for children (ChEDE) was administered to assess for LOC eating. Parents completed the Parental Feeding Styles Questionnaire (PFSQ) and the Child Feeding Questionnaire (CFQ) to assess parent feeding styles and behaviors. Children also completed a self-report measure of general parenting (Child Report of Parent Behavior Inventory, CRPBI-30). RESULTS: Forty-three children (36.40%) reported at least one LOC eating episode in the month prior to assessment. Parents who reported greater restriction and higher levels of pressure to eat were more likely to have children that reported LOC eating (ps < 0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating (ps < 0.05). Child-reported parenting behaviors were unrelated to child LOC eating (ps > 0.05). DISCUSSION: Parent feeding styles and behaviors appear to be differentially and uniquely related to LOC eating in treatment-seeking overweight and obese children. Future research is needed to determine if implementing interventions that target parent feeding behaviors may reduce LOC eating, prevent full-syndrome eating disorders, and reduce weight gain in youth.

Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions.

OBJECTIVE: We used validated sensitive and specific questions associated with clinically confirmed diagnoses of unexplained vulvar pain (vulvodynia) to compare the cumulative incidence of vulvar pain and prevalence of care-seeking behavior in Boston metropolitan area (BMA) and in Minneapolis/Saint Paul metropolitan area (MSP) from 2001 through 2005 using census-based data, and 2010 through 2012, using outpatient community-clinic data, respectively. STUDY DESIGN: We received self-administered questionnaires from 5440 women in BMA and 13,681 in MSP, 18-40 years of age, describing their history of vulvar burning or pain on contact that persisted >3 months that limited/prevented intercourse. RESULTS: By age 40 years, 7-8% in BMA and MSP reported vulvar pain consistent with vulvodynia. Women of Hispanic origin compared to whites were 1.4 times more likely to develop vulvar pain symptoms (95% confidence interval, 1.1-1.8). Many women in MSP (48%) and BMA (30%) never sought treatment, and >50% who sought care with known health care access received no diagnosis. CONCLUSION: Using identical screening methods, we report high prevalence of vulvar pain in 2 geographic regions, and that access to health care does not increase the likelihood of seeking care for chronic vulvar pain.

An intervention based on Schachter's externality theory for overweight children: the regulation of cues pilot.

OBJECTIVE: This study evaluated the feasibility, acceptability, and initial efficacy of an intervention based on Schachter's externality theory; the Regulation of Cues (ROC) program. METHODS: 44 overweight and obese 8-12-year-old children and their parents were randomly assigned to a 4-month ROC program or the control group. Outcomes were assessed at baseline, posttreatment, and 4 months posttreatment and included acceptability and feasibility, body weight, and eating behaviors. RESULTS: The ROC program had moderate to high acceptability ratings. Significant improvements were found for the ROC group compared with the control group on child food responsiveness at posttreatment and eating in the absence of hunger at 4 months posttreatment. Improvements were seen for the ROC group compared with the control group on body weight measures and food responsiveness, although these only approached significance. CONCLUSION: The ROC intervention may be useful with overweight and obese children. Larger, fully powered studies are needed to further evaluate the efficacy of this model.

Concurrent and convergent validity of the eating in the absence of hunger questionnaire and behavioral paradigm in overweight children.

OBJECTIVE: This study aimed to assess the concurrent and convergent validity of the Eating in the Absence of Hunger (EAH) questionnaire parent report of child (EAH-PC) and child self-report (EAH-C) with the EAH behavioral paradigm (EAH%) and usual dietary intake. METHOD: Data were obtained at baseline assessment for 117 treatment-seeking overweight and obese (BMI > 85th percentile) 8- to 12-year old children (53% female, 54% white) and their parents. Children participated in the EAH free access paradigm after a standardized ad libitum meal. Parents and children completed EAH questionnaires, and the children completed three 24 h recalls. EAH External Eating subscale and total scores were assessed. RESULTS: EAH% was inversely associated with the EAH-PC total score (p < .04), however, it was not associated with the EAH-PC External Eating scale, EAH-C total score or EAH-C External Eating scale. Daily caloric intake was positively related to both the EAH-C total score (p < .02) and External Eating subscale (p < .007). Daily caloric intake was inversely related to EAH-PC total score (p < .05), but was not related to EAH-PC External Eating subscale or EAH%. DISCUSSION: Concurrent validity was not supported for EAH questionnaires, but convergent validity was supported for EAH-C and child daily caloric intake. Further research is warranted to assess whether EAH questionnaires and paradigm are measuring different aspects of EAH in treatment-seeking children.

Overeating phenotypes in overweight and obese children.

The purpose of this study was to identify overeating phenotypes and their correlates in overweight and obese children. One hundred and seventeen treatment-seeking overweight and obese 8-12year-old children and their parents completed the study. Children completed an eating in the absence of hunger (EAH) paradigm, the Eating Disorder Examination interview, and measurements of height and weight. Parents and children completed questionnaires that evaluated satiety responsiveness, food responsiveness, negative affect eating, external eating and eating in the absence of hunger. Latent profile analysis was used to identify heterogeneity in overeating phenotypes in the child participants. Latent classes were then compared on measures of demographics, obesity status and nutritional intake. Three latent classes of overweight and obese children were identified: High Satiety Responsive, High Food Responsive, and Moderate Satiety and Food Responsive. Results indicated that the High Food Responsive group had higher BMI and BMI-Z scores compared to the High Satiety Responsive group. No differences were found among classes in demographics or nutritional intake. This study identified three overeating phenotypes, supporting the heterogeneity of eating patterns associated with overweight and obesity in treatment-seeking children. These finding suggest that these phenotypes can potentially be used to identify high risk groups, inform prevention and intervention targets, and develop specific treatments for these behavioral phenotypes.

Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology.

Emotional eating is the tendency to eat in response to negative emotions. Prior research has identified a relationship between parenting style and child emotional eating, but this has not been examined in clinical samples. Furthermore, the relationship between specific parenting practices (e.g., parent feeding practices) and child emotional eating has not yet been investigated. The current study examined relationships between child emotional eating and both general and specific parenting constructs as well as maternal symptoms of depression and binge eating among a treatment-seeking sample of overweight children. Participants included 106 mother-child dyads who attended a baseline assessment for enrollment in a behavioral intervention for overeating. Ages of children ranged from 8 to 12 years old. Mothers completed self-report measures of their child's emotional eating behavior, their own feeding practices, and symptoms of depression and binge eating. Children completed a self-report measure of their mothers' general parenting style. A stepwise regression analysis was conducted to identify the parent variable that was most strongly related to child emotional eating, controlling for child age and gender. Emotional feeding behavior (i.e., a tendency to offer food to soothe a child's negative emotions) was the parent factor most significantly related to child emotional eating. Findings suggest that emotional feeding practices in parents may be related to emotional eating in children. Treatment with overweight children who engage in emotional eating may be improved by targeting parent feeding practices.

Effects of Inclusion of Food Purchase Restrictions and Incentives in a Food Benefit Program on Diet Quality and Food Purchasing: Results From a Randomized Trial.

BACKGROUND: There is interest in reshaping the Supplemental Nutrition Assistance Program (SNAP) to better support family nutrition. OBJECTIVE: The Grocery Assistance Program Study (GAPS) for Families evaluated the effects of prohibiting using program funds for the purchase of certain sugary foods on the nutritional quality of foods purchased and consumed by program participants. DESIGN: A randomized experimental trial was carried out with participants randomized to one of three food benefit conditions. Baseline and follow-up measures collected included interviewer-administered 24-hour dietary recalls, food purchase receipts, food security, height, and weight. PARTICIPANT/SETTING: Adult-child dyads in households eligible for SNAP but currently not enrolled were recruited from the Minneapolis/St Paul MN metropolitan area from May of 2018 through May of 2019. A total of 293 adult-child dyads received the intervention as allocated. Of these dyads, 233 adults completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 20.5%. A total of 224 children completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 23.5%. INTERVENTION: Participants were randomized to 1 of 3 conditions: restriction (not allowed to buy sugar-sweetened beverages [SSB], sweet baked goods, or candy with program funds); restriction paired with incentive (30% incentive for fruits and vegetables [FV] purchased with funds); and control (funds provided with no restrictions or incentives). Funds were provided on a 4-week cycle for 20 weeks via a study-provided debit card. MAIN OUTCOME MEASURES: The primary outcome was the Healthy Eating Index (HEI)-2015 total score. Additional outcomes included selected HEI-2015 component scores; energy intake; food security; body weight; and purchasing of SSB, sweet baked goods, candies, fruits, and vegetables. STATISTICAL ANALYSIS: Linear regression analyses were conducted with change in the outcome regressed on treatment condition for the primary outcome analyses. RESULTS: No differences were observed between conditions in change in the nutrition and food security measures examined. Purchases of SSB and sweet baked goods and candies significantly differed by experimental condition. Purchase of restricted foods was lower at follow-up in the restriction and restriction paired with incentive conditions compared with the control condition. For example, spending on SSB at follow-up was significantly lower in the restriction ($2.66/week) and restriction paired with incentive ($2.06/week) conditions in comparison with control condition ($4.44/week) (P < 0.0003 and P < 0.0001, respectively). CONCLUSIONS: This study failed to find evidence in support of prohibiting the purchase of sugary foods with food program funds as a strategy to improve program participant nutrition, even when paired with an FV incentive. Research carried out in the context of the SNAP program is needed for a more robust evidence base.

Perceived stereotyping and seeking care for chronic vulvar pain.

OBJECTIVES: We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. DESIGN: Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". SETTING AND PARTICIPANTS: Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. OUTCOME MEASURES: Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. RESULTS: Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). CONCLUSIONS: Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized.

Results from an experimental trial at a Head Start center to evaluate two meal service approaches to increase fruit and vegetable intake of preschool aged children.

BACKGROUND: Strategies to increase fruit and vegetable consumption of preschool aged children are needed. OBJECTIVES: Evaluate the independent effects of the following meal service strategies on intake of fruits and vegetables of preschool children: 1.) Serving fruits and vegetables in advance of other menu items as part of traditional family style meal service; and 2.) Serving meals portioned and plated by providers. METHODS: Fifty-three preschool aged children completed a randomized crossover experiment conducted at a Head Start center in Minneapolis, MN. Over a six week trial period each of the experimental meal service strategies (serving fruits and vegetable first and serving meals portioned by providers) was implemented during lunch service for two one-week periods. Two one-week control periods (traditional family style meal service with all menu items served at once) were also included over the six week trial period. Childrens lunch intake was observed as a measure of food and nutrient intake during each experimental condition. RESULTS: Fruit intake was significantly higher (p<0.01) when fruits and vegetables were served in advance of other meal items (0.40 servings/meal) compared to the traditional family style meal service control condition when they were served in tandem with other menu items (0.32 servings/meal). Intakes of some nutrients found in fruits (vitamin A and folate) were concomitantly higher. In contrast, fruit and vegetable intakes were significantly lower and energy intake significantly higher during the provider portioned compared with control condition. CONCLUSIONS: Serving fruits in advance of other meal items may be a low cost easy to implement strategy for increasing fruit intake in young children. However, serving vegetables first does not appear to increase vegetable intake. Results provide support for current recommendations for traditional family style meal service in preschool settings.

Cost and cost-effectiveness of the 'Stand and Move at Work' multicomponent intervention to reduce workplace sedentary time and cardiometabolic risk.

OBJECTIVE: Few studies have reported the cost and cost-effectiveness of workplace interventions to reduce sedentary time. The purpose of this study was to complete an economic evaluation of a multilevel intervention to reduce sitting time and increase light-intensity physical activity (LPA) among employees. METHODS: We conducted a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a 12-month multilevel intervention with (STAND+) and without (MOVE+) a sit-stand workstation, across 24 worksites (N=630 employee participants) enrolled in a cluster randomized clinical trial. We estimated the intervention costs using activity-based costing strategy. The intervention costs were further expressed as per person and per worksite. CEA was conducted using an incremental cost-effectiveness ratio (ICER) metric, expressed as costs for additional unit of sitting time (minute/day), LPA (minutes/day), cardiometabolic risk score, and quality-adjusted life years (QALY) increased/decreased at 12 months. We assessed the cost analysis and CEA from the organizational (ie, employer) perspective with a one-year time horizon. RESULTS: Total intervention costs were $134 and $72 per person, and $3939 and $1650 per worksite for the STAND+ (N worksites = 12; N employees = 354) and MOVE+ (N worksites = 12; N employees = 276) interventions, respectively. The ICER was $1 (95% CI $0.8-1.4) for each additional minute reduction of workplace sitting time (standardized to 8-hour workday); and $4656 per QALY gained at 12 months. There was a modest and non-significant change of loss of work productivity improvement (-0.03 hours, 95% CI -4.16-4.09 hours), which was associated with a $0.34 return for every $1 invested. CONCLUSIONS: The multi-level intervention with sit-stand workstations has the potential to be widely implemented to reduce workplace sitting time. Future research into work productivity outcomes in terms of cost-benefits for employers is warranted.