Informing State-Wide Coalition Efforts to Implement and Integrate Nutrition Best Practices in Early Care and Education: Focus Group Insights from Child Care Providers.

A healthy diet in early childhood is an important contributor to ensuring lifelong health and in reducing risk for obesity. The child care environment is critical to supporting nutrition as a majority of young children less than 5 years of age are enrolled in out-of-home care. In order to better understand barriers to implementing and integrating nutrition best practices, we conduced focus groups with child care providers (n = 25) in Illinois. Providers from low-income communities, rural communities, and communities of color were prioritized. Focus group participants reported several challenges including the high cost of nutritious food, picky eating, and their perception that parents did not set good examples at home. Many providers identified the Child and Adult Care Food Program (CACFP) as a critical resource in helping them implement best practices. Providers discussed needing and wanting more training, more money for food, and more parental support. These results indicate support for additional resources and sustained training and technical assistance to address perceived challenges. The evidence of the importance of CACFP in helping providers engage in nutrition best practices indicates support for expansion and strengthening of the program.

Oncology Registered Dietitian Nutritionists' Knowledge, Attitudes, and Practices Related to Food Insecurity among Cancer Survivors: A Qualitative Study.

BACKGROUND: Understanding the knowledge, attitudes, and practices pertaining to food insecurity among oncology registered dietitian nutritionists (RDNs) is critical to ensuring that cancer survivors have adequate nutrition-a fundamental component of successful treatment and recovery. OBJECTIVE: To qualitatively assess oncology RDNs' knowledge, attitudes, and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis. DESIGN: The qualitative cross-sectional study was conducted from September 2018 to January 2019. PARTICIPANTS AND SETTING: Forty-one oncology RDNs working with cancer survivors in various clinical settings across the United States participated. MAIN OUTCOME MEASURES: Participants completed a semistructured, in-depth interview via telephone, lasting an average of 49 minutes. STATISTICAL ANALYSES PERFORMED: Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program Dedoose was used to organize and analyze the data. RESULTS: Participants defined food insecurity (FI) as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the United Staes, has a greater influence on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs. CONCLUSIONS: Although Oncology RDNs have heard of FI, they do not routinely assess patients' food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs to enhance their ability to screen for and address FI with their patients.

"I took it off most of the time 'cause I felt comfortable": unmasking, trusted others, and lessons learned from a coronavirus disease 2019 reinfection: a case report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 reinfection prevalence is unknown. It is essential to understand reinfection symptoms and, importantly, the lived experience. CASE PRESENTATION: Case study design is the best method for understanding this contemporary pandemic and rare occurrence of reinfections. A 19-year-old White Non-Hispanic woman presented with presumed severe acute respiratory syndrome coronavirus 2 reinfection 6 weeks after initially mild symptomatic infection and consistent repeat negative results. Real-time reverse-transcription polymerase chain reaction from saliva was used for detection. Twice-weekly saliva samples were collected (a) before initial infection, (b) resumed on day 10 after initial infection until reinfection was detected, and (c) resumed on day 10 post-reinfection. A 1.5-hour virtual interview was conducted, transcribed, and independently analyzed by two researchers. Four themes emerged: (1) perceived invincibility or inevitability and subsequent immunity increases risk of transmission via inconsistent preventive behaviors; (2) normalcy desires, trusted others, and implicit social pressures to not wear masks and distance increase one's coronavirus disease 2019 risk; (3) physical symptoms are more severe with reinfection compared with first infection; and (4) mental health sequelae (trauma and stigma) are more severe and enduring than physical health outcomes. CONCLUSIONS: Unmasked social interactions contradicting public health recommendations were rationalized by social circle members with heavy reliance on feeling asymptomatic, lacking a positive test (testing negative or not testing), or attributing symptoms to allergies. Stigma of testing positive and consequences of not conforming to social group behaviors is overwhelming and creates pressure to take risks. This case study provides insights and lessons learned relevant for public health messaging and continued preventive behaviors.

What Do Childcare Providers Know about Environmental Influences on Children's Health? Implications for Environmental Health Literacy Efforts.

Children are uniquely vulnerable to toxicant exposures in their environment, which can have long-lasting impacts on their health. Childcare providers are an important population to target for environmental health literacy, as most children in the United States under five years of age spend a significant number of waking hours in non-parental care. There is an increasing body of evidence that children are exposed to toxicants in the childcare environment, and yet little is known about what childcare providers know about environmental influences on the health of children in their care. We conducted semi-structured interviews with 36 home- and center-based Illinois childcare providers to better understand their knowledge, attitudes, and behaviors as they relate to environmental influences on children's health. We found that the majority of providers had a low level of understanding of potential sources of exposure in the childcare environment, and they did not feel that environmental exposures posed a significant risk to children. Future efforts to increase environmental health literacy should focus on raising awareness and knowledge of environmental health issues for childcare providers before addressing ways that providers can reduce or prevent toxicant exposures to children in their care.

Do Infants in the First Year of Life Expect Equal Resource Allocations?

Recent research has provided converging evidence, using multiple tasks, of sensitivity to fairness in the second year of life. In contrast, findings in the first year have been mixed, leaving it unclear whether young infants possess an expectation of fairness. The present research examined the possibility that young infants might expect windfall resources to be divided equally between similar recipients, but might demonstrate this expectation only under very simple conditions. In three violation-of-expectation experiments, 9-month-olds (N = 120) expected an experimenter to divide two cookies equally between two animated puppets (1:1), and they detected a violation when she divided them unfairly instead (2:0). The same positive result was obtained whether the experimenter gave the cookies one by one to the puppets (Experiments 1-2) or first separated them onto placemats and then gave each puppet a placemat (Experiment 3). However, a negative result was obtained when four (as opposed to two) cookies were allocated: Infants looked about equally whether they saw a fair (2:2) or an unfair (3:1) distribution (Experiment 3). A final experiment revealed that 4-month-olds (N = 40) also expected an experimenter to distribute two cookies equally between two animated puppets (Experiment 4). Together, these and various control results support two broad conclusions. First, sensitivity to fairness emerges very early in life, consistent with claims that an abstract expectation of fairness is part of the basic structure of human moral cognition. Second, this expectation can at first be observed only under simple conditions, and speculations are offered as to why this might be the case.

Infants expect ingroup support to override fairness when resources are limited.

Recent research suggests that the foundations of human moral cognition include abstract principles of fairness and ingroup support. We examined which principle 1.5-y-old infants and 2.5-y-old toddlers would prioritize when the two were pitted against each other. In violation-of-expectation tasks, a puppet distributor brought in either two (two-item condition) or three (three-item condition) items and faced two potential recipients, an ingroup and an outgroup puppet. In each condition, the distributor allocated two items in one of three events: She gave one item each to the ingroup and outgroup puppets (equal event), she gave both items to the ingroup puppet (favors-ingroup event), or she gave both items to the outgroup puppet (favors-outgroup event). Children in the two-item condition looked significantly longer at the equal or favors-outgroup event than at the favors-ingroup event, suggesting that when there were only enough items for the group to which the distributor belonged, children detected a violation if she gave any of the items to the outgroup puppet. In the three-item condition, in contrast, children looked significantly longer at the favors-ingroup or favors-outgroup event than at the equal event, suggesting that when there were enough items for all puppets present, children detected a violation if the distributor chose to give two items to one recipient and none to the other, regardless of which recipient was advantaged. Thus, infants and toddlers expected fairness to prevail when there were as many items as puppets, but they expected ingroup support to trump fairness otherwise.

Productivity, impact, and collaboration differences between transdisciplinary and traditionally trained doctoral students: A comparison of publication patterns.

Transdisciplinary (TD) approaches are increasingly used to address complex public health problems such as childhood obesity. Compared to traditional grant-funded scientific projects among established scientists, those designed around a TD, team-based approach yielded greater publication output after three to five years. However, little is known about how a TD focus throughout graduate school training may affect students' publication-related productivity, impact, and collaboration. The objective of this study was to compare the publication patterns of students in traditional versus TD doctoral training programs. Productivity, impact, and collaboration of peer-reviewed publications were compared between traditional (n = 25) and TD (n = 11) students during the first five years of the TD program. Statistical differences were determined by t-test or chi square test at p < 0.05. The publication rate for TD students was 5.2 ± 10.1 (n = 56) compared to 3.6 ± 4.5 per traditional student (n = 82). Publication impact indicators were significantly higher for TD students vs. traditional students: 5.7 times more citations in Google Scholar, 6.1 times more citations in Scopus, 1.3 times higher journal impact factors, and a 1.4 times higher journal h-index. Collaboration indicators showed that publications by TD students had significantly more co-authors (1.3 times), and significantly more disciplines represented among co-authors (1.3 times), but not significantly more organizations represented per publication compared to traditional students. In conclusion, compared to doctoral students in traditional programs, TD students published works that were accepted into higher impact journals, were more frequently cited, and had more cross-disciplinary collaborations.

Do infants have a sense of fairness?

Two experiments examined infants' expectations about how an experimenter should distribute resources and rewards to other individuals. In Experiment 1, 19-month-olds expected an experimenter to divide two items equally, as opposed to unequally, between two individuals. The infants held no particular expectation when the individuals were replaced with inanimate objects, or when the experimenter simply removed covers in front of the individuals to reveal the items (instead of distributing them). In Experiment 2, 21-month-olds expected an experimenter to give a reward to each of two individuals when both had worked to complete an assigned chore, but not when one of the individuals had done all the work while the other played. The infants held this expectation only when the experimenter could determine through visual inspection who had worked and who had not. Together, these results provide converging evidence that infants in the 2nd year of life already possess context-sensitive expectations relevant to fairness.