Education as a Moderator of Help Seeking Behavior in Subjective Cognitive Decline.

OBJECTIVE: Disparities in Alzheimer disease (AD) and differences in help seeking (HS) across sociodemographic groups warrant public health concern. Research addressing such disparities must shift toward the earliest clinical manifestations of AD to optimize diagnosis, intervention and care planning. Subjective cognitive decline (SCD), a risk state for AD, provides an important context in which to examine sociodemographic-related disparities in HS. PARTICIPANTS AND METHODS: One hundred sixty-seven cognitively healthy older adults (M age =73, M education =16) (26.4% Black, Asian, or "Other") completed SCD questionnaire, HS questions, and mood measures (depression and anxiety). Binary logistic adjusted regressions examined: (a) the association between SCD and HS; and (b) the extent to which education moderated the relationship between SCD and HS. SCD [b = 0.06, SE=0.13, P <0.001, odds ratio=1.06, 95% CI (1.03, 1.08)] and education [b=0.32, SE=0.09, P <0.001, odds ratio=1.37, 95% CI (1.15, 1.64)] were independently associated with HS, with significant interaction between education and SCD on HS [b=0.2, SE=0.01, P =0.01, odds ratio=1.02, 95% CI (1.00, 1.03)]. CONCLUSIONS: Findings elucidate the importance of tailoring SCD-related psychoeducational resources depending on educational background as a preliminary stepping-stone in encouraging HS among older adults who may be at particular risk for developing dementia.

Financial decision-making and self-awareness for financial decision-making is associated with white matter integrity in older adults.

Financial decision-making (FDM) and awareness of the integrity of one's FDM abilities (or financial awareness) are both critical for preventing financial mistakes. We examined the white matter correlates of these constructs and hypothesized that the tracts connecting the temporal-frontal regions would be most strongly correlated with both FDM and financial awareness. Overall, 49 healthy older adults were included in the FDM analysis and 44 in the financial awareness analyses. The Objective Financial Competency Assessment Inventory was used to measure FDM. Financial awareness was measured by integrating metacognitive ratings into this inventory and was calculated as the degree of overconfidence or underconfidence. Diffusion tensor imaging data were processed with Tracts Constrained by Underlying Anatomy distributed as part of the FreeSurfer analytic suite, which produced average measures of fractional anisotropy and mean diffusivity in 18 white matter tracts along with the overall tract average. As expected, FDM showed the strongest negative associations with average mean diffusivity measure of the superior longitudinal fasciculus -temporal (SLFT; r = -.360, p = .011) and -parietal (r = -.351, p = .014) tracts. After adjusting for FDM, only the association between financial awareness and average mean diffusivity measure of the right SLFT (r = .310, p = .046) was significant. Overlapping white matter tracts were involved in both FDM and financial awareness. More importantly, these preliminary findings reinforce emerging literature on a unique role of right hemisphere temporal connections in supporting financial awareness.

Examining the Role of Aging Perceptions in Subjective Cognitive Decline.

OBJECTIVE: While subjective cognitive decline (SCD) is gaining ground as a "preclinical" risk state for Alzheimer disease, its utility depends on our understanding of the factors linked to SCD. Rarely examined sociocultural factors including perceptions of aging may relate to the subjective experience of cognitive aging. Identifying such associations will help to refine the utility of SCD as an early marker of AD while setting the stage for addressing modifiable factors contributing to SCD. METHODS: The study consisted of N=136 participants (68% female; 73% White; 22% Black race, age mean =74.72; education mean =16.01). Questionnaires assessed SCD, depressive symptoms, and age perceptions (essentialist aging beliefs, subjective age, age group identification, and explicit/implicit age stereotypes). Cognitive functioning was measured with a semantic interference and learning task. RESULTS: SCD was correlated with essentialist aging beliefs, age identification, and depressive symptoms [ rrange =0.18 to 0.22, Prange =0.009 to 0.02, confidence interval (CI) range =0.00-0.39]. Essentialist aging beliefs were correlated with subjective age and age group identification ( rrange =0.22 to 0.42, Prange <0.001 to 0.003, CI range =0.08-0.57). Both age group identification and essentialism were correlated with depressive symptoms ( rrange =0.22, Prange =0.009 to 0.01, CI range =0.04-0.39). In the adjusted regression model including depressive symptoms, age perceptions, and SCD, only SCD was associated with cognition ( b =-0.31, P <0.001). CONCLUSION: Although correlated with SCD, perceptions of aging do not explain the relationship between SCD and performance on a sensitive cognitive test among older adults.

Serotonin type-3 receptors differentially modulate anxiety and aggression during withdrawal from adolescent anabolic steroid exposure.

Male Syrian hamsters (Mesocricetus auratus) administered anabolic/androgenic steroids during adolescent development display increased aggression and decreased anxious behavior during the adolescent exposure period. Upon withdrawal from anabolic/androgenic steroids, this neurobehavioral relationship shifts and hamsters exhibit decreased aggression and increased anxious behavior. This study investigated the hypothesis that alterations in anterior hypothalamic signaling through serotonin type-3 receptors modulate the behavioral shift between adolescent anabolic/androgenic steroid-induced aggressive and anxious behaviors during the withdrawal period. To test this, hamsters were administered anabolic/androgenic steroids during adolescence then withdrawn from drug exposure for 21 days and tested for aggressive and anxious behaviors following direct pharmacological manipulation of serotonin type-3 receptor signaling within the latero-anterior hypothalamus. Blockade of latero-anterior hypothalamic serotonin type-3 receptors both increased aggression and decreased anxious behavior in steroid-treated hamsters, effectively reversing the pattern of behavioral responding normally observed during anabolic/androgenic steroid withdrawal. These findings suggest that the state of serotonin neural signaling within the latero-anterior hypothalamus plays an important role in behavioral shifting between aggressive and anxious behaviors following adolescent exposure to anabolic/androgenic steroids.

"Everything else comes first": a mixed-methods analysis of barriers to health behaviors among military spouses.

BACKGROUND: Military spouses are integral to the health of their families, but have demonstrated elevated levels of stress, depression, and anxiety. Participating in health behaviors such as physical activity and healthy eating may have a positive impact on spouses' physical and mental health, but emerging evidence suggests spouses' participation in these behaviors is scarce. Thus, the purpose of this study was to examine the most frequently reported barriers to health behaviors among military spouses. METHODS: Military spouses were recruited to complete surveys (N = 230) or participate in focus group sessions (N = 22). On the surveys, participants indicated up to 3 of their most frequent barriers to physical activity, diet, social connection, and stress management. Responses were coded and summed to identify the most commonly reported barriers to each health behavior. Subsequently, focus group sessions were conducted to gain a more in-depth understanding of the challenges military spouses face when trying to maintain a healthy lifestyle. Focus group transcripts were coded using thematic data analysis to identify the most frequently discussed barriers for each behavior. RESULTS: On the surveys, lack of time was the most prevalent barrier for physical activity, social connection, and stress management, and the second most prevalent barrier for diet. Financial concerns were the most prevalent barrier to maintaining a healthy diet. Barriers related to parent/family responsibilities were commonly reported across all health behaviors. During the focus group sessions, the transient military lifestyle was reported to have a significant impact on all of the health behaviors. Other military-related stressors including deployments and the necessity to "do it all" alone were frequently discussed. Many participants exhibited rigid definitions of what "counts" as exercise or health eating. Overall, participants reported sacrificing participation in health behaviors to attend to other priorities. CONCLUSIONS: Military spouses reported numerous barriers to health behaviors that made it difficult for them to prioritize their own health and well-being. Although some of the barriers reported were similar to barriers reported by civilians, unique stressors associated with military life further impeded participation in health behaviors. These findings can be used to inform future health promotion interventions for military spouses.

Perceptions of Preventable Cancer Burden Among US-Based Firefighters: A Mixed Methods Cross-Sectional Study.

OBJECTIVE: Characterize experiences with cancer and perceptions of the preventable cancer burden attributable to diet among firefighters. DESIGN: A cross-sectional survey was distributed to assess cancer history and perceptions of cancer. SETTING: US. PARTICIPANTS: US-based firefighters. MAIN OUTCOME MEASURE(S): History of cancer, perceptions of cancer, and perceptions of diet as a means to prevent cancer. ANALYSIS: Descriptive statistics and use of the Behaviour Change Technique Taxonomy v1 (BCTTv1) to evaluate qualitative responses. RESULTS: A total of 471 firefighters participated. Nearly half (48.4%) voiced they strongly agreed that they were at risk for cancer, whereas 44.6% agreed that changing diet could decrease cancer risk. The most common BCTTv1 codes focused on types of education, including "Instruction on how to perform the behavior" (45.1%, n = 189), followed by those centered on behavior execution (eg, "Action planning" [24.8%, n = 104]). Qualitatively, many were concerned about misinformation. CONCLUSIONS AND IMPLICATIONS: Firefighters acknowledge the role of diet in cancer risk and have a desire for knowledge and behavioral support (eg, goal setting) that includes an emphasis on evidence and tackling misinformation. This information should serve as the basis of future interventions that target diet.

Opportunities for Maximizing the Dietary Quality of Fad Diets.

The quality of American diets, measured by the Healthy Eating Index (HEI), has remained stable and low since 2005. The Dietary Guidelines for Americans 2020-2025 call for research analyzing dietary patterns to determine how guidelines might be altered to increase healthy eating. The present paper seeks to determine the dietary quality of popular fad dietary patterns among Americans. A definition of "fad diet" was created, and Google Trends© was searched for popular diets to determine popular dietary patterns based on the fad diet definition. Finally, eight dietary patterns were identified for inclusion. One-week sample menus were created for each dietary pattern, maximizing alignment with the DGAs but staying within the dietary pattern parameters, and then scored according to the HEI 2015 to determine the dietary quality. Total HEI scores ranged from 26.7 (Carnivore) to 89.1 (Low-FODMAP); the six highest total HEI scores were in the range of 77.1-89.1 out of 100 points. This analytical approach showed that some of the included popular fad dietary patterns have the potential to attain a high dietary quality. Rather than suggesting one "best" diet or dietary pattern, there is opportunity to maximize dietary quality in the context of dietary patterns that are considered fad diets.

Relationship between Body Mass Index and Health and Occupational Performance among Law Enforcement Officers, Firefighters, and Military Personnel: A Systematic Review.

The prevalence of overweight and obesity among tactical populations is estimated at 70%-75%, which may negatively impact health and performance. The relationship between BMI and health and performance is well established among the general population, however, literature on such relationships among tactical populations has yet to be reviewed and evaluated. The purpose of this study was to systematically review available literature on the relationship between BMI and health and occupational performance among law enforcement officer, firefighters, and military personnel. After reviewing the literature, 27 articles were included. Nine studies found BMI was positively associated with cardiovascular disease (CVD) risk factors. Studies involving BMI and cancer were lacking. One study found BMI was positively associated with type 2 diabetes (T2DM) risk. Five studies on occupational/physical performance and 12 studies on injury found a higher BMI was often indicative of decreased performance and increased risk of injury in general, but protective against stress fractures. Overall, higher BMI was often associated with negative health and performance outcomes among tactical populations, especially when beyond the overweight classification. Public health practitioners should focus efforts on improving nutrition and physical activity to promote a healthy BMI among these individuals.

Breastfeeding among South Sudanese refugees in protracted settlements in Adjumani district, Uganda: facilitators and barriers.

BACKGROUND: Evidence suggests that forced migration and refugee status may adversely impact mothers' breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda. METHODS: This study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15-16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12. RESULTS: Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers' fear of pain during breastfeeding and maternal mental health issues. CONCLUSION: Interventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations.

Association of Subjective Cognitive Decline With Progression to Dementia in a Cognitively Unimpaired Multiracial Community Sample.

BACKGROUND AND OBJECTIVES: This prospective study seeks to examine the utility of subjective cognitive decline (SCD) as a marker of future progression to dementia in a community-based cohort of non-Latinx White, non-Latinx Black, and Latinx individuals. Debate surrounds the utility of SCD, the subjective perception of decline in one's cognition before such impairment is evident in traditional neuropsychological assessments, as an early indicator of impending Alzheimer disease. Unfortunately, most studies examining SCD have been conducted in non-Latinx White samples and commonly exclude groups of individuals shown to be most vulnerable to dementia. METHODS: Participants were enrolled into this cohort study from the Washington Heights-Inwood Columbia Aging Project if they were cognitively unimpaired, had baseline measurement of SCD, and self-identified as non-Latinx White, non-Latinx Black, or Latinx. SCD was measured as a continuous sum of 10 items assessing cognitive complaints. Competing risk models tested the main effects of baseline SCD on progression to dementia. Models were adjusted for age, sex/gender, years of education, medical comorbidity burden, enrollment cohort, and baseline memory test performance with death jointly modelled as a function of race/ethnicity. RESULTS: A total of 4,043 (1,063 non-Latinx White, 1,267 non-Latinx Black, and 1,713 Latinx) participants were selected for this study with a mean age of 75 years, 67% women, and with a mean follow-up of 5 years. Higher baseline SCD was associated with increased rates of incident dementia over time in the full sample (hazard ratio [HR] 1.085, CI 1.047-1.125, p < 0.001) and within Latinx (HR 1.084, CI 1.039-1.130, p < 0.001) and non-Latinx Black individuals (HR 1.099, CI 1.012-1.194, p = 0.024). DISCUSSION: Overall results of this study support SCD as a prodromal marker of dementia in a multiracial community sample, and in Latinx and non-Latinx Black individuals in particular. Because models examining the risk of dementia were adjusted for baseline memory test performance, the results support the idea that SCD, a subjective reflection of one's own current cognitive functioning, contributes information above and beyond standard memory testing. Current findings highlight the importance of carefully evaluating any memory concerns raised by older adults during routine visits and underscore the potential utility of screening older adults for SCD.

Analysis of a State Police Academy Menu Cycle for Dietary Quality and Performance Nutrition Adequacy.

Law enforcement officers have high rates of overweight and obesity. With diet as a leading risk factor, training academies present an opportunity for early-career nutrition intervention. Our purpose was to determine the dietary quality (DQ) and performance nutrition adequacy of a state police academy's cafeteria menu. This cross-sectional content analysis included six weeks (three daily meals, Monday-Friday) of a police academy menu. Nutrient content was determined by portioning menus, gathering food specifications, and performing nutrient analysis. DQ was assessed using the Healthy Eating Index (HEI) 2015. Statistical analyses included independent t-tests and Cohen's d. The total HEI score was 54/100. Subcomponent scores indicating adequacy included added sugar (5/5), total protein (4.97/5) and whole fruits (4.77/5). Seafood/plant proteins (0.33/5), fatty acid ratio (1.31/5), and dairy scores (1.59/10) needed significant improvement. The menu met the recommended intake for 13 of 19 nutrients investigated. Nutrients that did not meet adequacy were calories (% mean difference, needs-menu = 36.7%), carbohydrates (52.3%), vitamins D (82.5%) and E (66.7%), magnesium (44.1%), and potassium (41.8%). The academy menu leaves room for improvement in DQ and shortfall nutrients. By increasing low scores, the overall DQ of the menu will increase and supplement missing nutrients.

The Nutritional Adequacy and Diet Quality of Vegetarian Menu Substitutions in Urban Kansas Childcare Centers.

While plant-based eating has become increasingly popular, little is known of how this trend has impacted childcare center meals. The purpose of this study was to measure the nutrient content and diet quality of vegetarian alternative lunches and compare these measures to those of standard childcare lunches and nutrient benchmarks representing one-third of the Dietary Reference Intake for 3-year-olds and 4-5-year-olds. Menu data were obtained from seven urban Kansas childcare centers participating in the Child and Adult Care Food Program and regularly providing a vegetarian alternative lunch. The centers provided detailed menu information for 27 days' worth of meals. The most common vegetarian substitution was cheese, which was used to fulfill all or part of the meat/meat alternative requirement in over three-quarters of the vegetarian alternative meals (n = 22). Compared to the standard meals, the vegetarian alternative meals were higher in calories, fat, saturated fat, calcium, and sodium and lower in protein, choline, and diet quality (p = 0.05). Both lunch options met the benchmarks for vitamin A, vitamin D, vitamin B12, calcium, and protein. Iron content for both (95% CI: standard 1.61-2.17 mg; vegetarian 1.37-2.7 mg) was below the benchmark. Although additional research is needed to better understand how vegetarianism has impacted childcare meals in the U.S., important differences in the nutrient contents were observed between the standard and vegetarian alternative meals. In addition, the results suggest vegetarian alternative meals that rely heavily on cheese may be of lower diet quality.

Subjective Cognitive Decline Is More Accurate When Metamemory Is Better.

Objective: Subjective cognitive decline (SCD) has emerged as one of the first manifestations of Alzheimer's disease (AD). However, discrepancies in its relationship with tests of memory and other cognitive abilities have hindered SCD's diagnostic utility. Inter-individual heterogeneity in metamemory, or memory awareness, and the use of clinical measures of cognition lacking sensitivity to early cognitive dysfunction, may contribute to these discrepancies. We aimed to assess if the relationship between SCD and markers of early cognitive dysfunction is moderated by metamemory abilities. Methods: The sample included 79 cognitively healthy older adults (77% female, 68% White, and 32% Black participants) with a mean age of 74.4 (SD = 6.1) and 15.9 (SD = 2.7) years of education. Metamemory was assessed using an episodic Feeling of Knowing test with four 5-item trials. Outcome measures included a resolution metric defined as a gamma correlation reflecting the accuracy of item-level predictions ("Will you know the correct answer?"). Early cognitive dysfunction was measured through the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) and the Short-Term Memory Binding Test (STMB), measures sensitive to preclinical AD. SCD was assessed with a 20-item questionnaire that asked participants to compare themselves to others their age on a 7-point Likert scale. Regression analyses examined whether a potential relation between SCD and early cognitive dysfunction was moderated by metamemory. Results: Subjective cognitive decline was associated with susceptibility to semantic proactive interference such that greater complaints were associated with increased susceptibility to semantic proactive interference (b = -0.30, p = 0.003) only. Metamemory moderated the association between SCD and susceptibility to and recovery of semantic proactive interference such that those with more accurate metamemory showed a stronger association between increased complaints and susceptibility to semantic proactive interference (b = -0.71, p = 0.005; b = -0.62, p = 0.034). Metamemory, however, did not moderate the association of SCD with retroactive semantic interference nor short term memory binding. Discussion: The accuracy of an individual's metamemory, specifically their ability to adjust moment to moment predictions in line with their performance, can influence the extent to which SCD maps onto objective cognition. Such self-referential assessment should be considered when interpreting SCD.

Self-awareness for financial decision making abilities is linked to right temporal cortical thickness in older adults.

Everyday financial decision making and the awareness of the integrity of one's financial decision making abilities (or financial awareness) are both critical to study in older adults as they can help identify those at risk for making suboptimal financial decisions and prevent financial loss. In the current study, we examined the cognitive and cortical thickness correlates of financial decision making and financial awareness in 59 community-dwelling participants co-enrolled in a larger study (mean age=68.35 years (SD=5.5), mean education=15.91 (SD=2.36), 61% = women, 67% = White, 30% = Black participants). Data from standardized measures of financial decision making and cognition was investigated along with FreeSurfer (v. 5.3) derived thickness regions. Based on metacognitive frameworks, financial awareness was measured along with a well-validated measure of memory awareness. Results revealed that numeracy, executive functioning and vocabulary were associated with financial decision making, whereas in analysis adjusted for financial decision making, memory awareness relative to cognition was most strongly linked to financial awareness. No significant associations between thickness and financial decision making were found. However, both financial and memory awareness were associated with the same right-hemisphere temporal thickness regions underscoring the idea of a common substrate of awareness. Interestingly, our findings converge with the emerging work on financial exploitation in which the right sided temporal regions have been found to play a prominent role. Incorporating the contributing role of self-awareness in various models of financial exploitation will be an important consideration for future studies.

Optimizing Subjective Cognitive Decline to Detect Early Cognitive Dysfunction.

BACKGROUND: The utility of subjective cognitive decline (SCD) as an indicator of preclinical AD is overshadowed by its inconsistent association with objective cognition. OBJECTIVE: This study examines if manipulations of SCD measurement affect its association with early cognitive dysfunction characteristic of preclinical AD. METHODS: Cognitively healthy older adults (n = 110) completed SCD questionnaires that elicited complaints in general, compared to 5 years ago (retrospective SCD) and compared to their peers (age-anchored SCD) in binary and Likert scales. Outcome cognitive tasks included an associative memory task (Face-Name Test), a visual short-term memory binding task (STMB test), and a clinical neuropsychological list learning test (Selective Reminder Test). RESULTS: SCD complaints, when compared to age-matched peers (age-anchored SCD) were endorsed less frequently than complaints compared to 5 years ago (retrospective SCD) (p < 0.01). In demographically adjusted regressions, age-anchored ordinal-rated SCD was associated with short term memory binding (ß= -0.22, p = 0.040, CI = -0.45, -0.01), associative memory (ß= -0.26, p = 0.018, CI = -0.45, -0.06), and list learning (ß= -0.31, p = 0.002, CI = -0.51, -0.12). Retrospective and general ordinal-rated SCD was associated with associative memory (ß= -0.25, p = 0.012, CI = -0.44, -0.06; ß= -0.29, p = 0.003, CI = -0.47, -0.10) and list learning only (ß= -0.25, p = 0.014, CI = -0.45, -0.05; ß= -0.28, p = 0.004, CI = -0.48, -0.09). CONCLUSION: Ordinal age-anchored SCD appears better suited than other SCD measurements to detect early cognitive dysfunction characteristic of preclinical AD.

A Model for Improving Diet Quality within Child Nutrition Programs: The U.S. Army's Child and Youth Services Healthy Menu Initiative.

The U.S. Army's Child, Youth, and School Services (CYS), which has the capacity to serve more than 70,000 meals/snacks per day, is a geographically dispersed system with facilities worldwide. This case report is a description and evaluation of the implementation of a major food program initiative within the CYS system. In collaboration with Kansas State University, the Healthy Menu Initiative was established to standardize the system's menus, reflect the guidance contained within the 2015-2020 Dietary Guidelines for Americans, and take into account the Child and Adult Care Food Program regulations that went into effect on 1 October 2017. Food storage space, food service equipment, product availability, food safety considerations, and staff shortages have all proven to be challenges in the development and implementation of the menus. Participant acceptance has been an issue in some instances, and special diet requirements add to the workload of the staff. To overcome these challenges, input was solicited from CYS management, care providers, food service staff, and participant families, as well as participants themselves. Taste testing and classroom cooking activities have been developed to increase acceptance, and over 500 CYS food program staff have attended in-depth training sessions to support the initiative. Overall, the initiative has been well received, and there has been an improvement in the diet quality of the foods served within the program. This improvement is noteworthy, as optimal growth and development during childhood and adolescence are reliant on sound nutrition.

Evaluation of Variability in Dietary Quality of School Lunches Meeting National School Lunch Program Guidelines by Socioeconomic Status and Rurality.

Research suggests that the dietary quality (DQ) of school lunches meeting the National School Lunch Program (NSLP) requirements may vary significantly. Possible drivers of variation include factors, such as socioeconomic status (SES) and rurality. The purpose of this cross-sectional study was to determine whether there was variation in nutrient content and DQ by SES and rurality, when analyzing middle school lunch menus meeting NSLP requirements. A random sample of 45 Kansas middle school lunch menus each were obtained from websites of randomly selected districts from low- and high-SES strata. Thirty-day menus were analyzed for nutrient content. Healthy Eating Index (HEI) 2015 scores were calculated for DQ. Rurality was determined for schools by National Center for Education Statistics (NCES) locale. There were significant differences in added sugar (p < 0.001) and calcium (p = 0.001) favoring high-SES menus, and in sodium (p = 0.001) favoring low-SES menus. There were no nutrient differences by rurality. The HEI scores were not different by SES or rurality, with a mean score (SD) 61.9 (2.6) across all schools. Middle school lunch DQ in Kansas does not vary by SES or rurality. Efforts to improve DQ should focus on all foodservice operations, not specifically low-SES or rural schools.

Acceptability and Feasibility of Best Practice School Lunches by Elementary School-Aged Children in a Serve Setting: A Randomized Crossover Trial.

BACKGROUND: National School Lunch Program (NSLP) standards have improved school lunch dietary quality (DQ), however, further improvements could be made. Acceptability and feasibility of higher DQ are potential barriers. Thus, the purpose is to compare acceptability and feasibility of best practice (BPSL, optimizing DQ) with typical school lunches (TSL, meeting minimum NSLP standards) served separately and concurrently. METHODS: Forty elementary school-aged participants were recruited for a randomized crossover trial. Participants attended three meal conditions (MC) choosing one of two meal types-MC1) BPSL1/BPSL2, MC2) TSL1/TSL2, MC3) BPSL/TSL. Acceptability included taste test surveys, weighted plate waste assessments, and hunger scales. Feasibility included meal cost, time, and skill and equipment requirements. RESULTS: There were no significant differences in total taste test score, average total plate waste, or change in hunger (ps > 0.017) before or after adjusting for covariates. TSL was selected significantly more often in MC3 (TSL = 83.3%, BPSL = 16.7%, p = 0.001). Meal cost (p = 0.783) and skill and equipment requirements were not significantly different between meal types. BPSL required significantly longer preparation time (TSL = 60 ± 25 min, BPSL = 267 ± 101 min, p = 0.026). CONCLUSIONS: Results indicate few differences in acceptability and feasibility between BPSL and TSL. This study could inform decision and policy-makers seeking to improve school lunch DQ and acceptance of higher DQ meals.

Variability in Dietary Quality of Elementary School Lunch Menus with Changes in National School Lunch Program Nutrition Standards.

National School Lunch Program (NSLP) standards recently changed significantly. The Healthy, Hunger-Free Kids Act (HHFKA) presumably improved the dietary quality (DQ) of meals, whereas Child Nutrition Program (CNP) Flexibilities appear to decrease DQ. This variability has not been quantified. Our objective was to determine differences in DQ between elementary school lunch menus meeting NSLP standards: School Meal Initiative (SMI), HHFKA, CNP Flexibilities, and evidence-based best practices (BP). A base menu was portioned per NSLP standards and analyzed for nutrient content and DQ. Statistical analyses included 1-factor ANOVA, Kruskal-Wallis, and Dunnett's test. The BP menu had higher whole fruit and whole grain Healthy Eating Index scores than SMI (Ps < 0.0083). The BP and HHFKA menus had higher refined grain and added sugars scores than SMI (Ps < 0.0083). The SMI menu had lower total vegetable and saturated fat scores than all menus (Ps < 0.0083). This study informs policy toward improving standards, positively affecting child health and academic performance through higher-DQ lunches.

Technology Use in Everyday Financial Activities: Evidence from Online and Offline Survey Data.

OBJECTIVE: Internet use and mobile devices permeate every aspect of our lives and are changing our financial habits. Assessment of financial decision-making (FDM) has not yet caught up to apparent changes in financial behavior. To modernize assessment methods and create current and comprehensive FDM frameworks, we first need to establish the most commonly used and most preferred methods of performing specific financial activities. METHOD: Cross-sectional survey data were collected using an online platform and offline approaches (in person and by mail) (N = 234). The frequency of using technological (e.g., laptop) and non-technological (e.g., in-person banking) means of completing seven financial activities was assessed first, including Depositing checks, Reviewing bank statements, Keeping track of money spent, Transferring funds, Withdrawing cash, Paying bills, and Purchasing products online. Second, preference for technological versus non-technological methods was assessed. Finally, linear regression models examined associations between demographics and preference for technological methods for each financial activity. RESULTS: The majority of respondents (77% online, 74% offline) used technology to perform various financial activities and preferred technological to non-technological methods for completing five out of the six financial activities. Increased preference for technological methods was associated with younger age for all the financial activities, and higher education was associated with reviewing bank statement and transferring funds. CONCLUSIONS: Our survey findings provide empirical evidence for the changing nature of our financial habits. We discuss the implications of this change for researchers, clinicians, and the individuals themselves and emphasize the importance of modernizing FDM tools.