Dietary Quality and Diet-Related Factors Among U.S. Emerging Adults (18-23y) Are a Cause for Concern, NHANES 2015-2018.

BACKGROUND: Poor dietary quality is a risk factor for diet-related chronic disease and suboptimal nutritional patterns often begin early in the life course. While the dietary intakes of young children, adolescents, and middle-aged and older adults are well established, much less is known about emerging adults, who represent a unique timepoint in life, as they are undergoing significant changes in food environments, autonomy, finances, and caregiver and parental involvement. OBJECTIVE: To examine dietary quality, as assessed via the Healthy Eating Index (HEI), by demographic, socioeconomic, and health-related characteristics among U.S. emerging adults (18-23y) who participated in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). METHODS: NHANES data were collected via a household interview and 2 24-hour dietary recalls (24HR). Usual dietary intakes from the 24HRs were approximated using the multivariate National Cancer Institute Method to compute mean HEI-2015 overall and component scores (range 0-100, higher scores indicating higher dietary quality). RESULTS: Overall dietary quality among U.S. emerging adults [HEI-2015: 50.3±1.3] was significantly lower than other U.S. adults (≥24y) [HEI-2015: 56.3±0.5; p<0.0001], with differences primarily driven by lower intakes of whole fruit, vegetables, and whole grains, and higher intakes of sodium, refined grains, and saturated fat. Few differences in HEI-2015 scores were noted across population subgroups by sex, food security, family income, and food assistance program participation, except for added sugar; intakes of added sugar were significantly higher among women, food insecure, and food assistance program participants as compared to their counterparts, respectively. CONCLUSIONS: Dietary quality is poor among U.S. emerging adults and persists across all population subgroups, suggesting a significant need for tailored public health interventions to improve dietary quality among this population. Future research investigating to what extent emerging adults prioritize healthful behaviors and exploring other indicators for identifying nutritionally vulnerable subgroups may be impactful for identifying disparities among this life stage.

Dinner planning and preparation considerations of parents with children attending childcare.

The objective of this study was to explore the meal-related thought processes, planning, and purchasing behaviors of primary caregivers on weeknights. A mixed-methods study design was applied using a cross-sectional survey and qualitative interviews. Thirty-three primary caregivers from early childhood education centers were enrolled in the study. Descriptive statistics of sample characteristics were conducted and an a-priori thematic analysis of interview recordings was completed using NVivo Qualitative software. The following key themes were identified: satisfaction with dinner, feeding behaviors before the COVID-19 pandemic, regretful feeding experiences, meal planning, food purchasing, social support, and general feelings about dinner preparation and cooking. Important considerations for food purchasing included family satisfaction, price, convenience, and healthfulness. Satisfaction around dinner choices varied, with dissatisfaction often related to a bad workday, being stressed, or making meals that family members disliked. Findings demonstrate the need for more research and interventions around the topic of meal planning and preparation, specifically for working parents, that further examine tasks required for providing meals, the physical and cognitive time for meal preparation, and helpful means of support.

Timing and factors associated with complementary feeding in India.

Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7-9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups.

Neighborhood disadvantage and the sales of unhealthy products: alcohol, tobacco and unhealthy snack food.

BACKGROUND: Individuals may use unhealthy coping mechanisms such as alcohol, tobacco, and unhealthy snack consumption. The purpose of this study was to assess how neighborhood disadvantage is associated with sales of alcohol, tobacco, and unhealthy snacks at stores of a discount variety store chain. METHODS: Alcohol, tobacco, and unhealthy snack sales were measured monthly for 20 months, 2017-2018, in 16 discount variety stores in the United States. Mixed effects linear regressions adjusted for population size, with store-specific random effects, to examine the relationship of weekly unit sales with three outcome variables and neighborhood disadvantage, measured using the Area Deprivation Index (ADI). RESULTS: The discount variety stores were located in neighborhoods where the median ADI percentile was 87 [interquartile range 83,89], compared to the median ADI percentile of 50 for all US communities, indicating that the stores were located in substantially disadvantaged neighborhoods. For every 1% increase in ADI, weekly unit sales of unhealthy snack food increased by 43 [95% confidence interval, CI 28-57], and weekly unit sales of tobacco products increased by 11.5 [95% CI 5-18] per store. No significant relationship between neighborhood disadvantage and the weekly unit sales of alcohol products was identified. CONCLUSIONS: The positive relationship between neighborhood disadvantage and the sale of tobacco and snack foods may help explain the pathway between neighborhood disadvantage and poor health outcomes. It would be useful for future research to examine how neighborhood disadvantage influences resident health-related behaviors.

Black-white disparities in alcohol consumption trends among women in the United States, 1990-2015.

Alcohol consumption has more adverse consequences among African American women than among white women. Yet little is known about trends in alcohol consumption among African American women. Using the National Survey on Drug Use and Health, we examined trends in alcohol consumption among African American (n = 4,079) and white (n = 17,512) women, 1990-2015. We calculated population prevalence and used the Cochrane-Armitage test to examine trends, controlling for sociodemographic factors. In adjusted analyses, binge consumption increased for African American and white women; not consuming alcohol decreased among African Americans (all p < 0.05). Results highlight the need for culturally sensitive prevention and intervention strategies.

Alcohol consumption among older women in the United States.

Few studies have examined alcohol consumption among older women. Using the nationally representative National Survey on Drug Use and Health, we examined binge, moderate, and no alcohol consumption among women ages 50+ (n = 21,178). We calculated population prevalence by age and used multivariate logistic regression, controlling for seven sociodemographic factors. In adjusted results, women ages 65+ were more likely to have moderate or no alcohol consumption than those 50-64; Hispanic and African American women were more likely to engage in binge consumption than whites (all p < .01). More research is needed to understand binge alcohol consumption among older women in racial/ethnic minorities.

Is having any prenatal care associated with lower infant mortality in West Africa? Evidence from the Demographic and Health Surveys.

Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.

Does longer duration of breastfeeding prevent childhood asthma in low-income families?

OBJECTIVE: The objective of this study was to examine the relationship of breastfeeding duration with childhood asthma among low-income families in Karachi, Pakistan. METHODS: Mothers/caregivers of 200 children with asthma and an equal number of children without asthma were interviewed about breastfeeding duration. Based on the responses, 6 different binary variables were constructed: breastfeeding 3 months or less, 6 months or less, 9 months or less, 12 months or less, 18 months or less, and 24 months or less. Asthma status of the child was determined by clinical examination by a primary care physician. Data was analyzed using multiple logistic regression method, adjusted for age and sex of the child, household income, parental ethnicity, number of older siblings, family history of asthma or hay fever, presence of mold, parental smoking, number of people in the household, and body mass index of the child. RESULTS: The average duration of breastfeeding was 21.4 months (SD = 7.33 months). Breastfeeding for at least 24 months was associated with increased odds of asthma (aOR = 1.77, 95%CI: 0.99, 3.16). Whereas breastfeeding for 12 months or less, and to some extent 18 months or less, was protective against childhood asthma. There was some evidence this protective effect may be delayed in children with a family history of asthma or hay fever. CONCLUSIONS: This study found breastfeeding for 12 months or less may have a protective effect against asthma. The protective effect weans down after 18 months, and if continued 24 months or more may place the child at-risk of asthma.

Associations of government health expenditures, the supply of health care professionals, and country literacy with prenatal care use in ten West African countries.

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries.

Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.

Prenatal exposure to secondhand smoke may increase the risk of postpartum depressive symptoms.

BACKGROUND: The harmful effects of smoking during pregnancy on occurrence of postpartum depressive symptoms (PPDS) have been well studied, but there is little research on the association of secondhand smoke (SHS) exposure during pregnancy with PPDS. This study aimed to explore the relationship between prenatal exposure to SHS during pregnancy and PPDS. METHODS: The authors analyzed data from 6884 women who participated in the North Carolina Pregnancy Risk Assessment and Monitoring System survey (2004-08). Data on the exposure (prenatal SHS), outcome (PPDS) and covariates were obtained from self-reported questionnaires. Univariable and multivariable logistic regression was used for data analysis. RESULTS: The prevalence of PPDS was 16.5%. In the unadjusted analysis, women exposed to SHS during pregnancy had nearly twice the odds of PPDS than the unexposed (odds ratio, OR = 1.90, 95% confidence interval, CI: 1.61-2.26). After adjusting for potential confounders, the association between SHS and PPDS was weakened but remained statistically significant (OR = 1.49, 95% CI: 1.23-1.80). A dose-response relationship was not evident in the analyses. Maternal smoking during pregnancy did not appear to modify the association between SHS and PPDS. CONCLUSIONS: The current study identified a positive association between SHS and PPDS.

Is breakfast skipping associated with physical activity among U.S. adolescents? A cross-sectional study of adolescents aged 12-19 years, National Health and Nutrition Examination Survey (NHANES).

OBJECTIVE: To examine the association between breakfast skipping and physical activity among US adolescents aged 12-19 years. DESIGN: A cross-sectional study of nationally representative 2007-2008 National Health and Nutrition Examination Survey (NHANES) data. SETTING: Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders. SUBJECTS: A total of 936 adolescents aged 12-19 years in the USA. RESULTS: After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12-19 years (OR = 0.95, 95% CI 0.56, 1.32). CONCLUSIONS: Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.

Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools.

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

The COVID-19 Pandemic, Rising Inflation, and Their Influence on Dining Out Frequency and Spending.

BACKGROUND: High intake of food away from home is associated with poor diet quality. This study examines how the COVID-19 pandemic period and Food Away from Home (FAFH) inflation rate fluctuations influenced dining out behaviors. METHODS: Approximately 2800 individuals in Texas reported household weekly dining out frequency and spending. Responses completed prior to the COVID-19 pandemic (2019 to early 2020) were compared to the post-COVID-19 period (2021 through mid-2022). Multivariate analysis with interaction terms was used to test study hypotheses. RESULTS AND CONCLUSION: From the COVID-19 period (before vs. after), the unadjusted frequency of dining out increased from 3.4 times per week to 3.5 times per week, while the amount spent on dining out increased from $63.90 to $82.20. Once the relationship between dining out (frequency and spending) was adjusted for FAFH interest rate and sociodemographic factors, an increase in dining out frequency post-COVID-19 remained significant. However, the unadjusted increase in dining out spending did not remain significant. Further research to understand the demand for dining out post-pandemic is warranted.

Healthy Food Policies Documented in University Food Service Contracts.

In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations.

Association between family composition and the well-being of vulnerable children in Nairobi, Kenya.

The objective of this study is to examine the relationship between a vulnerable child's family composition (family size and primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using 2006-2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424 children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals to examine the relationship between family composition measures and child well-being. Multivariate results were also stratified by orphan status. Vulnerable children who live in household sizes of 4-6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95% CI: 1.13-2.01, OR = 9.02, 95% CI: 4.62-17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19, 95% CI 0.07-0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related to childhood immunization education and intervention programs. The findings also underscore the need for policies which support families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development designed to meet needs of vulnerable children.

Examining the relationship between Latinas' perceptions about what constitutes domestic violence and domestic violence victimization.

Domestic violence is a serious issue for U.S. Latinas. Better understanding of the potential risk or protection that cultural perceptions about what constitutes domestic violence may convey can help strengthen interventions. Therefore, a convenience sample of 93 Latinas was surveyed about their current levels of domestic violence victimization, acculturation, and demographics, as well as about whether 5 behavioral scenarios constituted domestic violence. Hierarchical multiple regressions were performed to examine the relationships between the 5 perception items and domestic violence victimization. After adjusting for established risk factors, only viewing male partner stalking and female verbal aggression as domestic violence were significantly associated with decreased domestic violence victimization. Findings can be integrated into the development and implementation of culturally competent interventions targeting Latinas.

Use of complementary and alternative medicine for physical performance, energy, immune function, and general health among older women and men in the United States.

We examined use of complementary and alternative medicine (CAM) for health and well-being by older women and men. Data were from the 2007 National Health Interview Survey, representing 89.5 million Americans ages 50+. Multivariate logistic regression accounted for the survey design. For general health, 52 million people used CAM. The numbers for immune function, physical performance, and energy were 21.6, 15.9, and 10.1 million respectively. In adjusted results, women were much more likely than men to use CAM for all four reasons, especially energy. Older adults, particularly women, could benefit from research on CAM benefits and risks.

SNAP and Cardiometabolic Risk in Youth.

Increasing numbers of children and adolescents have unhealthy cardiometabolic risk factors and show signs of developing metabolic syndrome (MetS). Low-income populations tend to have higher levels of risk factors associated with MetS. The Supplemental Nutrition Assistance Program (SNAP) has the potential to reduce poverty and food insecurity, but little is known about how the program affects MetS. We examine the relationship between SNAP and the cardiometabolic risk factors in children and adolescents using regression discontinuity to control for unobserved differences between participants and nonparticipants. We find that SNAP-eligible youth who experience food insecurity have significantly healthier outcomes compared to food-insecure youth just over the income-eligibility threshold. Our findings suggest that SNAP may be most beneficial to the most disadvantaged households. Policy makers should consider the broad range of potential health benefits of SNAP.

Age of Bottle Cessation and BMI-for-Age Percentile among Children Aged Thirty-Six Months Participating in WIC.

Background: Children's age at bottle weaning typically ranges from 12 to 24 months. The recommended age of bottle weaning varies. The American Academy of Pediatrics recommends weaning by 12 months; The American Academy of Pediatric Dentistry recommends 12-15 months; The US Department of Agriculture recommends 18 months. Prolonged bottle use is associated with dental caries, iron-deficiency anemia, and child overweight or obesity. We examined factors associated with age of bottle cessation, and the association between age of bottle cessation and BMI-for-age percentile at age 36 months among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants. Methods: Data were from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2). The ITFPS-2, a longitudinal study of WIC participants (mothers and their children) began in 2013. We used Cox proportional hazards models to identify factors associated with bottle cessation and multivariate linear regression to examine the association between age of bottle cessation and BMI. Results: About 34% of children used a bottle longer than 12 months, and 13% longer than 18 months. Bottle cessation at older ages was associated with Hispanic ethnicity, multiparity, low income, low education, higher caregiver weight, and not initiating breastfeeding. The adjusted children's BMI-for-age percentile at age 36 months increased by 0.47 for each additional month of bottle use. Conclusion: Prolonged bottle use was associated with increased children's BMI-for-age percentile. Future research is warranted to determine the optimal age to recommend bottle cessation for WIC participants.