Height and Weight Measurement and Communication With Families in Head Start: Developing a Toolkit and Establishing Best Practices.

Background: Head start (HS) programs are required to collect children's height and weight data. Programs also communicate these results to families. However, no standardized protocol exists to guide measurements or communicate results. The purpose of this article was to describe the development of a measurement toolkit and best practices for communication. Methods: HS programs contributed to the development and pilot testing of a toolkit for HS staff to guide child measurement. We used a three-phase iterative approach and qualitative methods to develop and test the toolkit, which included a video and handout. In addition, we convened an advisory group to draft best practices for communication. Results: HS program staff appreciated the toolkit materials for their simplicity and content. The advisory group highlighted the importance of weight stigma and the need to be cautious in the way that information is communicated to families. The group underscored the role of emphasizing health behavior change, instead of focusing solely on BMI. Best practices were organized into (1) Policies and procedures for communicating screening results, (2) training for HS program staff to improve communication related to screening and health behaviors, and (3) other best practices to promote health behaviors and coordinate data systems. Conclusions: Our toolkit can improve anthropometric measurements of HS to ensure that potential surveillance data are accurate. Advisory group best practices highlight opportunities for HS to develop and implement policies, procedures, and trainings across the country to improve communication with HS families. Future research should test the implementation of these best practices within HS.

Reported Adherence to the 10 Steps to Successful Breastfeeding is Higher Among Baby-Friendly Hospitals.

OBJECTIVE: Quantify and compare reported breastfeeding support practices in the Baby-Friendly Hospital Initiative (BFHI) and non-BFHI facilities. DESIGN: Cross-sectional survey. SETTING: Regions across the US. PARTICIPANTS: Two hundred and eighty-six facilities (110 BFHI and 176 non-BFHI) selected by a stratified (by hospital size) random sample of 50% BFHI and 50% non-BFHI facilities. INTERVENTION: Emailed survey Fall 2019 through Spring 2020. MAIN OUTCOME MEASURE: Reported adherence to the 10 Steps to Successful Breastfeeding. ANALYSIS: Wilcoxon rank sum test with continuity correction, Pearson chi-square test of independence, and Fisher's exact test. RESULTS: Baby-Friendly Hospital Initiative facilities were more likely to report adherence to the 10 Steps to Successful Breastfeeding. Only 2 of the reported steps were not significantly different: immediate postnatal care and responsive feeding. CONCLUSIONS AND IMPLICATIONS: This research supports breastfeeding support interventions within hospitals as both BFHI and non-BFHI facilities have room for improvement. Interventions targeting non-BFHI facilities are an opportunity to close the disparity in breastfeeding care.

Bayesian kernel machine regression for count data: modelling the association between social vulnerability and COVID-19 deaths in South Carolina.

The COVID-19 pandemic created an unprecedented global health crisis. Recent studies suggest that socially vulnerable communities were disproportionately impacted, although findings are mixed. To quantify social vulnerability in the US, many studies rely on the Social Vulnerability Index (SVI), a county-level measure comprising 15 census variables. Typically, the SVI is modelled in an additive manner, which may obscure non-linear or interactive associations, further contributing to inconsistent findings. As a more robust alternative, we propose a negative binomial Bayesian kernel machine regression (BKMR) model to investigate dynamic associations between social vulnerability and COVID-19 death rates, thus extending BKMR to the count data setting. The model produces a 'vulnerability effect' that quantifies the impact of vulnerability on COVID-19 death rates in each county. The method can also identify the relative importance of various SVI variables and make future predictions as county vulnerability profiles evolve. To capture spatio-temporal heterogeneity, the model incorporates spatial effects, county-level covariates, and smooth temporal functions. For Bayesian computation, we propose a tractable data-augmented Gibbs sampler. We conduct a simulation study to highlight the approach and apply the method to a study of COVID-19 deaths in the US state of South Carolina during the 2021 calendar year.

Cannabis Smoking and Storage within the Home: A Cross-Sectional Survey of Pregnant Women and Women with Young Children.

INTRODUCTION: Child cannabis exposure has increased in recent years - a trend that parallels changes to state cannabis legality. Yet, little is known about household cannabis practices. To address this gap, this study aimed to examine household cannabis practices among a geographically diverse sample of US women of reproductive age. We also examined variations in household cannabis practices across state cannabis policies. METHODS: The study sample (N = 114) included pregnant women and women with young children in their home. In Spring of 2021, 114 women completed a single cross-sectional online survey that included demographic information and asked about cannabis use, household cannabis practices (e.g., indoor smoking, cannabis storage), and cannabis use risk perceptions. We analyzed data using descriptive statistics and Fisher's exact tests. RESULTS: A total of 69.23% of women reported cannabis products were allowed in their home and 42.98% reported that smoking cannabis was permitted in one or more rooms. Self-reported cannabis use, as well as partner or family cannabis use were significantly associated with allowing cannabis products in the home (p < 0.001). There was no difference in cannabis smoking rules among women in states with legalized cannabis (47.73%) than those in states that had yet to legalize (40.00%), p = 0.339. CONCLUSIONS: Amid rapidly shifting cannabis policies, further examination of household cannabis practices is needed. Public heath efforts should focus on reducing in-home cannabis exposure and promote safe storage and smoking practices for families with children in the home.

Policies, Practices, and Environmental Characteristics Among Family Child Care Homes in South Carolina.

Background: Child care program requirements have adopted nutrition and physical activity standards to address childhood obesity, but few studies have examined the effects of these standards in family child care homes (FCCHs). Methods: In a cross-sectional study (2017-2019), the Childcare Home Eating and Exercise study examined self-reported provider characteristics and observed policies and practices related to physical activity and nutrition in FCCHs in South Carolina. Two-sample t-tests were used to compare observed nutrition and physical activity policy, practice, and environment scores in child care homes that participated in versus did not participate in the state's ABC Quality program, which is designed to improve child care and includes policies and practices intended to increase physical activity levels and improve diet quality. Results: Environment and Policy Assessment and Observation results for nutrition and physical activity were 7.5 out of 21 and 11.8 out of 30, respectively, indicating much room for improvement in nutrition and physical activity policies, practices, and environment in South Carolina FCCHs. The study found one difference between FCCHs that did and did not participate in the ABC Quality program; non-ABC homes provided more time for physical activity. Conclusions: Future research should develop ways to strengthen the guidelines and improve the implementation of obesity prevention standards in FCCHs.

Breastfeeding and less healthy beverage intake during the first year of life.

BACKGROUND AND OBJECTIVES: Breastfeeding during infancy is associated with healthier beverage consumption later in childhood, but little is known about this relation during infancy. This was a longitudinal study of breastfeeding and less healthy beverage consumption during the first year of life, in a birth cohort study conducted 2013-2018 in the Southeastern United States (n = 666). METHODS: We estimated monthly rates of 100% juice and sugar-sweetened beverage (SSB) consumption comparing infants who were exclusively or partially breastfed, versus those who were not, in multivariable adjusted models. RESULTS: Mothers had a median age of 26.5 years, 71% identified as Black/African-American, and 61% reported household incomes <$20 000/year. The prevalence of any breastfeeding during the first month was 78.2% and 18.7% at month 12. By age 12 months, infants consumed juice a mean (SD) 9.1 (10.1) times per week and SSBs 3.6 (9.5) times per week. Breastfed infants had a 38% lower incidence rate of weekly juice consumption (95% CI 52%, 15%, p = 0.003) and a 57% lower incidence rate of weekly SSB consumption (95% CI 76%, 22%, p = 0.006), compared with infants who were not breastfed. CONCLUSIONS: Research on early-life correlates of dietary health should focus on the earliest beverages, given evidence that consumption of obesogenic beverages may begin prior to age 1 year.

Associations of Plastic Bottle Exposure with Infant Growth, Fecal Microbiota, and Short-Chain Fatty Acids.

BACKGROUND/OBJECTIVES: Murine models show that plastics, via their chemical constituents (e.g., phthalates), influence microbiota, metabolism, and growth. However, research on plastics in humans is lacking. Here, we examine how the frequency of plastic bottle exposure is associated with fecal microbiota, short-chain fatty acids (SCFAs), and anthropometry in the first year of life. SUBJECTS/METHODS: In 442 infants from the prospective Nurture birth cohort, we examined the association of frequency of plastic bottle feeding at 3 months with anthropometric outcomes (skinfolds, length-for-age, and weight-for-length) at 12 months of age and growth trajectories between 3 and 12 months. Furthermore, in a subset of infants (n = 70) that contributed fecal samples at 3 months and 12 months of age, we examined plastic bottle frequency in relation to fecal microbiota composition and diversity (measured by 16S rRNA gene sequencing of V4 region), and fecal SCFA concentrations (quantified using gas chromatography mass spectrometry). RESULTS: At 3 months, 67.6% of infants were plastic bottle fed at every feeding, 15.4% were exclusively breast milk fed, and 48.9% were exclusively formula fed. After adjustment for potential confounders, infants who were plastic bottle fed less than every feeding compared to those who were plastic bottle fed at every feeding at 3 months did not show differences in anthropometry over the first 12 months of life, save for lower length-for-age z-score at 12 months (adjusted ß = -0.45, 95% CI: -0.76, -0.13). Infants who were plastic bottle fed less than every feeding versus every feeding had lower fecal microbiota alpha diversity at 3 months (mean difference for Shannon index: -0.59, 95% CI: -0.99, -0.20) and lower isovaleric acid concentration at 3 months (mean difference: -2.12 µmol/g, 95% CI: -3.64, -0.60), but these results were attenuated following adjustment for infant diet. Plastic bottle frequency was not strongly associated with microbiota diversity or SCFAs at 12 months after multivariable adjustment. Frequency of plastic bottle use was associated with differential abundance of some bacterial taxa, however, significance was not consistent between statistical approaches. CONCLUSIONS: Plastic bottle frequency at 3 months was not strongly associated with measures of adiposity or growth (save for length-for-age) over the first year of life, and while plastic bottle use was associated with some features of fecal microbiota and SCFAs in the first year, these findings were attenuated in multivariable models with infant diet. Future research is needed to assess health effects of exposure to other plastic-based products and objective measures of microplastics and plastic constituents like phthalates.

Interventions to prevent obesity in Latinx children birth to 6 years globally: a systematic review.

OBJECTIVE: To conduct a systematic review of obesity prevention interventions in Latinx children ages birth to 6 years published in any language from 2010-2020. DESIGN: We used PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online (SciELO) and Google Scholar databases to conduct a search on May 1 2020, January 1 2021 and November 1 2022. We included randomised controlled trials, quasi-experimental studies and non-randomised interventions with a control or comparison group that reported measures of adiposity. SETTING: Interventions taking place in the United States, Latin America or the Caribbean. PARTICIPANTS: Latinx children ages birth to 6 years. RESULTS: Of 8601 unique records identified, forty manuscripts about thirty-nine unique studies describing thirty distinct interventions in the United States and nine interventions in Latin America and the Caribbean met our inclusion criteria. Interventions were primarily based in early care and education centres (n 13) or combined home settings, for example home and community (n 7). Randomised interventions taking place in community or home settings were more likely to report significant reductions in adiposity or weight-related outcomes compared to other settings. Using the Cochrane risk of bias tools for randomised and non-randomised studies, we judged thirty-eight randomised trials and nine non-randomised interventions to have a high or unclear risk of bias. CONCLUSIONS: The results highlight a need for more rigorous designs and more effective intervention strategies in Latinx children at risk for having overweight and obesity. Registered with the PROSPERO database for systematic reviews under registration number CRD42020161339.

Young Children's Dietary Quality in Family Child Care and in Their Own Home.

BACKGROUND: Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care. OBJECTIVE: The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home. DESIGN: This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina. PARTICIPANTS/SETTING: Participants were 123 children in 52 family child-care homes between 2018 and 2019. MAIN OUTCOME MEASURE: The main outcome was total and component Healthy Eating Index 2015 scores. STATISTICAL ANALYSIS: The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling. RESULTS: Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (ß = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003). CONCLUSIONS: Children had healthier dietary intake in family child-care homes vs their respective homes.

A longitudinal study of infant 24-hour sleep: comparisons of sleep diary and accelerometer with different algorithms.

STUDY OBJECTIVES: To longitudinally compare sleep/wake identification and sleep parameter estimation from sleep diaries to accelerometers using different algorithms and epoch lengths in infants. METHODS: Mothers and other caregivers from the Nurture study (southeastern United States, 2013-2018) reported infants' 24-hour sleep in sleep diaries for 4 continuous days, while infants concurrently wore accelerometers on the left ankle at 3, 6, 9, and 12 months of age. We applied the Sadeh, Sadeh Infant, Cole, and Count-scaled algorithm to accelerometer data at 15 and 60 seconds epochs. For sleep/wake identification, we assessed agreement by calculating epoch-by-epoch percent agreement and kappas. We derived sleep parameters from sleep diaries and accelerometers separately and evaluated agreement using Bland-Altman plots. We estimated longitudinal trajectories of sleep parameters using marginal linear and Poisson regressions with generalized estimation equation estimation. RESULTS: Among the 477 infants, 66.2% were black and 49.5% were female. Agreement for sleep/wake identification varied by epoch length and algorithm. Relative to sleep diaries, we observed similar nighttime sleep offset, onset, and total nighttime sleep duration from accelerometers regardless of algorithm and epoch length. However, accelerometers consistently estimated about 1 less nap per day using the 15 seconds epoch, 70 and 50 minutes' shorter nap duration per day using the 15 and 60 seconds epoch, respectively; but accelerometers estimated over 3 times more wake after nighttime sleep onset (WASO) per night. Some consistent sleep parameter trajectories from 3 to 12 months from accelerometers and sleep diaries included fewer naps and WASOs, shorter total daytime sleep, longer total nighttime sleep, and higher nighttime sleep efficiency. CONCLUSIONS: Although there is no perfect measure of sleep in infancy, our findings suggest that a combination of accelerometer and diary may be needed to adequately measure infant sleep.

A multivariate spatiotemporal model for tracking COVID-19 incidence and death rates in socially vulnerable populations.

Recent studies have produced inconsistent findings regarding the association between community social vulnerability and COVID-19 incidence and death rates. This inconsistency may be due, in part, to the fact that these studies modeled cases and deaths separately, ignoring their inherent association and thus yielding imprecise estimates. To improve inferences, we develop a Bayesian multivariate negative binomial model for exploring joint spatial and temporal trends in COVID-19 infections and deaths. The model introduces smooth functions that capture long-term temporal trends, while maintaining enough flexibility to detect local outbreaks in areas with vulnerable populations. Using multivariate autoregressive priors, we jointly model COVID-19 cases and deaths over time, taking advantage of convenient conditional representations to improve posterior computation. As such, the proposed model provides a general framework for multivariate spatiotemporal modeling of counts and rates. We adopt a fully Bayesian approach and develop an efficient posterior Markov chain Monte Carlo algorithm that relies on easily sampled Gibbs steps. We use the model to examine incidence and death rates among counties with high and low social vulnerability in the state of Georgia, USA, from 15 March to 15 December 2020.

Supporting breastfeeding equity: A cross-sectional study of US birthing facility administrators.

Disparities in breastfeeding have continued in the United States (US) despite efforts to increase breastfeeding rates. Hospitals are in a unique position to enable breastfeeding and help reduce disparities; however, it is unclear whether hospital administration is supportive of breastfeeding equity practices or plans. This study aimed to assess birthing facility plans to support breastfeeding among women of low income and women of color across the US. We administered electronic surveys to 283 US hospital administrators between 2019 and 2020. We assessed whether facilities had a plan in place to support breastfeeding among women of low income and women of color. We assessed associations between Baby-Friendly Hospital Initiative (BFHI) status and having a plan in place. We examined reported activities provided through open-ended responses. Fifty-four percent of facilities had a plan in place to support breastfeeding among women of low income and 9% had a plan in place to support breastfeeding among women of color. Having a plan was not associated with having a BFHI designation. A lack of plan to specifically help those with the lowest rates of breastfeeding may perpetuate rather than reduce inequities. Providing anti-racism and health equity training to healthcare administrators may help birthing facilities achieve breastfeeding equity.

Adherence to Healthy Default Beverage Laws for Children's Meals in 3 U.S. Cities.

INTRODUCTION: Healthy default beverage laws are relatively new interventions designed to improve the healthfulness of children's meals in restaurants. In this study, researchers assessed adherence to healthy default beverage laws among children's meals ordered online in Los Angeles (California statewide law effective from September 2018), Baltimore (effective from April 2018), and New York City (effective from April 2019) compared with that in Boston, where no law existed. METHODS: Between November and December 2020, researchers ordered children's meals from online ordering platforms (e.g., GrubHub, Uber Eats) from the top-grossing restaurant chains in each location (n=337 meal orders from 106 restaurants), coded these meals using four successively stricter definitions of adherence to the default beverage laws in each respective jurisdiction, and then applied each law to data collected in Boston to simulate different policy scenarios in a city with no such law. The team analyzed these data in late 2021. RESULTS: Differences in adherence existed across jurisdictions, with 15% adherent in Los Angeles, 30% in Baltimore, and 43% in New York City, compared with 7%-30% in Boston, using the most lenient definition of adherence. Fewer than 3% of all meals adhered to laws when applying the strictest definition of adherence. CONCLUSIONS: Overall adherence was low and variable across jurisdictions. Adherence may be lower in jurisdictions with fewer allowable default beverages, although more research is needed to assess this potential causal relation. In addition to increased resources and support for restaurants, additional policy design considerations may be necessary to increase adherence to healthy default beverage laws.

Confirmatory factor analysis of the infant feeding styles questionnaire in infant and toddler child care teachers.

Early childhood is a critical time of development. Caregiver feeding style, including of child care providers, has been implicated in influencing children's food preferences and obesity. A better understanding of the determinants of child care providers' feeding styles is important as children increasingly receive daily care and nutrition in child care centers. Valid instruments to measure provider feeding styles specifically for infants are needed. This study's objective was to validate, for use with child care providers, the Infant Feeding Styles Questionnaire (IFSQ), an instrument originally designed for parents of infants and toddlers. Study data came from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) study, a cluster randomized trial, designed to evaluate the efficacy of a six-month-long obesity prevention intervention in child care centers. The IFSQ was administered at baseline and follow-up to infant and toddler teacher participants (n = 244). Scores for baseline IFSQ teacher responses (n = 219) were calculated for the 13 sub-constructs across the five feeding styles. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. Reliability coefficients ranged from 0.42 to 0.82 for all sub-constructs. Goodness of fit indices for the final model ranged from: root mean square error of approximation (RMSEA) 0.000-0.082; comparative fit index (CFI) 0.943-1.000; Tucker-Lewis index (TLI) 0.906-1.000; and standardized root mean squared error (SRMR) 0.006-0.130. In a sample of racially diverse infant and toddler child care teachers, final models of the laissez-faire, pressuring, and responsive constructs and the restrictive-diet quality sub-construct performed well. Overall model fit was poor for the indulgence construct, but good for solely its corresponding belief items.

Food security and diet quality in a racially diverse cohort of postpartum women in the USA.

Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (ß: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (ß: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.

A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment.

BACKGROUND: Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards. METHOD: We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard. RESULTS: Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes. CONCLUSIONS: Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

Bayesian negative binomial regression with spatially varying dispersion: Modeling COVID-19 incidence in Georgia.

Overdispersed count data arise commonly in disease mapping and infectious disease studies. Typically, the level of overdispersion is assumed to be constant over time and space. In some applications, however, this assumption is violated, and in such cases, it is necessary to model the dispersion as a function of time and space in order to obtain valid inferences. Motivated by a study examining spatiotemporal patterns in COVID-19 incidence, we develop a Bayesian negative binomial model that accounts for heterogeneity in both the incidence rate and degree of overdispersion. To fully capture the heterogeneity in the data, we introduce region-level covariates, smooth temporal effects, and spatially correlated random effects in both the mean and dispersion components of the model. The random effects are assigned bivariate intrinsic conditionally autoregressive priors that promote spatial smoothing and permit the model components to borrow information, which is appealing when the mean and dispersion are spatially correlated. Through simulation studies, we show that ignoring heterogeneity in the dispersion can lead to biased and imprecise estimates. For estimation, we adopt a Bayesian approach that combines full-conditional Gibbs sampling and Metropolis-Hastings steps. We apply the model to a study of COVID-19 incidence in the state of Georgia, USA from March 15 to December 31, 2020.

Pouring rights contracts between universities and beverage companies: Provisions related to scientific research.

Pouring rights contracts between universities and beverage companies are common and grant companies the exclusive right to serve, sell, and market specific beverages on campuses. In exchange, universities receive financial payments and other incentives. At the same time, beverage industry-sponsored research at universities has increased. Pouring rights contracts may include provisions that allocate funds for or place limitations on scientific research. In this cross-sectional study, we assessed whether pouring rights contracts contained provisions that allocated funds for or placed limitations on scientific research. From 2019 to 2020, we obtained contracts through requests under public records laws from US universities (public, 4-year, ≥ 20,000 students) with contracts active 2018-2019. Of the 143 requests, 6 did not have contracts and 9 declined to provide contracts. Our final sample included 131 contracts from 124 universities in 38 states. Thirty contracts (22.9%) referenced research (18 Coke; 12 Pepsi). Three contracts (2.3%) included provisions that made direct grants or gifts of research funding, 3 (2.3%) permitted the university to acknowledge funding from competitors, and 26 (19.8%) allowed for research using beverages from competing companies. Given increases in industry-sponsored research, the absence of provisions that made direct grants or gifts of research funding suggests that sponsorship of research is occurring through other mechanisms. Additionally, universities must be able to acknowledge funding and conduct research on any beverage and should not need permission via contract provisions to do so. Future studies should consider practical implications of these provisions in pouring rights contracts and assess whether they facilitate or hinder research.

Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya: A Latent Class Analysis.

Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women's dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.