Examining capabilities, opportunities, and motivations for healthy eating behaviors in Latin American restaurants: a quantitative application of the COM-B model to inform future interventions.

BACKGROUND: Eating foods away from home has been associated with poor diet quality and adverse health outcomes. Research is needed to examine barriers and facilitators to making healthier eating choices in restaurant settings. We operationalized the Capability, Opportunity, and Motivation for Behavior Model (COM-B Model) to conduct a behavioral diagnosis for healthy eating behaviors at Latin American restaurants (LARs), an understudied yet increasingly important food environment with the potential to positively influence diets. METHODS: We conducted an online survey with adults in the United States that reported eating food from LARs at least once a month (n = 509) recruited via an online market research panel to examine capabilities - physical (e.g., skills) and psychological (e.g., knowledge), opportunities - social (e.g., norms) and physical (e.g., environmental), and motivations - reflective (e.g., self-conscious intentions) and automatic (e.g., emotions) associated with healthier choices at LARs. In a survey focused on LAR-associated behaviors, each COM-B domain was scored between 1-5, with scores ≥ 4 denoted as having high capability, opportunity, and motivation to eat healthfully at LARs (potential range of total score = 6-35). Regression analysis was used to examine the association between COM-B scores (total and by domain) and select demographic characteristics (age, gender, race, Latin heritage, income, education, marital status, and Latin majority state of residency). RESULTS: More than half of the participants (57.1%) were classified as having high physical capability, followed by psychological capability (43.9%) in the LAR environment. The proportions of participants with either high motivation or high opportunity were low, ranging from 37.3% (reflective motivation) to physical opportunity (15.6%). The overall mean COM-B total score was 19.8 ± 3.0. Higher total COM-B scores were associated with younger age, self-identifying as white, having Latin heritage, and having higher income (p < 0.05). CONCLUSIONS: This study expands the application of the COM-B framework using quantitative inquiry to evaluate levels of capability, motivation, and opportunity for healthy eating in LAR settings and initial demographic associations with determinants for healthy eating in these settings. This work can aid in tailoring interventions and developing evaluation tools for LAR-related healthy eating interventions.

Age at menarche, type 2 diabetes and cardiovascular disease complications in US women aged under 65 years: NHANES 1999-2018.

Background: Diabetes and diabetes complications are on the rise in US adults aged <65 years, while onset of menarche at a younger age is also increasing. We examined the associations of age at menarche with type 2 diabetes among women aged <65 years and with cardiovascular disease (CVD) complications among women with diabetes. Methods: Using the nationally representative cross-sectional National Health and Nutrition Examination Survey 1999-2018, women aged 20-65 years free of cancer were included in the current analysis. Diabetes was defined as a self-reported diabetes diagnosis. CVD was defined as coronary heart disease or stroke. Age at menarche was self-reported age of first menstruation and categorised into ≤10, 11, 12, 13, 14 and ≥15 years. Results: Of 17 377 women included in the analysis, 1773 (10.2%) reported having type 2 diabetes. Earlier age at menarche was associated with type 2 diabetes compared with median age at menarche of 13 years, after adjustment for age, race/ethnicity, education, parity, menopause status and family history of diabetes, smoking status, physical activity, alcohol consumption and body mass index (p for trend=0.02). Among women with diabetes, earlier age at menarche was associated with stroke with similar adjustment (p for trend=0.03), but not with total CVD. Extremely early age at menarche (≤10 years) was significantly associated with stroke (adjusted OR 2.66 (95% CI 1.07 to 6.64)) among women aged <65 years with diabetes with similar adjustment. Conclusions: Earlier age at menarche was associated with type 2 diabetes among young and middle-aged women in the USA and with stroke complications among these women living with diabetes.

The association between the observed and perceived neighbourhood food environment and household food insecurity in a low-income district in Lima, Peru.

The objective of the present study was to assess the association between the observed and perceived food environment and food insecurity among households with children <18 years in Lima, Peru. This was a cross-sectional study including an income-stratified random sample of households (n 329) in Villa el Salvador, a low-income district in Lima, Peru. Data were collected with a household questionnaire - including the Household Food Insecurity Access Scale (HFIAS) and the University of Pennsylvania's Perceived Nutrition Environment Survey (NEMS-P) - and a neighbourhood food outlet census, including recording of food outlets' GPS coordinates. Three-quarters of the households interviewed were food insecure. Compared with food secure households and adjusting for socio-demographic covariates, food insecure households were more likely to disagree to having easy access (OR 5⋅4; 95 % CI 2⋅1, 13⋅4), high quality (OR 3⋅1; 95 % CI 1⋅7, 5⋅5) and variety (OR 2⋅5; 95 % CI 1⋅4, 4⋅6) of fresh fruits and vegetables in their neighbourhood. About 60 % (513 out of 861) of the food outlets identified in participants' neighbourhoods were classified as fresh, including markets, bodegas, and fruit and vegetable vendors. There was no difference in distance to fresh food outlets by household food insecurity; all households were on average within 52-62 m from a fresh food outlet (~2-min walk). Despite negative perceptions of their neighbourhood food environment, food insecure households had similar physical access to fresh food sources than their food secure counterparts. Thus, changes to the food environment may not alleviate food insecurity in urban poor areas of Peru.

The double burden of malnutrition in Peru: An update with a focus on social inequities.

BACKGROUND: The decrease in stunting in Peru is seen as a "success story" in the fight against malnutrition; however, the parallel increase in obesity has often been ignored. OBJECTIVE: To investigate trends in the double burden of malnutrition (i.e., the coexistence of stunting and overweight/obesity) in Peru compared with trends in household food expenditures by family socioeconomic status and urban/rural residency. METHODS: Using Peruvian nationally representative surveys, we analyzed stunting (children aged 0-5 y) and overweight/obesity (women aged 18-49 y) trends between 1992 and 2017, as well as trends in household energy consumption from healthy and unhealthy foods between 2001 and 2017 by education, income, participation in the Juntos cash-transfer program, and urban/rural residency. Joinpoint software was used for all trends analyses. RESULTS: Overall, stunting decreased and obesity increased among all social groups between 1992 and 2017. Inequities in stunting by income and urban/rural residency widened over time. From 1992 to 2017, urban stunting prevalence decreased at an average annual percent change (AAPC) of -4.5% (SE = 0.27%, P < 0.0001), whereas rural stunting prevalence decreased at a lower AAPC of -2.6% (SE = 0.30%, P < 0.0001). On the contrary, inequities in obesity narrowed as obesity prevalence among women from the extremely poor group and those living in rural areas increased at a faster rate than that of their counterparts. Rural obesity prevalence increased at an AAPC of 8.5% (SE = 1.14%, P < 0.0001), whereas urban obesity prevalence increased at an AAPC of 2.0% (SE = 0.25%, P < 0.0001). Increases in energy consumption from unhealthy foods were observed along with decreases in energy consumption from healthy foods in most social groups. CONCLUSION: The prevalence of stunting and obesity is high in Peru. The need for multisectoral interventions addressing both ends of the malnutrition spectrum, particularly among disadvantaged groups to avoid further widening of social inequities, is warranted.

Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru.

Childhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is given to supplement children's diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the NUDGE (Narrow, Understand, Discover, Generate, Evaluate) approach, we identified the following behavioral barriers and facilitators: (1) caregivers' experiences with health care providers shaped their motivation to access MNP; (2) caregivers felt accessing MNP at clinics was inconvenient and created hassle factors; (3) caregivers' mental models about anemia prevention shaped MNP intentions and use; (4) caregivers' salient negative experiences could have caused them to stop giving MNP; (5) caregivers forgot to give MNP if they did not have cues to remind them but could be prompted with salient cues; and (6) caregivers were affected by emotional, cognitive, and attentional factors during feeding that were difficult to anticipate. Our results, based on a behavioral design approach, suggest opportunities to adapt current messaging, counseling, and education around MNP use. Adaptations include providing culturally relevant messages, leveraging caregivers' emotional and cognitive states, and encouraging small but impactful changes to feeding routines to address barriers to MNP use.

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels.

In Peru, nearly half of children aged 6-36 months were diagnosed with anaemia in 2017. To address this disease, the Peruvian Ministry of Health implemented a national programme in 2014, distributing free micronutrient powders (MNPs) to all children of this age. However, rates of childhood anaemia remain high. The aim of this study was to explore factors at all levels of the Social-Ecological Model that affect MNP use and adherence in Arequipa, an Andean city with childhood anaemia rates higher than the national average. We conducted in-depth interviews with 20 health personnel and 24 caregivers and 12 focus group discussions with 105 caregivers. We identified numerous barriers, including negative side effects (constipation, vomiting, and diarrhoea), poor taste of MNP, lack of familial and peer support for its use, insufficient informational resources provided by the health system, and limited human resources that constricted health personnel abilities to implement MNP programming successfully. Facilitators identified included concern about the long-term effects of anaemia, support from organizations external to the health system, well-coordinated care within the health system, and provision of resources by the Ministry of Health. We found that community or organizational and societal factors were key to limited MNP use and adherence, specifically the limited time health personnel have to address caregivers' doubts during appointments and the lack of informational resources outside of these appointments. Potential policy implications could be to increase informational resources available outside of individualized counselling by strengthening existing collaborations with community organizations, increasing media coverage, and providing group counselling.

Organocatalyzed Intramolecular Carbonyl-Ene Reactions.

An organocatalyzed intramolecular carbonyl-ene reaction was developed to produce carbocyclic and heterocyclic 5- and 6-membered rings from a citronellal-derived trifluoroketone and a variety of aldehydes. A phosphoramide derivative was found to promote the cyclization of the trifluoroketone, whereas a less acidic phosphoric acid proved to be a superior catalyst for the aldehyde substrates.

Modifiable lifestyle behavior patterns, sedentary time and physical activity contexts: a cluster analysis among middle school boys and girls in the SALTA study.

OBJECTIVE: To analyze how modifiable health-related variables are clustered and associated with children's participation in play, active travel and structured exercise and sport among boys and girls. METHODS: Data were collected from 9 middle-schools in Porto (Portugal) area. A total of 636 children in the 6th grade (340 girls and 296 boys) with a mean age of 11.64 years old participated in the study. Cluster analyses were used to identify patterns of lifestyle and healthy/unhealthy behaviors. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, sedentary time and participation in three different physical activity (PA) contexts: play, active travel, and structured exercise/sport. RESULTS: Four distinct clusters were identified based on four lifestyle risk factors. The most disadvantaged cluster was characterized by high body mass index, low high-density lipoprotein cholesterol and cardiorespiratory fitness and a moderate level of moderate to vigorous PA. Everyday outdoor play (OR=1.85, 95%CI 0.318-0.915) and structured exercise/sport (OR=1.85, 95%CI 0.291-0.990) were associated with healthier lifestyle patterns. There were no significant associations between health patterns and sedentary time or travel mode. CONCLUSION: Outdoor play and sport/exercise participation seem more important than active travel from school in influencing children's healthy cluster profiles.

Relationship of single measures of cardiorespiratory fitness and obesity in young schoolchildren.

The purpose of this study was to examine differences of cardiorespiratory fitness (CRF) among weight groups, and the associations of CRF with obesity (body mass index) in a sample of young children. Anthropometric data (height, body mass, and two skinfolds) were collected for 255 healthy children aged 8-10 years (127 boys and 128 girls). Children were placed in three groups (nonobese, overweight, and obese), using body mass index (BMI) sex- and age-specific cutoff points. Cardiorespiratory fitness was assessed with a 1-mile run test. Participants were separated into two groups: fit and unfit, according to age- and sex-specific scores defined by FITNESSGRAM. The prevalence of overweight (30.5% vs. 29.1%) and obesity (13.2% vs. 12.6%) was at the same magnitude for boys and girls. Overall, 109 children (42.7%) were overweight and obese. Sums of skinfolds, weight, and BMI were significantly lower (P < 0.05) in lean boys and girls compared to their overweight and obese counterparts. Regarding height, no significant differences were found in girls, while in boys, significant differences were only found between nonobese and obese. No differences were found in obesity groups according to CRF in boys, while significant differences were found for girls (P < 0.01). Logistic regression analysis showed that girls who were overweight (odds ratio = 0.05, P = 0.000) or obese (odds ratio = 0.09, P = 0.001) were likely to be unfit. No significant results were found in boys. Overweight and obese children presented higher sums of skinfolds and weight compared with their lean counterparts. Increased BMI was significantly associated with lower CRF in girls. Thus, our data clearly showed potential gender differences of body composition in CRF, which would be of great clinical significance. Therefore, even at young ages, at least for girls, the beneficial impact of low BMI values on CRF is shown with important clinical and public health implications.