Purpose: Several factors at the individual-, household-, and contextual-level contribute to rising rates of obesity in the United States. Using data from a sample of adults (>18yo) living in four New Jersey cities (Camden, Newark New Brunswick, and Trenton), we examined the association between changes in the neighborhood food environment and changes in BMI. We also explored whether this association is moderated by a composite measure of socioeconomic status (SES).

Methods: Respondents’ BMI was calculated at two time points between 2009 and 2017, using self-reported heights and weights. The count of different types of outlets (specifically, convenience stores, small grocery stores, upgraded stores, supermarkets, and fast-food restaurants) within ¼, ½, and 1 mile from the geocoded respondent residence was collected at baseline and tracked every month until follow-up. A binary (low/high) measure of SES was created through latent classes using four socioeconomic status indicators as well as race (to account for the intersectionality between SES and race). Multivariate linear regression first modelled the overall association between changes in BMI with measures of the food environment. Then the same models were replicated with the addition of interaction terms between SES and the food environment.

Results: Overall, an increase in the number of small grocery stores within ¼ mile was associated with a decrease in BMI (β=-1.4, p=0.015), while an increase in the number of fast-food restaurants, both within ½- and 1-mile radius, was associated with an increase in BMI (β=0.2, p=0.042, and β=0.1; p=0.042, respectively). The interaction analysis highlighted that different SES groups were affected differently by changes in food environment. For instance, the direct association between changes in the number of fast-food restaurants and changes in BMI was only observed among individuals in the lower SES group.

Conclusions: Contextual factors, specifically the food environment around one’s home, are independently associated with BMI over time. This work contributes to the obesity literature by focusing on both (1) the association between changes in the food environment and changes in BMI and (2) variations among vulnerable individuals who might experience a disproportionate impact of changes in the food environment.

Purpose: UK adolescents have poorer diets than other age groups, with soft and energy drinks the primary source of free sugars. Energy drinks contain large amounts of caffeine; sales have grown substantially over the past decade with adolescents the greatest consumers. To help inform policy change, we conducted a mixed-methods study.

Methods: Quantitative diet diary data from the UK National Diet and Nutrition Survey (NDNS), a repeated cross-sectional survey (2008-2016) with a nationally representative sample, were used to identify whether each participant aged 11-18 years (n=2587) consumed energy drinks. A diet quality score was derived for each participant using principal component analysis on 139 food groups; higher scores represented healthier diets. Household income and neighbourhood deprivation provided information on socioeconomic position. Logistic regression models were fitted to describe associations between energy drink consumption and diet and demographic variables.

Semi-structured interviews were conducted with 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK to learn about adolescents’ food habits. Qualitative data were coded in Nvivo by two researchers with input from three others.

Results: NDNS data showed adolescents’ consumption of energy drinks was associated with poorer dietary quality (OR 0.46SD; 95% CI 0.37, 0.58; p<0.001). Adolescents in more deprived areas (deprivation quintiles) and from lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Three themes were identified from the qualitative data. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don’t know why energy drinks are unhealthy. Third, adolescents felt that voluntary bans in retail outlets and schools do not work. 

Conclusions: This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents’ energy drink intake.

Purpose: People with a lower socioeconomic position (SEP) face more daily hassles than people with a higher SEP. Urgent goals associated with daily hassles are likely to limit one’s energy and time to address less pressing goals. Consequently, health-related goals may become less focal, which could jeopardize health and health-promoting behaviors. This study examined an understudied pathway: whether an increased severity of daily hassles resulted in a lower perceived importance of health and whether these two factors sequentially mediated socioeconomic inequalities in self-assessed health and food consumption.

Methods: A cross-sectional survey among 1,330 Dutch adults was conducted in 2019. Participants self-reported indicators of SEP (household income, educational level), the severity of eleven daily hassles (e.g., financial hassles, legal hassles), the perceived importance of health (not being ill, living a long life), and three outcomes (self-assessed health, fruit and vegetable consumption, and snack consumption). Structural equation modeling was used to examine whether daily hassles and the perceived importance of health sequentially mediated income and educational inequalities in self-assessed health, fruit and vegetable consumption, and snack consumption.

Results: Although socioeconomic inequalities in all three outcomes were observed, no evidence of sequential mediation through daily hassles and the perceived importance of health was found. Daily hassles explained 83% of income inequalities in self-assessed health (indirect effect: 0.05, total effect: 0.06) and 22% of income inequalities in fruit and vegetable consumption (indirect effect: 0.02, total effect: 0.09). The perceived importance of not being ill and living a long life each mediated 14% of educational inequalities in self-assessed health (indirect effects: 0.01 and -0.01, respectively, total effect: 0.07).

Conclusions: Income inequalities in self-assessed health and food consumption were explained by daily hassles, and educational inequalities in self-assessed health were explained by the perceived importance of health. The perceived importance of health does not seem compromised by a goal conflict with dealing with daily hassles. Interventions or policies addressing challenging circumstances (e.g., alleviating financial or administrative hassles) associated with a low income may improve self-assessed health and healthy food consumption among lower-income groups. 

Objective: To assess the effectiveness and appeal of delivering a virtual program regarding eating competence, interest and enjoyment in physical activity, and confidence related to consuming and providing fruits and vegetables for low-income mobile food pantry users.

Methods: In this study, 156 participants registered to join a free ten-week, non-diet virtual Whole-Body Approach (WBA) program which was offered in English and Spanish. Participants were asked to complete the pre-survey before the start of the program and a post-survey at the end of the program. The text messages were delivered using Simple Texting web interface. Text messages were delivered throughout the week to active participants relating to helpful tips regarding the topic of the week, a link to an educational video, and either a link to a recipe or second helpful tip. The topics that were discussed throughout the program include stress management, relationship with food, mindful eating, healthy body image, and enjoyable movement. Outcome measurement tools included Eating Competence Satter Inventory 2.0 (ecSI 2.0), fruit and vegetable Self-Efficacy Questionnaire, and the Interest/Enjoyment subscale of the Motives for Physical Activity Revised (MPAM-R). Paired samples t-test or Wilcoxon signed-rank test were used to compare baseline and follow-up outcome measures in participants who completed both the pre- and post-surveys.

Results:Of the 156 participants who registered, 100 completed pre-surveys (mean age 48 years, 89% female) before the beginning of the program. Over the span of 10 weeks, we maintained 112 participants and 21 completed post-surveys (median age 53.5 years, 96% female). The ecSI 2.0 showed a significant change (p=0.008) in internal food regulation and overall eating competence (p=0.02). Participants did not significantly increase their overall self-efficacy for fruits and vegetables or motivation for physical activity (p > 0.05).

Conclusion:The 10-week virtual nutrition education intervention for mobile food pantry users did not significantly improve exercise motivation and self-efficacy for fruit and vegetable related behaviors. Future studies may include a hybrid program where half of the classes will be in-person which may increase participant retention and engagement with the pro gram, a higher survey response rate, and significant improvements in outcome measurements.

Black/African American (AA) girls are disproportionately affected by obesity. Healthy eating and active living (HEAL) interventions have been effective for obesity prevention and should begin early in childhood. Innovative strategies that incorporate cultural and social norms are needed to engage this population. A possibility is to capitalize on parasocial relationships resulting from engaging media characters to promote behavior change using observational and play-based learning.

Purpose: Conduct formative research with AA girls (aged 4-8 years) and their primary caregiver to inform the development of a culturally relevant, childhood obesity prevention program using a smart doll to teach Black/AA girls to adopt HEAL practices.

Methods: Two semi-structured focus groups were conducted with a community advisory board (CAB) of Black/AA girls and primary caregiver dyads (n=6; child age=5.2±1.1 years; BMI percentile=96±3.1) who reside in Minnesota. Questions informed by the Social Cognitive Theory assessed girls’ HEAL behaviors for the intervention and preferences for the smart doll and multimedia app platform. A descriptive, narrative approach was utilized to analyze data using NVivo (v12).  

Findings: Dancing was reported as girls’ favorite indoor physical activity (n=3), while playing in the snow and sledding were girls’ favorite outdoor physical activities (n=3 and n=3, respectively). Daughters also reported baking (n=3), cooking (n=4), and grocery shopping (n=3) when asked what they do with food besides eating it. Girls shared that their favorite dolls have accessories (n=3) and look like them (n=5).

All primary caregivers in the CAB were mothers. For intervention strategies regarding HEAL behaviors, caregivers suggested avoiding “food shaming” (n=1) and developing fun (n=2), affordable (n=1), and age-appropriate (n=1) activities. One mother mentioned that discrimination occurring while being physically active outdoors influenced their choice of activity location.

Conclusions: Black/AA girls and their primary caregivers were enthusiastic about using an interactive smart doll to improve HEAL behaviors. The CAB provided culturally relevant feedback on the doll mirroring the girls’ image (i.e., curly hair, brown skin) and incorporating fun strategies for HEAL. The next steps include developing the smart doll and multimedia app based on the formative findings and pilot testing it with 20 Black/AA girls and their primary caregivers.