March 2022

New NCCOR Publication Looks at the Benefits of Improving the Built Environment

Can interventions that promote more walkable communities have the added benefit of improving safety?

A new NCCOR manuscript published in Preventive Medicine Reports seeks to address this question. The article, titled “Systematic Review on Quantifying Pedestrian Injury When Evaluating Changes to the Built Environment,” presents a literature review conducted by NCCOR’s Additional Benefits of Walkability workgroup. Researchers examined if previous studies had measured pedestrian injuries when evaluating interventions that promote walkability.

The NCCOR review found that few studies have quantified pedestrian injury relative to interventions in the built environment that foster walkable communities. The paper concludes with recommendations for quantifying injury prevention and clarifying the safety benefits of walkable communities. The authors urge greater collaboration between physical activity and injury prevention professionals.

NCCOR’s new publication is in response to The Surgeon General’s Call to Action to Promote Walking and Walkable Communities. This report described the need to develop measures and tools to quantify additional benefits of walkability and to evaluate the effectiveness of these interventions. Prior research demonstrated that walkable communities positively impact health, but there remained a lack of evidence about additional benefits, such as improved social cohesion on injury prevention. Interventions that improve walkability and promote pedestrian safety, for example, may also help foster buy-in from communities and other sectors.

For more information, visit NCCOR’s Physical Activity project page. In addition to injury prevention, NCCOR has been reviewing economic benefits of built environment approaches. NCCOR anticipates releasing translation materials for public health practitioners, decision makers, and communities to help support making the case for built environment improvements.

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NCCOR Toolbox: Evaluation Resource Library

NCCOR’s newest tool, A Toolkit for Evaluating Childhood Healthy Weight Programs, offers a robust resource library that compiles the best evaluation resources from government, academia, and community programs in one easy-to-access location. Users can link to resources directly online or download the resource list for later reference. The resource library is a perfect tool for those who are planning programs and for educators who are teaching evaluation methods.

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The American Academy of Nutrition and Dietetics Publishes New Position Paper on Childhood Obesity Prevention

A new paper from the American Academy of Nutrition and Dietetics offers recommendations for the role of Registered Dietitian Nutritionists in preventing childhood obesity and argues that prevention requires comprehensive culturally competent interventions during childhood and adolescence. These findings stem from a systemic review of childhood obesity interventions conducted by the Academy, which found a beneficial effect of nutrition and physical activity programs on markers of childhood obesity. The full paper is available for free on the Academy’s website.

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New Digital Resources Help Educators Promote Children’s Well-Being

Action for Healthy Kids (AFHK) recently expanded its digital resource library with resources to promote childhood nutrition and physical activity. It now has more than 250 free activities, tip sheets, and videos for educators and public health practitioners. Materials are available in English and Spanish. AFHK stated that these new resources will help to address food insecurity and promote holistic well-being among communities.

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New CPSTF Report Details the Economic Benefits of Housing First Programs

The Community Preventive Services Task Force (CPSTF) published a systemic review in the American Journal of Preventive Medicine outlining the benefits of Housing First programs for individuals and families who experience homelessness. Housing First refers to programs that provide sustained subsidized housing, often with a range of support programs. The new CPSTF paper finds that these programs provide a societal cost savings of 1.44 dollars for every dollar invested. They also decrease homelessness, increase housing stability, and improve quality of life.

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Children Eat What They Like, but Food Intake Driven More by What They Dislike

February 22, Penn State University

It is often said that “children eat what they like,” but the results of a new study by Penn State nutritionists and sensory scientists suggests that when it comes to meals, it is more accurate and more relevant to say, “children do not eat what they dislike.”

There is an important difference, according to lead researcher Kathleen Keller, associate professor in the departments of Nutritional Sciences and Food Science, who conducted an experiment involving 61 children ages 4-6 years to assess the relationship between their liking of foods in a meal and subsequent intake. The research revealed that when presented with a meal, disliking is a stronger predictor of what youngsters eat than liking.

“In other words, rather than high-liking driving greater intake, our study data indicate that lower-liking led children to avoid some foods and leave them on the plate,” she said. “Kids have a limited amount of room in their bellies, so when they are handed a tray, they gravitate toward their favorite thing and typically eat that first, and then make choices about whether to eat other foods.”

“For 50 plus years, we’ve known liking and intake are positively correlated, but this often leads to the mistaken assumption that if it tastes better, you will eat more,” he said. “Reality is a bit more nuanced. In adults, we know that if you really like a food, you may or may not eat it. But if you don’t like it, you’ll rarely or never eat it. These new data show the same pattern is true in young kids.”

Children participated in two identical laboratory sessions in the study conducted in Keller’s Children’s Eating Behavior Laboratory in the College of Health and Human Development, where seven foods — chicken nuggets, ketchup, potato chips, grapes, broccoli, cherry tomatoes and cookies — were included on a tray. Also included were two beverages, fruit punch and milk.

Before eating the meals, children were asked to rate their liking of each food on the following five-point scale — Super Bad, Bad, Maybe Good-Maybe Bad, Good and Super Good. After the children had eaten as much of the meal as they wanted, the researchers weighed what they ate and compared the results with what the kids said they liked and disliked. The correlations were striking.

In findings recently published in the journal Appetite, the researchers reported that the relationship between liking and intake was not strong for most of the foods. For instance, only liking for potato chips, grapes, cherry tomatoes and fruit punch was positively associated with the amount consumed. But no associations were found between liking and intake of other meal items.

However, there was a strong correlation between consumption — or nonconsumption in this case — and the foods the children said they didn’t like. At a multi-component meal, rather than eating what they like, these data are more consistent with the notion that children do not eat what they dislike, the researchers concluded.

Even at a young age, children’s food choices are influenced by their parents and peers, Keller pointed out. So, we need to be careful with assumptions about what truly is driving their behavior when they sit down to eat a meal.

“They pick up on what is said around the table about what foods are good, and while that may not actually correspond to kids eating them, they are taking it all in, and that’s affecting their perceptions of foods,” she said. “Milk is a good example of that — for some families, there may be a health halo effect around milk. Kids learn from an early age that drinking milk will give them a strong body, so they may drink milk even if it’s not their favorite beverage.”

Because children in the United States continue to consume insufficient amounts of vegetables, the findings of research projects such as this one are of great interest to parents, many of whom struggle to get their kids to eat vegetables, Keller believes. Parents want to know how they can improve their kids’ nutrition.

“Some parents struggle with kids who are very picky eaters,” she said. “That can cause long-term nutrition issues and creates a lot of stress for the family. I think picky eating is one of the most common complaints that I hear from parents — ‘How do I get my child to accept more foods? How do I make the dinner experience better and easier for my family?’”

Also contributing to this research were Catherine Shehan, a former graduate student in the Department of Food Science who is currently a quality manager at Epic in Madison, Wisconsin; Terri Cravener, research coordinator and manager of the Children’s Eating Lab at Penn State; and Haley Schlechter, nutritional sciences major.

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Positive Parenting Can Reduce the Risk that Children Develop Obesity

February 21, EurekAlert!

New research from Penn State found that children with positive, early interactions with their care givers — characterized by warmth, responsiveness, and a stimulating home environment — were at reduced risk of childhood obesity.

“A lot of the discussion around childhood obesity and other health risks focuses on identifying and studying the exposure to risk,” said Brandi Rollins, assistant research professor of biobehavioral health. “We took a strength-based approach in our analysis. We found that a supportive family and environment early in a child’s life may outweigh some of the cumulative risk factors that children can face.”

The study, “Family Psychosocial Assets, Child Behavioral Regulation, and Obesity,” recently appeared in the journal Pediatrics. In the article, Rollins and Lori Francis, associate professor of biobehavioral health, analyzed data from over 1,000 mother-child pairs and found that children’s early exposures to family psychosocial assets — including a quality home environment, emotional warmth from the mother, and a child’s ability to self-regulate — reduced the risk of developing childhood obesity.

Encouragingly, these factors were protective even when children faced familial risks for obesity, including poverty, maternal depression, or residence in a single-parent home.

“Research on parenting has shown that these types of family assets influence children’s behavior, academic success, career, and — not surprisingly — health,” Rollins said. “It is significant that these factors also protect against childhood obesity because the family assets we studied are not food or diet-specific at all. It is heartening to know that, by providing a loving, safe environment, we can reduce the risk that children will develop obesity.”

Severe Obesity
Children are deemed to have obesity when their body mass indices (BMIs) are greater than 95% of other children their age and gender. There is a great deal of variance, however, in the BMIs of children who exceed the obesity threshold. Children whose BMI is 20% higher than the obesity threshold are considered to have severe obesity.

The researchers found that children who had early-onset severe obesity did not face greater levels of family risk than children who were not obese. Children with severe obesity, however, did have fewer family assets than children who were not obese or who displayed moderate levels of obesity. More research is needed to understand which factors contribute to the development of severe obesity and which factors reduce the risk.

“Though the findings on severe obesity may seem discouraging, they offer some hope,” Rollins explained. “Some risk factors, like household poverty, can be very difficult to change. Assets, on the other hand, may be easier to build. People can learn to parent responsively. It is encouraging that parenting really matters, that family matters.”

What Parents Can Do
This work is based on research in parenting and child development. Responsive parenting, one of the family assets measured in the study, involves responding to children in a timely, sensitive, and age-appropriate manner based on the child’s presenting needs. Researchers in Penn State’s Center for Childhood Obesity Research are also exploring how responsive parenting can reduce the risk of childhood obesity.

This study focused on childhood obesity, but the researchers said that parents may improve many outcomes for their children by learning responsive-parenting skills. Knowledge of responsive-parenting skills, however, may not lead directly to implementing those skills in the home.

“No one can read a pamphlet about cars and suddenly expect to drive,” said Rollins. “Driving is a skill that requires education and practice. The same is true of responsive parenting.

“Public health professionals, clinicians, and researchers must collaborate to help families develop psychosocial assets, including responsive parenting and a structured home environment,” she continued. “This could improve childhood obesity rates and other important quality-of-life outcomes.”

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Picture Warnings Reduce Purchases of Sugary Drinks for Children

February 1, University of North Carolina Chapel Hill

Note: One of the authors profiled in this article, Lindsey Smith-Taillie, was a featured speaker during a recent NCCOR webinar. Click here to view her presentation.

A study published Feb. 1 in the journal PLOS Medicine is the first to examine in a realistic setting whether pictorial health warnings on sugary drinks — like juice and soda — influence which beverages parents buy for their children.

The findings are promising: The warnings reduced parental purchases of sugary drinks for their kids by 17%.

Researchers at the University of North Carolina at Chapel Hill Gillings School of Global Public Health conducted the study in a unique laboratory — the “UNC Mini Mart.” The space models a convenience store shopping experience.

“We created this store because we saw a major need for research that tests the impact of policies in a food store setting that is much more realistic,” said senior author Lindsey Smith Taillie, assistant professor in the UNC Gillings Department of Nutrition and a member of the UNC Carolina Population Center (CPC). “When people make choices about what food to buy, they are juggling dozens of factors like taste, cost and advertising and are looking at many products at once.

“Showing that warnings can cut through the noise of everything else that’s happening in a food store is powerful evidence that they would help reduce sugary drink purchases in the real world,” Taillie said.

Study co-authors include lead author Marissa G. Hall, assistant professor in the UNC Gillings Department of Health Behavior and a member of the CPC and UNC Lineberger Comprehensive Cancer Center (LCCC), and Anna H. Grummon, PhD, an alumna of the UNC Gillings Department of Health Behavior who is now a David. E. Bell Fellow at Harvard University.

Researchers from the Gillings School of Global Public Health created the UNC Mini Mart to examine how various obesity-prevention policies work in a realistic setting.

The positive findings about the effects of image-based warning labels highlight a recent but increasingly common approach to combating the global struggle with obesity.

Children in the United States and many other countries consume more than the recommended amount of sugary drinks, which increases their risk for obesity and diet-related chronic diseases, including Type 2 diabetes and heart conditions.

There also are pronounced disparities by race/ethnicity, with higher rates of sugary drink consumption and obesity among Black and Latino children compared to non-Latino white children, in part due to structural factors like targeted marketing.

Taillie has conducted research into warning labels and taxes on sugar-sweetened beverages and junk food in Chile, Mexico and South Africa. Hall researches the impact of warnings on tobacco and food products.

In their latest study, 325 parents of children aged 2-12 were randomly assigned to two different groups and asked to choose a drink and a snack for their child plus a household item in the store laboratory. The intervention group had pictorial health warnings about Type 2 diabetes  or heart disease displayed on drinks, while a control group had regular barcode labels.

Participants were instructed to choose one drink and one snack for their child, along with one household good; this shopping list was designed to mask the purpose of the study. After shopping, participants completed a survey about their selections and left with their drink of choice and a cash incentive.

The picture warnings led to a 17% reduction in purchases of sugary drinks, with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm.

The picture warnings also reduced calories purchased from sugary drinks and led to parents feeling more in control of healthy eating decisions and thinking more about the harms of sugary drinks.

The benefits of the picture warnings were similar for parents with different characteristics, including race, ethnicity and socioeconomic status, suggesting picture warnings could be effective across diverse populations. Larger studies are needed, however, to see how well warnings work for the groups at highest risk of diet-related disease.

“We think the paper could be useful for policymakers in the U.S. and globally,” Hall says. “This evidence supports strong front-of-package warnings to reduce children’s sugary drink consumption.”

Additional UNC-Chapel Hill authors include Isabella C. A. Higgins, a doctoral student in the UNC Gillings Department of Health Behavior and trainee at the CPC; Allison J. Lazard, PhD, E. Reese Felts Jr. Distinguished Associate Professor at the UNC Hussman School of Journalism and Media and a member of the Lineberger Comprehensive Cancer Center; Carmen E. Prestemon, a project coordinator at the CPC and Mirian I. Avendaño-Galdamez, a research assistant at the CPC.

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