April 2017





NCCOR Connect & Explore webinar series recordings on Measures Registry User Guides now available

April 27, 2017, NCCOR

NCCOR hosted a special Connect & Explore two-part webinar series highlighting the recently released Measures Registry User Guides. If you missed the webinars, you can access recordings and slides at https://www.nccor.org/archived-webinars/mruserguides.

The Measures Registry User Guides were launched in February to help childhood obesity researchers and practitioners choose appropriate measures for their research and evaluation efforts. The User Guides build on NCCOR’s Measures Registry—a free, online repository of scientific articles about measures. The four User Guides focus on core areas of childhood obesity research: individual diet, food environment, individual physical activity, and physical activity environment.

On March 28, the authors of the Individual Diet and Food Environment User Guides presented on key considerations in measuring dietary behavior and assessing the food environment. Speakers included Sharon Kirkpatrick, PhD, RD; Amanda Raffoul, MSc; Leslie Lytle, PhD; and Allison Myers, PhD, MPH.

On April 12, the authors of the Individual Physical Activity and Physical Activity Environment User Guides covered the behavior epidemiology framework, socio-ecological framework for active living, and validity and reliability of different measures including GIS-based measures. Speakers included Gregory Welk, PhD; James Morrow, Jr., PhD, FACSM, FNAK; Pedro Saint-Maurice, PhD; Jordan Carlson, PhD; and James Sallis, PhD.

More than 250 people attended both webinars. NCCOR’s post-webinar surveys suggest that respondents overwhelmingly agreed the webinars were a good use of their time (89 percent) and that they would recommend this webinar to a colleague or friend (85 percent). The majority of survey respondents were from academic institutions (49 percent), followed by government agencies (28 percent). Of the survey participants, 84 percent said they were either very likely or somewhat likely to use at least one of the Measures Registry User Guides. Most survey respondents indicated they would use them to select the correct measure for their research project (56 percent) or to determine tools and indicators for an evaluation project (51 percent).

Access the recordings and slides at https://www.nccor.org/archived-webinars/mruserguides.

NCCOR posts all Connect & Explore webinar recordings and slides on the NCCOR website at https://www.nccor.org/webinars/.

Original source: https://www.nccor.org/nccor-connect-explore-webinar-series-recordings-on-measures-registry-user-guides-now-available/

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Publications & Tools

2017 County Health Rankings Key Findings Report

The County Health Rankings & Roadmaps program helps communities identify and implement solutions that make it easier for people to be healthy in their neighborhoods, schools, and workplaces. Ranking the health of nearly every county in the nation, the County Health Rankings illustrate what we know when it comes to what is keeping people healthy or making people sick and how the opportunity for good health differs from one county to the next. Supporting a call to action, the Roadmaps show what we can do to create healthier places for everyone to live, learn, work, and play. The Robert Wood Johnson Foundation collaborates with the University of Wisconsin Population Health Institute to bring this program to communities across the nation.

Access the report: http://www.countyhealthrankings.org/reports/2017-county-health-rankings-key-findings-report

Access the 2017 rankings: http://www.countyhealthrankings.org/

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Status Report for Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities

Physical activity has many benefits, including reducing the risk of developing chronic diseases and supporting healthy aging. Walking is the most common form of physical activity across the country and an excellent way to help people become more active. In September 2015, the Office of the Surgeon General of the US Department of Health and Human Services released Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities to increase walking among people across the United States. The purpose of this report is to summarize the state of walking and walkability when the Call to Action was released, as well as selected activities done since to sustain the messages and promote the goals established by the Surgeon General.

Access the report: https://www.cdc.gov/physicalactivity/walking/call-to-action/pdf/status-report.pdf

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Working Toward Engaging Local Businesses in Community Obesity Solutions: A Preliminary Account from the Field

Childhood obesity continues to be a serious public health concern in the United States. About 12.7 million children and adolescents aged 2–19 years, or 17 percent of the population, have obesity. In addition to genetic and behavioral factors, the environments where children live, learn, and play impact their health and well-being. A lack of access to affordable, healthy foods; the absence of physical activity in schools and childcare centers; and a shortage of safe community spaces such as parks, sidewalks, and bike paths also contribute to obesity levels. While reversing and overcoming childhood obesity will be challenging, stakeholders from all sectors of society, including government, nonprofit organizations, business and industry, health care groups, and community members, need to create opportunities to identify and spearhead solutions.

2015–2020 Dietary Guidelines for Americans recognized the need for solutions and issued a call to action for all segments of society to “help change social norms and values and ultimately support a new prevention and healthy lifestyle paradigm that will benefit the U.S. population today as well as future generations.” Because the repercussions of obesity impact all of society, solutions-oriented engagement is critical not only for general population health, but for the health of the economy. Adult obesity takes a heavy toll on both individual and workforce health, as U.S. workers who have overweight or obesity miss an average of 450 million more work days per year compared with healthy workers of normal weight. In addition, adult obesity costs approximately $190 billion per year in medical expenses. Investing in childhood obesity solutions—whether through education, research, or greater community involvement—can support a healthier workforce and provide improved societal benefits for all.

Access the report: https://nam.edu/wp-content/uploads/2017/04/Working-Toward-Engaging-Local-Businesses-in-Community-Obesity-Solutions.pdf

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Childhood Obesity Research & News

Little kids’ regular bedtimes and ability to regulate emotions may lessen obesity risk

April 24, 2017, The Ohio State University

By Misti Crane

Family structure including regular bedtimes, mealtimes and limited screen time appear to be linked to better emotional health in preschoolers, and that might lower the chances of obesity later, a new study suggests.

“This study provides more evidence that routines for preschool-aged children are associated with their healthy development and could reduce the likelihood that these children will be obese,” said lead author Sarah Anderson of The Ohio State University.

The study – the first to look at the connections between early childhood routines and self-regulation and their potential association with weight problems in the pre-teen years – appears in the International Journal of Obesity.

Researchers evaluated three household routines when children were 3 years old: regular bedtime, regular mealtime and whether or not parents limited television and video watching to an hour or less daily. Then they compared those to parents’ reports of two aspects of children’s self-regulation at that same age.

Lastly, they investigated how the routines and self-regulation worked together to impact obesity at age 11, defined based on international criteria. (The U.S. criteria for childhood obesity is set lower and would have included more children.)

The research included 10,955 children who are part of the Millennium Cohort Study, a long-term study of a diverse population of children born in the United Kingdom from September of 2000 to January of 2002. At age 3, 41 percent of children always had a regular bedtime, 47 percent always had a regular mealtime and 23 percent were limited to an hour or less daily of TV and videos. At age 11, about 6 percent were obese.

All three household routines were associated with better emotional self-regulation – a measure based on parents’ responses to questions such as how easily the child becomes frustrated or over-excited. Those children with greater emotional dysregulation were more likely to be obese later.

“We saw that children who had the most difficulties with emotion regulation at age 3 also were more likely to be obese at age 11,” said Anderson, an associate professor in Ohio State’s College of Public Health.

Anderson and her colleagues also found that the absence of a regular preschool bedtime was an independent predictor of obesity at 11. Obesity risk increased even when children “usually” had a regular bedtime, as opposed to “always.” The risk was greatest for those who had the least amount of consistency in their bedtimes.

How persistent and independent children were at age 3 – another aspect of self-regulation – was not related to obesity risk, nor were routines associated with these aspects of self-regulation.

The new findings build on previous research by Anderson and her colleagues showing an association between earlier preschool bedtimes and decreased odds of obesity later. Previous work published in 2010 showed in a US national sample that obesity prevalence was lowest for children who got enough sleep, had limits on screen time and ate meals with their families.

“This research allows us to better understand how young children’s routines around sleep, meals, and screen time relate to their regulation of emotion and behavior,” Anderson said. “The large, population-based, UK Millennium Cohort Study afforded the opportunity to examine these aspects of children’s lives and how they impact future risk for obesity.”

This research should prompt future work looking at the role of emotional self-regulation in weight gain in children and how bedtime routines can support healthy development, Anderson said.

“Sleep is so important and it’s important for children in particular. Although there is much that remains unknown about how sleep impacts metabolism, research is increasingly finding connections between obesity and poor sleep,” she said.

While it’s impossible from this work to prove that routines will prevent obesity, “Recommending regular bedtime routines is unlikely to cause harm, and may help children in other ways, such as through emotion regulation,” Anderson said.

But competing family pressures including parents’ work schedules don’t always allow for consistency, Anderson pointed out.

“As a society, we should consider what we can do to make it easier for parents to interact with their children in ways that support their own and their children’s health.”

The National Institutes of Health and the U.K. Economic and Social Research Council supported the study.

Researchers from the University College London and Temple University also worked on the study.

Original source: https://news.osu.edu/news/2017/04/24/bedtimes-and-obesity/

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Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study

April 18, 2017, PLOS Medicine


Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake.

Methods and findings
Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents.

Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline.

Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day).

Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (−0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (−$0.36, p < 0.001) than in comparison stores (−$0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (−19.8%, p = 0.49) and in mean per capita SSB caloric intake (−13.3%, p = 0.56) from baseline to post-tax were not statistically significant.

Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley’s low baseline consumption.

One year following implementation of the nation’s first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.

Original source: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002283

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Paper: Nutrition label readers favor food quality over quantity

April 18, 2017, University of Illinois News Bureau

By Phil Ciciora

People who closely eyeball nutrition labels tend to eat differently than less-discerning diners in one key regard, according to research from a University of Illinois expert in food and nutrition policy and consumer food preferences and behaviors.

Although nutrition-label users and non-nutrition-label users eat roughly the same amount of food, the two groups diverge when it comes to the quality of the food they eat, says a new paper co-written by Brenna Ellison, a professor of agriculture and consumer economics at Illinois.

“Research has often concluded that people who use nutrition labels eat better. But we don’t necessarily talk about what better means,” Ellison said. “Is it eating less food, or is it eating better food? This study looks at people’s plates and considers both what they selected to eat and what they actually ate in an effort to determine which difference” – volume or quality – “is occurring.”

To examine the relationship between label use and food selection, servings and consumption, Ellison and co-author Mary J. Christoph of the University of Minnesota combined survey and photographic data of the lunch plates of college students at two different university dining halls. Food selection, servings and consumption were assessed using digital photography, a method with strong reliability for validating portion sizes compared with weighing food and visual estimation.

“In terms of measuring and evaluating the plates, we had students who built their own plates because it was a self-serve dining environment,” Ellison said. “Diners were only eligible if they were just sitting down to eat. It couldn’t be someone who was halfway through their meal, which would misrepresent what they were eating and skew the results.”

Based on the meals assessed, the quantity of foods served and consumed were roughly similar between the two groups. There were, however, distinct differences in the types of foods plated and consumed within MyPlate food categories between those who tended to read nutrition labels and those who didn’t, the researchers found.

The results indicate that a greater proportion of nutrition-label users selected more fruits, vegetables and beans, and fewer potatoes and refined grains, compared with non-label users. In addition, fewer label users selected fried foods and foods with added sugars, Ellison said.

“We find that it’s more about the types of food rather than the quantity of the food,” Ellison said. “The amount of food between label users and non-label users was roughly the same amount. It’s the differences in quality that are more prevalent than the sheer amount of food selected.”

Using digital photography also provided a more objective assessment of food selection, servings and consumption compared with self-reporting because “you don’t have to rely on students remembering how much of each food they ate,” Ellison said.

“That’s one big advantage to this study. Another one is that diners did not interact with our data collectors until after their plate was built. So our data collection methods shouldn’t have affected what they chose. For example, people weren’t picking more salad because they knew there was going to be a picture taken of their plate.”

Participants were further surveyed on socio-demographic and behavioral variables such as gender, body mass index, exercise frequency and nutrition education to better assess the possible link between label use and food selection, servings and consumption, according to the paper.

Examining nutrition labels is often recommended by doctors and dietitians to improve food choices, but choice does not always translate to consumption. Furthermore, evidence on the effectiveness of labels is mixed, and few studies can identify how labels actually influence behavior, Ellison said.

“Previous research has focused on portion control for weight loss or weight management, generally eating less. But, more-recent research indicates this may not be the most effective message. By eating less, consumers may feel deprived, or even ‘hangry,’ which can make it difficult to sustain long-term dietary behaviors,” she said. “Newer research indicates that eating less of certain types of foods, rather than all foods, may matter more.”

Although the results show label users eat differently than non-users, the implications of the research suggest there may be a need for greater consumption of fruit, vegetables, beans, whole grains and low-fat dairy among both groups.

In addition to posting labels, Ellison said dining facilities may want to increase offerings of nutrient-dense foods (whole grains and vegetables, for example) or consider product reformulations that creatively incorporate these foods to encourage healthy eating behaviors.

But Ellison warned that the study’s findings should still be cautiously interpreted, as the conclusions are based on only one meal.

The paper will appear in the Journal of the Academy of Nutrition and Dietetics.

Original source: https://news.illinois.edu/blog/view/6367/489411

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EU funds big data project to design strategies to combat childhood obesity

April 11, 2017, European Commission

BigO (bigoprogram.eu) is an EU-funded project that collects objective evidence on the causes of obesity in local communities and helps public health authorities design effective counter obesity interventions. A novel technological platform will be built relying on big data analytics and visualisation.

The BigO platform will use sensor technologies to record children’s daily eating and physical activity behaviour and correlate it with environment data from on-line sources. Widely spread sensors in smartphones or activity bracelets will be used, in combination with Mandometer®, a clinically validated device monitoring the rate of food intake. Data as a whole will include what and how children eat, how they move and sleep, along with characteristics of their urban, socioeconomic, commercial and school environment. Data driven analytics will then be employed to extract relationships between environment, personal behaviour, obesity risk factors and obesity prevalence and determine which particular local conditions are associated with the development of obesity in children of a specific region.

BigO will engage children and adolescents aged 9-18 years from Greece, Sweden and Ireland, to share their data as citizen scientists. Moreover, age-matched obese children will be recruited from obesity clinics in these countries. The project started in December of 2016 and aims to reach out to more than 25000 children in its 4-year duration.

Obesity is a major global and European public health problem, causing 2.8 million deaths among adults worldwide each year. Its prevalence has more than tripled in many European countries since the 1980s. “BigO is envisioned as a powerful tool for the public health officials”, says Anastasios Delopoulos, project coordinator and professor in Electrical and Computer Engineering at the Aristotle University of Thessaloniki, Greece. “For the first time, it will be possible to identify and prioritize the community environmental factors that lead to childhood obesity and plan appropriate programs tailored to local conditions. Supported by powerful visualizations, public health officials will also be able to predict the effectiveness of their interventions to the obesogenic behavior of the population and also to monitor and assess the result of their programs,” he adds.

The BigO consortium brings together a close-knit team of schools, health and clinical scientists, public health authorities, researchers in data analytics and personal health systems, technology providers and mobile communication providers. The 13 European partners are from Greece, Sweden, Ireland, Spain and the Netherlands.

Original source: http://cordis.europa.eu/news/rcn/140055_en.html

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