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Front-of-package warning labels introduced in Mexico in 2020 included disclaimers that caution against allowing children to consume products with non-sugary sweeteners and caffeine. We examined the awareness and use of the disclaimers among Mexican adults and youth 1 month after the regulation was implemented. We also investigated their impact on the perceived healthfulness of industrialised beverages designed for children.
Data on the awareness and use of the disclaimers were analysed. Two between-subjects experiments examined the effect of a sweetener disclaimer (Experiment 1, youth and adults) or a caffeine disclaimer (Experiment 2, only adults) on the perceived healthfulness of industrialised beverages. Interactions between experimental conditions and demographic characteristics were tested.
Online survey in 2020.
Mexican adults (≥18 years, n 2108) and youth (10–17 years, n 1790).
Most participants (>80 %) had seen the disclaimers at least rarely, and over 60 % used them sometimes or frequently. The sweetener disclaimer led to a lower perceived healthfulness of a fruit drink (adults: 2·74 ± 1·44; youth: 2·04 ± 0·96) compared with the no-disclaimer condition (adults: 3·17 ± 1·54; youth: 2·32 ± 0·96) (t’s: >4·0, P values: <0·001). This effect was larger among older adults and male youth. The caffeine disclaimer did not affect adult’s perceived healthfulness of a caffeinated drink (t = 0·861, P value = 0·3894).
There were high awareness and use of the sweeteners and caffeine disclaimers shortly after the warning labels were implemented. The sweetener disclaimer appears to be helping consumers modify their perceptions regarding industrialised beverages for children. Findings may help decision-makers improve the regulation and better target communication strategies.
Background: Since October 2020, the Infection Prevention Resource and Assessment Team (IPRAT) has provided infection prevention guidance and support to congregate-care settings throughout Michigan. Specifically, outreach to skilled nursing facilities (SNFs) in response to reported positive COVID-19 resident and staff cases. Case rates provide limited data and do not factor in additional variables, such as staffing shortages, geographical location, or access to supplies, which can increase the vulnerability of staff and residents to outbreaks. To facilitate equitable outreach, a risk assessment was developed using variables related to infection prevention and poor COVID-19 outcomes utilizing local, state, and federal data reporting websites. Methods: A retrospective data review of IPRAT’s electronic data repository was performed, and 2 distinct periods were identified between November 6, 2020, and December 5, 2022. Outreach method 1 involved only using case counts from November 6, 2020, to September 24, 2021. Outreach method 2 (new risk-assessment–based outreach) involved additional data points from April 12, 2021, to December 5, 2022. Data included 17 self-reported items from the NHSN, 3 characteristics regarding facilities’ COVID-19 units, and 7 community-level variables derived from county vaccine rates, social vulnerability index (SVI), and COVID-19 community transmission level. The scoring of each data point ranged from 0–10, and outreach was prioritized to facilities with the highest overall scores. Successful referrals (resulting in a site visit) were compared to the SVI and healthcare emergency regional maps to determine whether the new outreach method reached more facilities in vulnerable communities. Results: Of 358 outreach attempts, IPRAT had a higher success rate with method 2 (6.9%) compared to method 1 (5.3%) and improved outreach in rural Michigan regions 7 and 8 (15% vs 3%). Site visits in counties with a high SVI rating with method 2 were 14.5% versus 10.6% using method 1. COVID-19 prevention referral success rates were higher (4.4% vs 3.1%) using method 2. Conclusions: The risk-assessment–based outreach method showed improvement in overall referral success rates among facilities in rural and higher-SVI counties. These communities tend to experience higher health disparities and poorer health outcomes. Incorporating the more nuanced data variables correlated with at-risk congregate-care settings receiving timelier outreach. The limitations of the study include sample size, period of data collected (2 years), and the complexity of objectively measuring equity.
To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Adults aged 18–99; n 19 393.
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened fruit drink in an international sample of adult consumers.
Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and ‘High-in’ Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics.
Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States.
Adults (≥18 years, n 22 140).
Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from −0·62 to −1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics.
HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.
To examine awareness and recall of healthy eating public education campaigns in five countries.
Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.
Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).
Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).
In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.
To assess associations between household food security status and indicators of food skills, health literacy and home meal preparation, among young Canadian adults.
Cross-sectional data were analysed using logistic regression and general linear models to assess associations between food security status and food skills, health literacy and the proportion of meals prepared at home, by gender.
Participants recruited from five Canadian cities (Vancouver (BC), Edmonton (AB), Toronto (ON), Montreal (QB) and Halifax (NS)) completed an online survey.
1389 men and 1340 women aged 16–30 years.
Self-reported food skills were not associated with food security status (P > 0·05) among men or women. Compared to those with high health literacy (based on interpretation of a nutrition label), higher odds of food insecurity were observed among men (adjusted OR (AOR): 2·58, 95 % CI 1·74, 3·82 and 1·56, 95 % CI 1·07, 2·28) and women (AOR: 2·34, 95 % CI 1·48, 3·70 and 1·92, 95 % CI 1·34, 2·74) with lower health literacy. Women in food-insecure households reported preparing a lower proportion of breakfasts (β = −0·051, 95 % CI −0·085, −0·017), lunches (β = −0·062, 95 % CI −0·098, −0·026) and total meals at home (β = −0·041, 95 % CI −0·065, −0·016). Men and women identifying as Black or Indigenous, reporting financial difficulty and with lower levels of education had heightened odds of experiencing food insecurity.
Findings are consistent with other studies underscoring the financial precarity, rather than lack of food skills, associated with food insecurity. This precarity may reduce opportunities to apply health literacy and undertake meal preparation.
Middle grades education has been the object of efforts to remediate US education to address an array of social problems. Districts have sought out K-8 models to create smaller learning communities, require fewer school transitions, and allow sustained student connections. This paper offers a historical analysis of K-8 schools, drawing on statistical and spatial methods and a DisCrit intersectional lens to illustrate how creating K-8 schools produced enclaves of privilege in one urban school district. K-8 schools in our target district became whiter and wealthier than district averages. Students with disabilities attending K-8 schools tended to be placed in more inclusive classrooms, where they were more likely to be integrated alongside nondisabled peers than counterparts attending traditional middle schools. We consider how the configuration of K-8 schools, which could be considered an administrative decision to better serve students, has obscured interworkings of power and privilege.
Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.
To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.
Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.
2551 participants (aged 18–64 years); sub-sample (n 1949) used to investigate association between FI and overweight.
FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).
FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.
To estimate the prevalence and sociodemographic characteristics of youth and young adults in major Canadian cities with self-reported vegetarian dietary practices and examine efforts to alter their diets.
Data were collected in autumn 2016 via web-based surveys. Respondents reported vegetarian dietary practices (vegan, vegetarian or pescatarian) and efforts in the preceding year to consume more or less of several nutrients, food groups and/or foods with particular attributes. Logistic regression models examined sociodemographic correlates of each vegetarian dietary practice and differences in other eating practices by diet type.
Participants were recruited from five major Canadian cities.
Youth and young adults, aged 16–30 years (n 2566).
Overall, 13·6 % of respondents reported vegetarian dietary practices: 6·6 % vegetarian, 4·5 % pescatarian and 2·5 % vegan. Sex, race/ethnicity, self-reported frequency of using the Nutrition Facts table and health literacy were significantly correlated with self-reported vegetarian dietary practice (P < 0·01 for all). Efforts to consume more fruits and vegetables (66·8 %) and protein (54·8 %), and less sugar (61·3 %) and processed foods (54·7 %), were prevalent overall. Respondents with vegetarian dietary practices were more likely to report efforts to consume fewer carbohydrates and animal products, and more organic, locally produced, ethically sourced/sustainably sourced/fair trade and non-GM foods (P < 0·01 for all), compared with those without these reported dietary practices.
Nearly 14 % of the sampled youth and young adults in major Canadian cities reported vegetarian dietary practices and may be especially likely to value and engage in behaviours related to health-conscious diets and sustainable food production.
Generation of high-quality evidence on medical devices through clinical trials can be challenging. The United Kingdom's National Institute for Health and Care Excellence (NICE) has developed a research commissioning framework for producing clinical evidence where gaps in the literature prevent definitive recommendations in their medical technology guidance and diagnostics guidance. The research commissioning framework involves NICE's external assessment centers collaborating with clinical researchers to secure funding and to design, conduct, and publish a study to address research recommendations within 3 years of guidance publications. We aimed to describe the early results of the framework.
Publically available information and results from an informal survey of NICE's external assessment centers were reviewed.
As of December 2016, NICE has published a total of thirty medical technology guidance topics and twenty-four diagnostics guidance topics, five and twenty of which have research recommendations, respectively. A total of fourteen research commissioning framework-facilitated projects have been initiated. Two research projects have successfully secured external funding for a clinical trial: (i) non-contact low frequency ultrasound therapy for wound healing; and (ii) Parafricta bootees for pressure ulcer prevention. Further projects have produced published outputs without external funding. Four projects have been completed and undergone guidance review; one guidance topic was withdrawn and three have been transferred to the “static list”. Early experiences of NICE's research commissioning framework suggest that securing financial support from manufacturers or funding bodies for interventional clinical trials to answer single technology research questions within a short time frame is challenging but possible. The value of early feasibility studies to assess the likelihood of obtaining funding and of addressing NICE's research recommendations was recognised.
NICE can facilitate independent research through its research commissioning framework initiative. Securing funding has proved challenging but recent successes have shown that approach is possible. Outputs which fill the evidence gap to an extent where a definitive guidance update is possible have been rare.
To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults.
Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format.
Canadian youth and young adults (n 2008; aged 16–24 years).
In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package.
Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers’ accuracy should be examined. These results have direct implications for nutrition labelling policy.
To describe the effect of supplemental psychotropic medications, specifically anxiolytics with sedative/hypnotics (ASH) combined with lamotrigine (LTG) on stabilization of symptoms in patients with bipolar I disorder.
Symptomatic patients participating in two LTG maintenance trials were classified post-hoc as those initiating LTG as monotherapy (n=313) or as adjunctive therapy (n=814) and further characterized by supplemental add-on therapies received during an open-label treatment phase. Patients were considered stabilized if they reached a stable dose of LTG monotherapy (100–200 mg/day) and had a Clinical Global Impressions-Severity scale score ≤3 for at least 4 weeks. Stabilization rates were compared across initial- and supplemental-treatment groups.
Patients who initiated and were maintained on LTG monotherapy were stabilized at a slightly higher rate compared with those taking LTG adjunctive therapy (55% vs 48%; P=.080). Stabilization rates were numerically higher for LTG monotherapy patients who later received only ASH as supplemental medication compared with LTG monotherapy throughout, but this difference was not significant (66% vs 55%; P=.271). Stabilization rates were significantly higher for monotherapy patients who later received ASH alone versus other psychotropic medications (66% vs 28%; P=.001). For patients initiating LTG as adjunctive therapy, adding ASH alone resulted in significantly higher stabilization rates than adding another psychotropic medication (62% vs 33%; P<.001).
LTG and adjunctive treatment with ASH may be useful in the treatment of acute mood symptoms in patients with bipolar I disorder.
To compare energy (calories), total and saturated fats, and Na levels for ‘kids’ menu’ food items offered by four leading multinational fast-food chains across five countries.
A content analysis was used to create a profile of the nutritional content of food items on kids’ menus available for lunch and dinner in four leading fast-food chains in Australia, Canada, New Zealand, the UK and the USA.
Food items from kids’ menus were included from four fast-food companies: Burger King, Kentucky Fried Chicken (KFC), McDonald's and Subway. These fast-food chains were selected because they are among the top ten largest multinational fast-food chains for sales in 2010, operate in high-income English-speaking countries, and have a specific section of their restaurant menus labelled ‘kids’ menus’.
The results by country indicate that kids’ menu foods contain less energy (fewer calories) in restaurants in the USA and lower Na in restaurants in the UK. The results across companies suggest that kids’ menu foods offered at Subway restaurants are lower in total fat than food items offered at Burger King and KFC, and food items offered at KFC are lower in saturated fat than items offered at Burger King.
Although the reasons for the variation in the nutritional quality of foods on kids’ menus are not clear, it is likely that fast-food companies could substantially improve the nutritional quality of their kids’ menu food products, translating to large gains for population health.
Only about 19 of the 70 or so skeletons excavated at Cerro Portezuelo were brought back to UCLA, and adequate information is lacking for most of these. A detailed analysis of the excavation and curation records, as well as of the skeletons, was conducted in an attempt to identify their contexts and to evaluate their potential for contribution to our knowledge of the Cerro Portezuelo community. Although subadult dental health was good, adult levels of caries and antemortem loss were comparable to those of other Mesoamerican populations. Oxygen-isotope data suggest only limited long-distance immigration into the area. Further interpretation, however, is hampered by poor contextual data and the inability to assign most individuals to a specific period.
Despite formidable challenges and few successes in reintroducing large cats from captivity to the wild, the release of captives has widespread support from the general public and local governments, and continues to occur ad hoc. Commercial so-called lion Panthera leo encounter operations in Africa exemplify the issue, in which the captive breeding of the lion is linked to claims of reintroduction and broader conservation outcomes. In this article we assess the capacity of such programmes to contribute to in situ lion conservation. By highlighting the availability of wild founders, the unsuitability of captive lions for release and the evidence-based success of wild–wild lion translocations, we show that captive-origin lions have no role in species restoration. We also argue that approaches to reintroduction exemplified by the lion encounter industry do not address the reasons for the decline of lions in situ, nor do they represent a model that can be widely applied to restoration of threatened felids elsewhere.