1
|
Bhave VM, Ament Z, Levy DE, Thorndike AN, Kimberly WT. Workplace food purchases, dietary intake, and gut microbial metabolites in a secondary analysis of the ChooseWell 365 study. Am J Clin Nutr 2024:S0002-9165(24)00444-1. [PMID: 38677520 DOI: 10.1016/j.ajcnut.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Dietary choices can affect human health through alterations in gut microbial metabolism, and gut microbial metabolites could serve as biomarkers for disease risk conferred by dietary intake. However, self-reported dietary intake may not reflect true intake. OBJECTIVE We identified circulating metabolites, including gut microbiome-related metabolites, associated with adherence to a healthy diet in the ChooseWell 365 study. In this randomized clinical trial, the dietary choices of hospital employees were assessed over 24 months using not only 24-hour dietary recalls, but also electronic records of hospital cafeteria purchases. METHODS Plasma metabolites were profiled from 470 participants. Two targeted metabolomics methods were developed and implemented to expand detection coverage for metabolites related to gut microbial activity. Linear regression models were used to associate metabolites with Healthy Purchasing Scores (HPS) derived from cafeteria purchases and Healthy Eating Index-2015 (HEI-15) scores derived from dietary recalls. RESULTS Fourteen metabolites were concordantly associated with the HPS and HEI-15 scores in multivariable models adjusted for age, sex, and race, including the gut microbiome-related metabolites indole-3-propionic acid (HPS, β=0.16, 95% CI [0.07, 0.26], p=7.32x10-4; HEI-15, β=0.16, 95% CI [0.07, 0.25], p=6.79x10-4), hippuric acid (HPS, β=0.11, 95% CI [0.02, 0.21], p=1.97x10-2; HEI-15, β=0.10, 95% CI [0.01, 0.19], p=3.14x10-2), and indoxyl sulfate (HPS, β= -0.13, 95% CI [-0.23, -0.03], p=8.21x10-3; HEI-15, β= -0.12, 95% CI [-0.22, -0.03], p=8.50x10-3). These gut microbial metabolites were associated with the intake of specific food groups, such as whole fruits. These metabolites were also associated with clinical variables, including blood pressure, diabetes or prediabetes, and body mass index. CONCLUSIONS In a secondary analysis of the ChooseWell 365 study, associations between circulating gut microbiome-related metabolites and a healthy diet were confirmed using both objective and subjective measures of consumption. Accurate identification of diet-associated metabolites may help guide dietary or microbiome-based interventions aimed at disease prevention.
Collapse
Affiliation(s)
| | - Zsuzsanna Ament
- Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas E Levy
- Harvard Medical School, Boston, MA, USA; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - W Taylor Kimberly
- Harvard Medical School, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
2
|
Foo CYS, Potter K, Nielsen L, Rohila A, Maravic MC, Schnitzer K, Pachas GN, Levy DE, Reyering S, Thorndike AN, Cather C, Evins AE. Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study. medRxiv 2024:2024.01.26.24301835. [PMID: 38343842 PMCID: PMC10854356 DOI: 10.1101/2024.01.26.24301835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Objective Adults with serious mental illness have high tobacco use disorder rates and underutilization of first-line tobacco cessation pharmacotherapy. In a randomized trial, participants offered community health worker (CHW) support and primary care provider (PCP) education had higher tobacco abstinence rates at two years, partly through increased tobacco cessation pharmacotherapy initiation. This study determined the association between participant-CHW engagement and tobacco abstinence outcomes. Methods This was a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of CHW visit number and duration, CHW co-led smoking cessation group sessions attended, and CHW-attended PCP visit number on tobacco use disorder pharmacotherapy initiation and tobacco abstinence were modeled using logistic regression. Interviews with 12 CHWs, 16 participants, and 17 PCPs were analyzed thematically. Results Year-two tobacco abstinence was associated with CHW visit number (OR=1.85, 95% CI=[1.29, 2.66]) and duration (OR=1.85, 95% CI=[1.33, 2.58]) and number of groups attended (OR=1.51, 95% CI=[1.00, 2.28]); effects on pharmacotherapy initiation were similar. 1-3 CHW visits per month over two years was optimal for achieving abstinence. Interviews identified engagement facilitators, including CHWs establishing trust, providing goal accountability, skills reinforcement, and assistance overcoming barriers to treatment access and adherence related to social determinants of health and illness factors. Robust training and supervision facilitated CHW effectiveness. Barriers included PCPs' and care teams' limited understanding of the CHW role. Conclusions Feasible CHW engagement was associated with tobacco abstinence in adults with serious mental illness. CHW implementation may benefit from promoting CHW training and integration within clinical teams. Highlights Greater participant engagement with community health workers (CHWs) (e.g., visit number, duration) was associated with higher tobacco abstinence rates in a two-year intervention for adults with serious mental illness and tobacco use disorder.Interviews with participants, CHWs, and primary care providers (PCPs) indicated that CHWs built trust, facilitated health behavior change, helped participants overcome adverse social determinants of health and other barriers to obtaining effective tobacco use disorder treatment.Training and supervision were perceived to be essential to CHW effectiveness; CHWs and PCPs suggested insufficient integration of CHWs into psychiatric rehabilitation and healthcare teams as an addressable implementation barrier.
Collapse
|
3
|
Gu KD, Cheng J, Fung V, Levy DE, McGovern S, McCurley JL, Clark CR, Thorndike AN. Association of food insecurity with changes in diet quality, weight, and glycemia over two years in adults with prediabetes and type 2 diabetes on medicaid. Nutr Diabetes 2024; 14:16. [PMID: 38594250 PMCID: PMC11003964 DOI: 10.1038/s41387-024-00273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024] Open
Abstract
Little is known about longitudinal associations between food insecurity (FI) and diet, weight, and glycemia in people with prediabetes and type 2 diabetes (T2D). In a secondary analysis of Medicaid-enrolled health center patients with prediabetes or T2D in Boston, Massachusetts (N = 188), we examined associations between food security (FS) and measures of diet quality, weight, and hyperglycemia. FS (10-item USDA FS module) was ascertained at baseline, 1-year, and 2-year follow-up and categorized as persistently secure, intermittently insecure, or persistently insecure. Associations between FS category and changes in Healthy Eating Index-2020 (HEI-20), body mass index (BMI), and hemoglobin A1c (A1c) from baseline to year 2 were assessed using multivariate generalized linear models. Participants had median (p25, p75) age of 52 (42, 57); 71.8% were female and 62.8% Hispanic. Over follow-up, 32.4% were persistently food secure, 33.0% intermittently insecure, and 34.5% persistently insecure. Baseline mean (SD) HEI-20, BMI, and A1c were 55.8 (14.5), 35.9 (8.7) kg/m2, 7.1% (1.6) and did not differ by FS category. FS category was not associated with changes in HEI-20, BMI, and A1c at 2 years (all p > 0.05). Results suggest that Medicaid-enrolled adults with prediabetes or T2D, regardless of FS status, would benefit from dietary and weight management interventions.
Collapse
Affiliation(s)
- Kristine D Gu
- Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jessica Cheng
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Vicki Fung
- Harvard Medical School, Boston, MA, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas E Levy
- Harvard Medical School, Boston, MA, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney McGovern
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica L McCurley
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cheryl R Clark
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
4
|
Samuels-Kalow ME, Mayes K, Cash RE, Schiavoni KH, Vogeli C, Thorndike AN, Camargo CA. Missed Screening for Adverse Social Determinants of Health and Emergency Department Utilization. Ann Emerg Med 2024; 83:416-418. [PMID: 38142374 PMCID: PMC10960706 DOI: 10.1016/j.annemergmed.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katherine Mayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Katherine H Schiavoni
- Population Health Management, Mass General Brigham, Somerville, MA; Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Anne N Thorndike
- Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Ashburner JM, Carmichael TD, Bhattacharya R, Natarajan P, Singer DE, Thorndike AN. A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings. J Cardiopulm Rehabil Prev 2024; 44:143-145. [PMID: 38113350 PMCID: PMC10913854 DOI: 10.1097/hcr.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Jeffrey M. Ashburner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| | - Taylor D. Carmichael
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| | - Romit Bhattacharya
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| | - Pradeep Natarajan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| | - Daniel E. Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston (Drs Ashburner, Singer, and Thorndike); Department of Medicine, Harvard Medical School, Boston (Drs Ashburner, Bhattacharya, Natarajan, Singer, and Thorndike); Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (Ms Carmichael and Drs Bhattacharya and Natarajan); and Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts (Drs Bhattacharya and Natarajan)
| |
Collapse
|
6
|
Mayes KD, Cash RE, Schiavoni KH, Vogeli C, Thorndike AN, Camargo CA, Samuels-Kalow M. Social Risk, Social Need, and Use of the Emergency Department. JAMA Netw Open 2024; 7:e2352365. [PMID: 38241050 PMCID: PMC10799261 DOI: 10.1001/jamanetworkopen.2023.52365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Abstract
This cohort study examines the association of social risk and social need with emergency department use by patients within a Medicaid accountable care organization who were screened for adverse social determinants of health in primary care.
Collapse
Affiliation(s)
| | - Rebecca E. Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | | | - Christine Vogeli
- Mongan Institute Health Policy Center, Mass General Research Institute, Boston, Massachusetts
| | | | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | | |
Collapse
|
7
|
Grummon AH, Petimar J, Moran AJ, Anderson E, Lurie P, John S, Rimm EB, Thorndike AN. Effects of in-store marketing on food and beverage purchases: a longitudinal study of households with children. Public Health Nutr 2023; 27:e4. [PMID: 38037704 PMCID: PMC10830370 DOI: 10.1017/s1368980023002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Most food retailers display foods in prominent locations as a marketing strategy (i.e. 'placement promotions'). We examined the extent to which households with children change their food and beverage purchases in response to these promotions. DESIGN We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households' weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation. SETTING Two large supermarkets in Maine, USA. PARTICIPANTS Eight hundred and twenty-one households with children. RESULTS Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001). CONCLUSIONS In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.
Collapse
Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA94304, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, USA
| | - Alyssa J Moran
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma Anderson
- Department of Population Health Management, Cambridge Health Alliance, Cambridge, USA
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, USA
| | - Sara John
- Center for Science in the Public Interest, Washington, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
8
|
Kronsteiner-Gicevic S, Tello M, Lincoln LE, Kondo JK, Naidoo U, Fung TT, Willett WC, Thorndike AN. Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring. J Acad Nutr Diet 2023; 123:1541-1554.e7. [PMID: 37244591 DOI: 10.1016/j.jand.2023.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. OBJECTIVE The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. DESIGN A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. PARTICIPANTS/SETTING The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. MAIN OUTCOME MEASURES All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. STATISTICAL ANALYSES Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. RESULTS Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82). CONCLUSIONS The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.
Collapse
|
9
|
Salinger M, Levy DE, McCurley JL, Gelsomin ED, Rimm EB, Thorndike AN. Employees' Baseline Food Choices and the Effect of a Workplace Intervention to Promote Healthy Eating: Secondary Analysis of the ChooseWell 365 Randomized Controlled Trial. J Acad Nutr Diet 2023; 123:1586-1595.e4. [PMID: 37257691 PMCID: PMC10592532 DOI: 10.1016/j.jand.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Little is known about whether the effectiveness of workplace wellness programs differs by employees' baseline health behaviors. OBJECTIVE This study examined the association of baseline cafeteria food choices with the effect of a workplace intervention on cafeteria food choices, dietary quality, and body mass index (BMI). DESIGN This was a secondary analysis of the ChooseWell 365 randomized controlled trial, testing a set of behavioral interventions to improve diet and prevent weight gain. PARTICIPANTS/SETTING Participants were 602 employees of a Boston, MA, hospital who had purchased food from cafeterias, which used traffic-light food labeling. Data were collected in 2016-2020. INTERVENTION The 12-month intervention (plus 12 months' follow-up) involved financial incentives and personalized feedback on cafeteria purchases. The control group received monthly letters with generic healthy eating and exercise tips. MAIN OUTCOME MEASURES Healthy purchasing scores (HPS) were calculated by weighting color categories (red = 0, yellow = 0.5, green = 1) and scaling from 0 to 100 (healthiest); employees were categorized into baseline (pre-intervention) HPS tertiles (T1 = least healthy, T3 = healthiest). Healthy eating index (HEI-2015) scores were calculated from two 24-hour dietary recalls. Intervention effects on 12- and 24-month changes in HPS (primary outcome), HEI-2015 score, and BMI were compared among tertiles. Subgroup analyses examined whether changes by tertile varied with financial rewards received. STATISTICAL ANALYSES Adjusting for baseline characteristics, multivariable linear regression assessed intervention effects across baseline HPS tertiles. RESULTS Compared with T3, T1 employees had lower education; higher obesity, hypertension, and pre-diabetes; and lower HEI-2015 scores. The intervention increased HPS, but no change was observed in HEI-2015 scores or BMI; the intervention effect did not differ among tertiles at 12 or 24 months. Financial incentives were associated with a larger effect on 12-month HPS changes for T1 than for T2/T3 (P-interaction < 0.001). CONCLUSION Compared with employees with healthier baseline food choices, employees with the least healthy food choices and highest cardiometabolic risk had similar improvements in the nutritional quality of cafeteria purchases as a result of the behavioral intervention, and they appeared to be more responsive to financial incentives.
Collapse
Affiliation(s)
- Maggie Salinger
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jessica L. McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily D. Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, MA
| | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Carter J, Swack N, Isselbacher E, Donelan K, Thorndike AN. Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study. JMIR Cardio 2023; 7:e47818. [PMID: 37698975 PMCID: PMC10580132 DOI: 10.2196/47818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. OBJECTIVE We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. METHODS Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. RESULTS Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating." CONCLUSIONS A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention.
Collapse
Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Natalia Swack
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Eric Isselbacher
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Karen Donelan
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
11
|
Petimar J, Moran AJ, Grummon AH, Anderson E, Lurie P, John S, Rimm EB, Thorndike AN. In-Store Marketing and Supermarket Purchases: Associations Overall and by Transaction SNAP Status. Am J Prev Med 2023; 65:587-595. [PMID: 36878416 PMCID: PMC10475490 DOI: 10.1016/j.amepre.2023.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION In-store placement promotions are used widely in supermarkets, but their effects on customer purchases remain largely unknown. This study examined associations of supermarket placement promotions with customer purchases overall and by Supplemental Nutrition Assistance Program (SNAP) benefit use. METHODS Data on in-store promotions (e.g., endcaps, checkout displays) and transactions (n=274,118,338) were obtained from a New England supermarket chain with 179 stores from 2016 to 2017. Product-level analyses examined multivariable-adjusted changes in products' sales when they were promoted (versus not) across all transactions and stratified by whether the transaction was paid for with SNAP benefits. Food group-level analyses examined the extent to which a 20% increase from the mean number of weekly promotions for a food group (e.g., increasing the number of candy promotions from 17.0 to 20.4) was associated with total food group sales. Analyses were conducted in 2022. RESULTS Across stores, the mean (SD) number of promotions per week was highest for sweet/salty snacks (126.3 [22.6]), baked goods (67.5 [18.4]), and sugar-sweetened beverages (48.6 [13.8]) and lowest for beans (5.0 [2.6]) and fruits (6.6 [3.3]). Product sales were between 16% (low-calorie drinks) and 136% (candy) higher when promoted versus not promoted. In 14 of 15 food groups, associations were stronger among transactions made with SNAP benefits than among those not made with SNAP benefits. The number of in-store promotions was generally not associated with total food group sales. CONCLUSIONS In-store promotions, which were mostly for unhealthy foods, were associated with large product sales increases, particularly among SNAP purchasers. Policies limiting unhealthy in-store promotions and incentivizing healthy promotions should be explored.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Alyssa J Moran
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Anna H Grummon
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emma Anderson
- Department of Population Health Management, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Sara John
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Anderson E, McCurley JL, Sonnenblick R, McGovern S, Fung V, Levy DE, Clark CR, Thorndike AN. Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis. J Acad Nutr Diet 2023; 123:1470-1478.e2. [PMID: 37207956 PMCID: PMC10524583 DOI: 10.1016/j.jand.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Adults with mental illnesses are more likely to have low income and diet-related chronic diseases. OBJECTIVE This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries. DESIGN This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program. PARTICIPANTS/SETTING Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system. MAIN OUTCOME MEASURES Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls. STATISTICAL ANALYSES Multivariable regression analyses adjusted for demographics, income, and survey date. RESULTS Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99). CONCLUSION In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.
Collapse
|
13
|
Ashburner JM, Carmichael TD, Bhattacharya R, Bapat AC, Natarajan P, Atlas SJ, Singer DE, Thorndike AN. A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: A Pilot Study. Res Sq 2023:rs.3.rs-3369346. [PMID: 37841859 PMCID: PMC10571629 DOI: 10.21203/rs.3.rs-3369346/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Lifestyle modification programs, such as cardiac rehabilitation, may reduce atrial fibrillation (AF) burden and improve quality of life (QOL), but remain unproven. The objective of this pilot study was to assess feasibility, acceptability, and preliminary effectiveness of an exercise and nutrition-based cardiac rehabilitation-like program for AF patients. Methods We enrolled overweight adults aged ≥ 30 years with symptomatic AF in a 12-week cardiac lifestyle group program, including 6 virtual and 6 in-person visits. All visits included discussion and education about nutrition, exercise, and behavior modification. In-person visits included supervised aerobic exercise and strength training. Outcomes at baseline and 12 weeks included feasibility of participation, acceptability, change in weight and BMI, and changes in survey-based AF burden, symptoms, and QOL. Results From 84 invitees, 11 (13.1%) were enrolled (mean age 64; baseline BMI 38 kg/m2); 9 (82%) completed the program. Patients attended an average of 9.7 (81%) visits (Range: 6-11). Mean weight loss was 9.1 pounds (Range: 0-16); mean BMI decrease was 1.4 kg/m2 (Range: 0-2.6). Patients found the program helpful overall: all reported making diet and exercise changes during the program. Compared to baseline, patients reported decreased AF burden (12.9 vs. 11.7, p = 0.03) and symptom (10.1 vs. 5.6, p = 0.003) scores at the conclusion of the program. Patients also reported increased QOL overall (68.9 vs. 86.4, p = 0.001). Conclusions Participation in a cardiac rehab-like program was feasible and acceptable for overweight patients with symptomatic AF. Results suggest preliminary effectiveness of the program for reducing AF burden and symptoms and increasing QOL.
Collapse
|
14
|
Hua SV, Petimar J, Mitra N, Roberto CA, Kenney EL, Thorndike AN, Rimm EB, Volpp KG, Gibson LA. Philadelphia Beverage Tax and Association With Prices, Purchasing, and Individual-Level Substitution in a National Pharmacy Chain. JAMA Netw Open 2023; 6:e2323200. [PMID: 37440231 PMCID: PMC10346119 DOI: 10.1001/jamanetworkopen.2023.23200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Taxes on sweetened beverages are being implemented around the globe; an understanding of these taxes on individual-level behavior is necessary. Objective To evaluate the degree to which the sweetened beverage tax in Philadelphia, Pennsylvania, was associated with changes in beverage prices and individual-level purchasing over time at a national pharmacy chain in Philadelphia compared with Baltimore, Maryland. Design, Setting, and Participants Using a difference-in-differences approach and generalized linear mixed models, this cohort study examined beverage purchases made by loyalty cardholders at a national chain pharmacy retailer with stores in Philadelphia and Baltimore (control city) from before tax to after tax. Beverage sales (in US dollars) were linked by unique loyalty card numbers to enable longitudinal analyses. Data were collected from January 1, 2015, through December 31, 2017 (2 years before tax and 1 year after tax); data analyses were conducted from January through October 2022. Exposure Implementation of Philadelphia's 1.5 cents/oz tax on sweetened beverages. Main Outcomes and Measures The outcomes were the change in mean beverage price per-ounce and mean beverage volume purchased per cardholder transaction. Individual-level point-of-sale scanner data from all beverage purchases were analyzed. Results A total of 1188 unique beverages were purchased from the same stores before tax and after tax. There were 231 065 unique cardholders in Philadelphia and 82 517 in Baltimore. Mean prices of taxed beverages (n = 2 094 220) increased by 1.6 (95% CI, 1.3-2.0) cents/oz (106.7% pass-through) in Philadelphia compared with Baltimore from before tax to after tax. Philadelphia cardholders purchased 7.8% (95% CI -8.1% to -7.5%) fewer ounces of taxed beverages and 1.1% (95% CI, 0.6%-1.7%) more ounces of nontaxed beverages per transaction. Taxed beverages made up a smaller percentage of cardholders' overall beverage purchases after tax (-13.4% [95% CI, -14.2% to -12.6%]), while nontaxed beverages made up a larger share (9.3% [95% CI, 7.7%-10.7%]). Conclusions and Relevance In this longitudinal cohort study of the Philadelphia beverage tax, the tax was completely passed through to prices and was associated with a 7.8% decline in ounces of taxed beverages purchased at a national pharmacy chain.
Collapse
Affiliation(s)
- Sophia V. Hua
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erica L. Kenney
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N. Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Eric B. Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Laura A. Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
15
|
McCurley JL, Fung V, Levy DE, McGovern S, Vogeli C, Clark CR, Bartels S, Thorndike AN. Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization. JAMA Health Forum 2023; 4:e231191. [PMID: 37266960 PMCID: PMC10238945 DOI: 10.1001/jamahealthforum.2023.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/03/2023] [Indexed: 06/03/2023] Open
Abstract
Importance Health systems are increasingly addressing health-related social needs. The Massachusetts Flexible Services program (Flex) is a 3-year pilot program to address food insecurity and housing insecurity by connecting Medicaid accountable care organization (ACO) enrollees to community resources. Objective To understand barriers and facilitators of Flex implementation in 1 Medicaid ACO during the first 17 months of the program. Design, Setting, and Participants This mixed-methods qualitative evaluation study from March 2020 to July 2021 used the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework. Two Mass General Brigham (MGB) hospitals and affiliated community health centers were included in the analysis. Quantitative data included all MGB Medicaid ACO enrollees. Qualitative interviews were conducted with 15 members of ACO staff and 17 Flex enrollees. Main Outcomes and Measures Reach was assessed by the proportion of ACO enrollees who completed annual social needs screening (eg, food insecurity and housing insecurity) and the proportion and demographics of Flex enrollees. Qualitative interviews examined other RE-AIM/PRISM constructs (eg, implementation challenges, facilitators, and perceived effectiveness). Results Of 67 098 Medicaid ACO enrollees from March 2020 to July 2021 (mean [SD] age, 28.8 [18.7] years), 38 442 (57.3%) completed at least 1 social needs screening; 10 730 (16.0%) screened positive for food insecurity, and 7401 (11.0%) screened positive for housing insecurity. There were 658 (1.6%) adults (mean [SD] age, 46.6 [11.8] years) and 173 (0.7%) children (<21 years; mean [SD] age, 10.1 [5.5]) enrolled in Flex; of these 831 people, 613 (73.8%) were female, 444 (53.4%) were Hispanic/Latinx, and 172 (20.7%) were Black. Most Flex enrollees (584 [88.8%] adults; 143 [82.7%] children) received the intended nutrition or housing services. Implementation challenges identified by staff interviewed included administrative burden, coordination with community organizations, data-sharing and information-sharing, and COVID-19 factors (eg, reduced clinical visits). Implementation facilitators included administrative funding for enrollment staff, bidirectional communication with community partners, adaptive strategies to identify eligible patients, and raising clinician awareness of Flex. In Flex enrollee interviews, those receiving nutrition services reported increased healthy eating and food security; they also reported higher program satisfaction than Flex enrollees receiving housing services. Enrollees who received nutrition services that allowed for selecting food based on preferences reported higher satisfaction than those not able to select food. Conclusions and Relevance This mixed-methods qualitative evaluation study found that to improve implementation, Medicaid and health system programs that address social needs may benefit from providing funding for administrative costs, developing bidirectional data-sharing platforms, and tailoring support to patient preferences.
Collapse
Affiliation(s)
- Jessica L. McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Psychology, San Diego State University, San Diego, California
| | - Vicki Fung
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Douglas E. Levy
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Sydney McGovern
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Christine Vogeli
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Cheryl R. Clark
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen Bartels
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
Hua SV, Kenney EL, Miller JM, Musicus AA, Roberto CA, Thorndike AN, Rimm EB. Naming Matters: Prompting Smaller Portions in an Online RCT. Am J Prev Med 2023; 64:805-813. [PMID: 36792450 PMCID: PMC10200744 DOI: 10.1016/j.amepre.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Large portions, which can lead people to eat more, are becoming increasingly common in U.S. restaurants. This study tested whether portion-size descriptions on menus and different pricing strategies influence the selection of smaller portion sizes. STUDY DESIGN This was a 4 × 2 between-subjects online randomized controlled experiment. SETTING/PARTICIPANTS This was an online simulated menu-ordering study conducted in 2021 among 2,205 U.S. adults. INTERVENTION Adults viewed a fast-casual and full-service menu with entrées available in 2 sizes and ordered an entrée from each. Participants were randomized to view 1 of 4 portion-size descriptors (smaller/larger portion): (1) no descriptor/large (control), (2) standard/large, (3) just right/large, and (4) no descriptor/hearty. Participants were also randomized to either linear (i.e., reduced price=50% larger portion's price) or nonlinear pricing (i.e., reduced price=70% larger portion's price) (4 × 2 factorial design). MAIN OUTCOME MEASURES In 2022, logistic regression models were used to analyze whether the interventions increased the likelihood of choosing a reduced portion. RESULTS Regardless of pricing scheme, participants in the standard/large condition selected reduced portions by 10 (95% CI=0.04, 0.16) and 13 (95% CI=0.07, 0.18) percentage points more than those in the control condition (fast-casual and full-service menus, respectively). Selection of reduced portions in the just right/large condition increased by 9 (95% CI=0.04, 0.15) and 8 (95% CI=0.02, 0.14) percentage points. For the fast-casual menu, keeping portion-size descriptors constant, participants ordered a reduced portion by 5 percentage points more with nonlinear pricing than with linear pricing. CONCLUSIONS Portion-size descriptions on restaurant menus, even with nonlinear pricing, are a low-cost strategy to promote the selection of lower-calorie, smaller portions without restricting choice.
Collapse
Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
17
|
Merino J, Dashti HS, Levy DE, Del Rocío Sevilla-González M, Hivert MF, Porneala BC, Saxena R, Thorndike AN. Genetic predisposition to macronutrient preference and workplace food choices. Mol Psychiatry 2023; 28:2606-2611. [PMID: 37217678 DOI: 10.1038/s41380-023-02107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
Prior research identified genetic variants influencing macronutrient preference, but whether genetic differences underlying nutrient preference affect long-term food choices is unknown. Here we examined the associations of polygenic scores for carbohydrate, fat, and protein preference with 12 months' workplace food purchases among 397 hospital employees from the ChooseWell 365 study. Food purchases were obtained retrospectively from the hospital's cafeteria sales data for the 12 months before participants were enrolled in the ChooseWell 365 study. Traffic light labels, visible to employees when making purchases, measured the quality of workplace purchases. During the 12-month study period, there were 215,692 cafeteria purchases. Each SD increase in the polygenic score for carbohydrate preference was associated with 2.3 additional purchases/month (95%CI, 0.2 to 4.3; p = 0.03) and a higher number of green-labeled purchases (β = 1.9, 95%CI, 0.5-3.3; p = 0.01). These associations were consistent in subgroup and sensitivity analyses accounting for additional sources of bias. There was no evidence of associations between fat and protein polygenic scores and cafeteria purchases. Findings from this study suggest that genetic differences in carbohydrate preference could influence long-term workplace food purchases and may inform follow-up experiments to enhance our understanding of the molecular mechanisms underlying food choice behavior.
Collapse
Affiliation(s)
- Jordi Merino
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Magdalena Del Rocío Sevilla-González
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 100 Cambridge, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
18
|
Gu KD, Faulkner KC, Thorndike AN. Housing instability and cardiometabolic health in the United States: a narrative review of the literature. BMC Public Health 2023; 23:931. [PMID: 37221492 DOI: 10.1186/s12889-023-15875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.
Collapse
Affiliation(s)
- Kristine D Gu
- Division of Endocrinology, Massachusetts General Hospital, 50 Staniford Street, Suite 340, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Katherine C Faulkner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
19
|
Arguello D, Cloutier G, Thorndike AN, Castaneda Sceppa C, Griffith J, John D. Impact of Sit-to-Stand and Treadmill Desks on Patterns of Daily Waking Physical Behaviors Among Overweight and Obese Seated Office Workers: Cluster Randomized Controlled Trial. J Med Internet Res 2023; 25:e43018. [PMID: 37191995 PMCID: PMC10230356 DOI: 10.2196/43018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Sit-to-stand and treadmill desks may help sedentary office workers meet the physical activity guideline to "move more and sit less," but little is known about their long-term impact on altering the accumulation patterns of physical behaviors. OBJECTIVE This study explores the impact of sit-to-stand and treadmill desks on physical behavior accumulation patterns during a 12-month multicomponent intervention with an intent-to-treat design in overweight and obese seated office workers. METHODS In total, 66 office workers were cluster randomized into a seated desk control (n=21, 32%; 8 clusters), sit-to-stand desk (n=23, 35%; 9 clusters), or treadmill desk (n=22, 33%; 7 clusters) group. Participants wore an activPAL (PAL Technologies Ltd) accelerometer for 7 days at baseline, 3-month follow-up (M3), 6-month follow-up (M6), and 12-month follow-up (M12) and received periodic feedback on their physical behaviors. Analyses of physical behavior patterns included total day and workday number of sedentary, standing, and stepping bouts categorized into durations ranging from 1 to 60 and >60 minutes and usual sedentary, standing, and stepping bout durations. Intervention trends were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. RESULTS The treadmill desk group favored prolonged sedentary bouts (>60 min), whereas the sit-to-stand desk group accrued more short-duration sedentary bouts (<20 min). Therefore, compared with controls, sit-to-stand desk users had shorter usual sedentary bout durations short-term (total day ΔM3: -10.1 min/bout, 95% CI -17.9 to -2.2; P=.01; workday ΔM3: -20.3 min/bout, 95% CI -37.7 to -2.9; P=.02), whereas treadmill desk users had longer usual sedentary bout durations long-term (total day ΔM12: 9.0 min/bout, 95% CI 1.6-16.4; P=.02). The treadmill desk group favored prolonged standing bouts (30-60 min and >60 min), whereas the sit-to-stand desk group accrued more short-duration standing bouts (<20 min). As such, relative to controls, treadmill desk users had longer usual standing bout durations short-term (total day ΔM3: 6.9 min/bout, 95% CI 2.5-11.4; P=.002; workday ΔM3: 8.9 min/bout, 95% CI 2.1-15.7; P=.01) and sustained this long-term (total day ΔM12: 4.5 min/bout, 95% CI 0.7-8.4; P=.02; workday ΔM12: 5.8 min/bout, 95% CI 0.9-10.6; P=.02), whereas sit-to-stand desk users showed this trend only in the long-term (total day ΔM12: 4.2 min/bout, 95% CI 0.1-8.3; P=.046). The treadmill desk group accumulated more stepping bouts across various bins of duration (5-50 min), primarily at M3. Thus, treadmill desk users had longer usual stepping bout durations in the short-term compared with controls (workday ΔM3: 4.8 min/bout, 95% CI 1.3-8.3; P=.007) and in the short- and long-term compared with sit-to-stand desk users (workday ΔM3: 4.7 min/bout, 95% CI 1.6-7.8; P=.003; workday ΔM12: 3.0 min/bout, 95% CI 0.1-5.9; P=.04). CONCLUSIONS Sit-to-stand desks exerted potentially more favorable physical behavior accumulation patterns than treadmill desks. Future active workstation trials should consider strategies to promote more frequent long-term movement bouts and dissuade prolonged static postural fixity. TRIAL REGISTRATION ClinicalTrials.gov NCT02376504; https://clinicaltrials.gov/ct2/show/NCT02376504.
Collapse
Affiliation(s)
- Diego Arguello
- Human Performance and Exercise Science Lab, Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Gregory Cloutier
- Center for Cognitive and Brain Health, College of Science, Northeastern University, Boston, MA, United States
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Carmen Castaneda Sceppa
- Bouve College of Health Sciences, Institute on Urban Health Research, Northeastern University, Boston, MA, United States
| | - John Griffith
- Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Dinesh John
- Department of Health Sciences, Northeastern University, Boston, MA, United States
| |
Collapse
|
20
|
McCurley JL, Buckholtz JW, Roberto CA, Levy DE, Anderson EM, Chang Y, Thorndike AN. The association of impulsivity with effects of the ChooseWell 365 workplace nudge intervention on diet and weight. Transl Behav Med 2023; 13:281-288. [PMID: 36548448 PMCID: PMC10182420 DOI: 10.1093/tbm/ibac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Impulsivity is associated with unhealthy food choices. Nudge interventions in the food environment may be particularly helpful for individuals with high impulsivity. To examine if trait, choice, and action impulsivity were associated with the effectiveness of a workplace-based nudge intervention to improve diet and weight. This was a planned secondary analysis of 487 participants of ChooseWell 365, a randomized controlled trial that tested a 12-month nudge intervention to improve cafeteria purchases among hospital employees. Trait impulsivity was measured with the Barratt Impulsiveness Scale. Choice and action impulsivity were assessed with delay discounting and response inhibition tasks, respectively. Tertiles were generated for each measure. Multivariable regression models examined the association of impulsivity with cafeteria purchases [Healthy Purchasing Score (HPS)] over 12 months, dietary intake [Healthy Eating Index-2015 (HEI) score], and body mass index (BMI) measured at 12 months. Interaction terms tested differences in intervention effect by level of impulsivity. Participants with higher trait (p = .02) and choice (p < .001) impulsivity had lower baseline HPS than those with lower impulsivity. Employees of all impulsivity levels increased healthy eating, but higher trait impulsivity was associated with smaller increase in HPS over 12 months (p = .03). In the highest action impulsivity tertile, 12-month BMI increased less for intervention vs. control participants (0.3 vs. 0.5 kg/m2; p-interaction = .04). There were no interaction effects for trait or choice impulsivity. A workplace nudge intervention improved food choices among employees of all impulsivity levels and attenuated weight gain in those with higher action impulsivity.
Collapse
Affiliation(s)
- Jessica L McCurley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychology, San Diego State University, San Diego, CA
| | - Joshua W Buckholtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychology, Harvard University, Cambridge MA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Douglas E Levy
- Harvard Medical School, Boston, MA
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Yuchiao Chang
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
21
|
Cheng J, Malone A, Thorndike AN. Importance of Nutrition Security to CVD Prevention Efforts in the USA. Curr Atheroscler Rep 2023; 25:219-230. [PMID: 36995553 PMCID: PMC10060138 DOI: 10.1007/s11883-023-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW The importance of addressing nutrition security for the primary and secondary prevention of cardiovascular disease (CVD) in the USA is reviewed by describing the relationships between food security, diet quality, and CVD risk along with the ability of governmental, community, and healthcare policies and interventions to address nutrition security. RECENT FINDINGS Existing safety net programs have shown to be effective at improving food security and diet quality and reducing risk for CVD, but continued efforts to increase reach and improve standards are needed. Adoption of policies, healthcare initiatives, and community- and individual-level interventions addressing the nutritional intake of socioeconomically disadvantaged populations may also lessen CVD burden, but scaling interventions remains a key challenge. Research suggests simultaneously addressing food security and diet quality is feasible and could help reduce socioeconomic disparities in CVD morbidity and mortality. Intervening at multiple levels among high-risk groups should be a priority.
Collapse
Affiliation(s)
- Jessica Cheng
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Ashlie Malone
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA
| |
Collapse
|
22
|
Feig EH, Szapary C, Harnedy LE, Thorndike AN, Psaros C, Millstein RA, Huffman JC. Using Positive Psychology to Address Emotional Barriers to Physical Activity After Bariatric Surgery: Proof-of-Concept Trial of the Gaining Optimism After Weight Loss Surgery (GOALS) Project. Cognitive and Behavioral Practice 2023. [DOI: 10.1016/j.cbpra.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
23
|
Grummon AH, Musicus AA, Salvia MG, Thorndike AN, Rimm EB. Impact of Health, Environmental, and Animal Welfare Messages Discouraging Red Meat Consumption: An Online Randomized Experiment. J Acad Nutr Diet 2023; 123:466-476.e26. [PMID: 36223865 PMCID: PMC10166581 DOI: 10.1016/j.jand.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reducing red meat consumption is a key strategy for curbing diet-related chronic diseases and mitigating environmental harms from livestock farming. Messaging interventions aiming to reduce red meat consumption have focused on communicating the animal welfare, health, or environmental harms of red meat. Despite the popularity of these 3 approaches, it remains unknown which is most effective, as limited studies have compared them side by side. OBJECTIVE Our aim was to evaluate responses to red-meat-reduction messages describing animal welfare, health, or environmental harms. DESIGN This was an online randomized experiment. PARTICIPANTS In August 2021, a convenience sample of US adults was recruited via an online panel to complete a survey (n = 2,773 nonvegetarians and vegans were included in primary analyses). INTERVENTION Participants were randomly assigned to view 1 of the 4 following messages: control (neutral, non-red meat message), animal welfare, health, or environmental red-meat-reduction messages. MAIN OUTCOME MEASURES After viewing their assigned message, participants ordered hypothetical meals from 2 restaurants (1 full service and 1 quick service) and rated message reactions, perceptions, and intentions. STATISTICAL ANALYSES PERFORMED Logistic and linear regressions were performed. RESULTS Compared with the control message, exposure to the health and environmental red-meat-reduction messages reduced red meat selection from the full-service restaurant by 6.0 and 8.8 percentage points, respectively (P = .02 and P < .001, respectively), while the animal welfare message did not (reduction of 3.3 percentage points, P = .20). None of the red-meat-reduction messages affected red meat selection from the quick-service restaurant. All 3 red-meat-reduction messages elicited beneficial effects on key predictors of behavior change, including emotions and thinking about harms. CONCLUSIONS Red-meat-reduction messages, especially those describing health or environmental harms, hold promise for reducing red meat selection in some types of restaurants. Additional interventions may be needed to discourage red meat selection across a wider variety of restaurants, for example, by making salient which menu items contain red meat.
Collapse
Affiliation(s)
- Anna H Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Meg G Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
24
|
Dashti HS, Alimenti K, Levy DE, Hivert MF, McCurley JL, Saxena R, Thorndike AN. Chronotype Polygenic Score and the Timing and Quality of Workplace Cafeteria Purchases: Secondary Analysis of the ChooseWell 365 Randomized Controlled Trial. Curr Dev Nutr 2023; 7:100048. [PMID: 37181927 PMCID: PMC10111586 DOI: 10.1016/j.cdnut.2023.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
Background Studies on the link between chronotype (i.e., propensity for morning or evening preference) and dietary intake have relied on self-reported data, estimating consumption, and chronotype from questionnaires. Objectives This study examined the associations between genetically proxied evening chronotype, objectively estimated workplace dietary choices, and the effectiveness of a behavioral intervention in hospital employees enrolled in the ChooseWell 365 study. Methods ChooseWell 365 was a randomized trial of a 12-mo automated, personalized intervention to prevent weight gain and improve diet. Cafeteria sales data were used to measure the timing and healthfulness of workplace food purchases of employees during the 12-mo-long baseline, intervention, and postintervention follow-up periods. A genome-wide polygenic score for evening chronotype was calculated for all participants and the population was divided into quartiles; the highest quartile indicated the most evening chronotype. Associations between polygenic score quartiles and workplace purchases at baseline, 12 mo, and 24 mo and changes from baseline at 12 and 24 mo were tested using adjusted multivariable linear regression models. Results At baseline, the highest chronotype quartile was associated with self-reported breakfast skipping. Over the 24-mo study, the highest quartile was associated with later timing of the first workplace purchase, but not with the healthfulness of purchases. There were no differences by the chronotype quartile in the effectiveness of the ChooseWell 365 intervention in improving employees' healthy food choices at work. Conclusions A chronotype polygenic score was associated with breakfast skipping and later workplace mealtimes of hospital employees, but not with the nutritional quality of objectively measured workplace food purchases. In addition, employees across the chronotype spectrum benefited from the workplace healthy eating intervention.This trial was registered at clinicaltrials.gov as NCT02660086 (https://clinicaltrials.gov/ct2/show/NCT02660086?cond=NCT02660086&draw=2&rank=1).
Collapse
Affiliation(s)
- Hassan S. Dashti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kaitlyn Alimenti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Harvard Medical School, Boston MA, United States
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, United States
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Jessica L. McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Broad Institute, Cambridge, MA, United States
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anne N. Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
25
|
Millstein RA, Harnedy L, Thorndike AN, Kim S, Castillo C, Park ER, Healy BC, Huffman JC. Abstract P511: Physical Activity, Medical, and Mental Health Outcomes of a Pilot Multilevel Intervention for People With Metabolic Syndrome. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background/Objectives:
This pilot randomized controlled trial aimed to help people with metabolic syndrome increase physical activity and well-being. Intervening on lifestyle behaviors such as physical activity, can improve metabolic syndrome outcomes.
Methods:
Primary care patients with metabolic syndrome were recruited from clinics across our hospital system. Eligibility criteria were: <150 minutes/week of moderate-vigorous physical activity (MVPA), having ≥2 of 5 metabolic syndrome criteria, and not having cardiovascular disease or diabetes, as this was a prevention study. The multilevel intervention (MAPP) included 8-weekly 60-minute group sessions, physical activity self-monitoring/goal setting using Fitbits, physical activity/motivational interviewing (MI) topics, positive psychology (PP) topics, a weekly group walk prior to COVID, and neighborhood walkability assessments. Participants were randomized to an immediate or waitlist control group. They wore an Actigraph GT3X+ accelerometer for one week before beginning and after the last session (8-weeks). We obtained pre-post weight measurements. Mean baseline to 8-week individual difference results were compared between groups using t-tests with unequal variances.
Results:
Sixty-four participants enrolled, with 32 randomized to each arm; 51 provided complete follow-up data, and 63% (10/16) of the groups were conducted virtually (post-COVID). Most (92%; 59/64) were non-Hispanic White, 69% (44/64) were female, and mean age was 60. Average daily physical activity did not increase significantly by objective measures. The estimated change in mean difference for sedentary time decreased for the intervention group compared to the control group by 46.8 minutes/day (CI: -47.5-141.1;
d=
0.28). Light physical activity increased by an average of 21.0 minutes/day (CI: -13.9-55.9;
d=
0.34), steps/day increased by 376.6 (CI: -949.6-1702.9;
d
=0.16), and moderate-vigorous physical activity increased by 4.1 minutes/day (CI: -4.5-12.8; d=0.27). The estimated change in mean weight was significant: 8.4 pounds lost for the intervention group compared to the control group (CI: -13.5-3.2;
p
=.002;
d
=0.92).
Discussion:
This 8-week randomized controlled trial of a multilevel physical activity PP-MI intervention was associated with small to medium effect sizes for changes in physical activity, and a significant decrease in weight, despite weight not being an intervention target. Changes of this magnitude are associated with reduced cardiovascular disease risk and mortality. These findings are all in expected directions, producing signals even amidst different modalities and COVID-19-related disruptions. We plan to test this in a larger efficacy trial with broader reach and implementation.
Collapse
Affiliation(s)
| | | | | | - Sonia Kim
- Massachusetts General Hosp, Boston, MA
| | | | | | | | | |
Collapse
|
26
|
Feig EH, Szapary C, Harnedy LE, Castillo C, Psaros C, Thorndike AN, Huffman JC. Abstract MP70: Proof-of-Concept Trial of a Positive Psychology-Based Physical Activity Intervention After Bariatric Surgery: The Gaining Optimism After Weight Loss Surgery (GOALS) Project. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Metabolic/bariatric surgery (MBS) is the most effective treatment available for severe obesity, but weight regain is common, increasing risk for cardiometabolic disease. Physical activity (PA) reduces these risks and aids with weight loss maintenance; however, over 90% of adults after MBS do not achieve at least 150 minutes/week of moderate-to-vigorous physical activity (MVPA) when measured objectively. Negative emotional associations with PA are common in this population (e.g., physical pain or injury, weight stigma). Positive psychological interventions are simple exercises shown to increase psychological well-being. The Gaining Optimism After weight Loss Surgery (GOALS) Project aims to target the emotional barriers to PA in adults with recent MBS using a positive psychological approach combined with motivational interviewing and goal-setting for PA. We tested feasibility, acceptability, and pre-post change in PA and psychological, behavioral, and physiological outcomes in a single-arm proof-of-concept trial to refine GOALS and prepare for a future RCT. GOALS included 10 weekly phone calls plus a written manual and a Fitbit to track PA. Each session included a positive psychology exercise, a PA-related topic, and setting a weekly PA goal. Participants were adults with MBS in the past 6-12 months who reported low physical activity. Primary outcomes were feasibility (session completion rates) and acceptability (participant ratings of session ease and utility). Pre-post assessments included physical activity measured with Actigraph GT3X-BT, a 6-minute walk test, BMI, percent body fat and waist circumference, and self-report measures of depression, anxiety, optimism, internalized weight bias, attitudes around physical activity, and post-MBS behavioral adherence. Mixed effects regression models with a random intercept measured change in outcomes including participants with missing data. Effect sizes (Cohen’s d) estimated magnitude of change given low study power. We enrolled 12 participants (58% female,
M
age 46 years, 67% non-Hispanic white). They completed 8.5/10 intervention sessions on average and gave high ratings (
M
between 8.3 and 8.8/10) of ease and utility. There were increases in MVPA equivalent to an additional 17 minutes/day (d=0.61, p=0.09), 6-minute walk test distance (d=1.06, p=0.01) and reductions in BMI (d=0.81, p=0.04), depression (d=1.22, p<0.01), anxiety (d=0.51, p=0.16), and internalized weight bias (d=0.98, p=0.03), and increases in post-MBS adherence (d=1.44, p<0.01). The GOALS intervention demonstrated feasibility, acceptability, and pre-post improvements in PA and psychological well-being in a small proof-of-concept trial. The intervention is now being tested in a pilot RCT compared to a PA education control. If it continues to show similar effects, the intervention could be integrated into post-MBS clinical care to improve outcomes.
Collapse
|
27
|
Cheng J, Levy D, McCurley J, Rimm EB, Thorndike AN. Abstract P213: A Behavioral Economics Workplace Healthy Eating Intervention Similarly Benefits Employees With and Without Chronic Disease Risk. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Workplace interventions using behavioral economics approaches may provide low-cost opportunities for promoting healthy lifestyle. It is unknown if employees at higher chronic disease risk are more likely to benefit from workplace health promotion programs than employees at lower risk. This analysis assessed the differential effect of a 12-month behavioral workplace healthy eating intervention on improving dietary choices of employees’ with and without chronic disease risk.
Hypothesis:
We hypothesized that the intervention effect on cafeteria food purchases and diet quality would be stronger among employees with chronic disease risk compared to those without.
Methods:
This was a secondary data analysis of the ChooseWell 365 RCT conducted among hospital employees to test the effect of personalized feedback, peer comparisons, and financial incentives on improving cafeteria purchases, dietary intake, and weight. All hospital cafeterias used traffic-light food labeling. Published main results showed an intervention effect on cafeteria purchases but not overall diet quality or weight change. Diet quality was calculated from dietary recalls and measured via the Healthy Eating Index (HEI-2015), scored 0-100 (healthiest). Healthy purchasing scores (HPS) were calculated for each participant, weighting purchases’ color categories (red=0, yellow=0.5, green=1), scaled from 0-100 (healthiest). HEI-2015 and HPS were calculated at baseline, 6, 12, and 24 months. Participants were classified as having chronic disease risk if they self-reported hypertension, hyperlipidemia, heart disease, stroke, pre-diabetes, diabetes, cancer or another serious illness at baseline. Mixed models with random effects were used to compare dietary changes by study arm and risk categorization adjusted for body mass index, age, and race.
Results:
Participants (N=562) were mostly female (80.3%) and white (81.1%) with a median (p25, p75) age of 42 (33, 55) years; 38.1% reported at least one chronic disease risk condition. There was no differential intervention effect on HPS at any timepoint by chronic disease risk (all p-interaction>0.05): Among those with chronic disease risk, intervention participants increased HPS (unadjusted mean [SD]) from baseline through 24 months (68 [13] to 74 [13]) compared to control (68 [14] to 68 [16]). This was similar to the difference between intervention (67 [12] to 72 [13]) and control participants (69 [12] to 72 [12]) without risk. There was no differential intervention effect on HEI by chronic disease risk (all p-interaction>0.05).
Conclusions:
The ChooseWell 365 behavioral intervention improved the healthfulness of cafeteria purchases of employees with and without chronic disease risk, suggesting that workplace health promotion programs can improve lifestyle behaviors that contribute to both the prevention and treatment of chronic disease.
Collapse
Affiliation(s)
- Jessica Cheng
- Massachusetts General Hosp & Harvard Sch of Public Health, Boston, MA
| | | | | | | | | |
Collapse
|
28
|
Jia J, Burgun R, Reilly A, Sonnenblick R, Fiechtner L, Zack RM, Porneala B, Thorndike AN. A food bank program to help food pantries improve healthy food choices: mixed methods evaluation of The Greater Boston Food Bank's Healthy Pantry Program. BMC Public Health 2023; 23:355. [PMID: 36797729 PMCID: PMC9936683 DOI: 10.1186/s12889-023-15243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The Greater Boston Food Bank's (GBFB) Healthy Pantry Program (HPP) is an online training that teaches food pantry staff to implement behavioral nudges (e.g., traffic-light nutrition labels, choice architecture) to promote healthier client choices. This study assessed if HPP was associated with healthier food bank orders by food pantries and identified implementation facilitators and barriers. METHODS This mixed methods study collected quantitative data from a matched cohort of 10 HPP food pantries and 99 matched control food pantries in eastern Massachusetts that allow clients to choose their own food, and qualitative data from structured individual interviews with 8 HPP pantry staff. A difference-in-differences analysis compared changes in percentage of pantries' food bank orders (by weight) of foods labeled green/yellow (healthier choices) and fresh produce from baseline to 6 and 10 months between HPP and control pantries. Interviews were coded for implementation facilitators and barriers. RESULTS Before starting HPP, green-yellow ordering was 92.0% (SD 4.9) in control and 87.4% (SD 5.4) in HPP pantries. Participation in HPP was not associated with changes in green-yellow or fresh produce ordering at 6 or 10 months. HPP implementation facilitators included HPP training being accessible (sub-themes: customizable, motivating) and compatible with client-choice values. Barriers included resource limitations (sub-themes: staff shortage, limited space) and concerns about stigmatizing client food choices with use of labels for unhealthy foods. CONCLUSIONS An online program to help pantries promote healthier client choices was not associated with changes in how much healthy food pantries ordered from the food bank, suggesting it did not substantially change client choices. Implementation challenges and high baseline healthy ordering may have influenced HPP's effectiveness.
Collapse
Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Division of General Internal Medicine, Department of Medicine, Northwestern University, 750 Lakeshore Drive, 10th floor, Chicago, IL, 60611, USA.
| | | | - Alexa Reilly
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ross Sonnenblick
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren Fiechtner
- Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, Mass General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
29
|
Brown MC, Hawley C, Ornelas IJ, Huber C, Best L, Thorndike AN, Beresford S, Howard BV, Umans JG, Hager A, Fretts AM. Adapting a cooking, food budgeting and nutrition intervention for a rural community of American Indians with type 2 diabetes in the North-Central United States. Health Educ Res 2023; 38:13-27. [PMID: 36342521 PMCID: PMC9853931 DOI: 10.1093/her/cyac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 05/24/2023]
Abstract
American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process of adapting the evidence-based Cooking Matters® program for use by AI adults with type 2 diabetes in a rural and resource-limited setting in the North-Central United States. We conducted three focus groups with AI adults with diabetes to (i) identify Cooking Matters® adaptations and (ii) gather feedback on appropriateness of the adapted intervention using Barrera and Castro's cultural adaptation framework. Transcripts were coded using an inductive, constant comparison approach. Queries of codes were reviewed to identify themes. Contextual considerations included limited access to grocery stores and transportation barriers, reliance on government food assistance and the intergenerational burden of diabetes. Adaptations to content and delivery included incorporating traditional and locally available foods; appealing to children or others in multigenerational households and prioritizing visual over written content. Our use of Barrera and Castro's framework adds rigor and structure to the cultural adaptation process and increases the likelihood of future intervention success. Other researchers may benefit from using this framework to guide the adaptation of evidence-based interventions in AI communities.
Collapse
Affiliation(s)
- Meagan C Brown
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA and Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Caitie Hawley
- Department of Medicine, University of Washington, Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - India J Ornelas
- Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Corrine Huber
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Lyle Best
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Anne N Thorndike
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA and Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Shirley Beresford
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Barbara V Howard
- Field Studies Division, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
| | - Jason G Umans
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
- Field Studies Division and Biomarker, Biochemistry, and Biorepository Core, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
| | - Arlette Hager
- Cheyenne River Sioux Tribe Adult Diabetes Program, 24276 166th St. Airport Road, P.O. Box 590 Eagle Butte, SD 57625, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| |
Collapse
|
30
|
Vadiveloo MK, Parker HW, Thorndike AN. Participant Characteristics Associated with High Responsiveness to Personalized Healthy Food Incentives: a Secondary Analysis of the Randomized Controlled Crossover Smart Cart Study. J Nutr 2023; 152:2913-2921. [PMID: 36040345 DOI: 10.1093/jn/nxac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Personalized dietary behavioral interventions could be enhanced by understanding factors accounting for individual variability in dietary decisions. OBJECTIVE This study was a secondary analysis of the Smart Cart randomized controlled trial to determine whether participant characteristics predicted high responsiveness to personalized grocery incentives for purchasing healthy food. METHODS This secondary analysis of a 9-mo crossover study included 192 regular shoppers (86%) from a Rhode Island supermarket. To analyze whether health, behavioral, and/or sociodemographic characteristics predicted responsiveness to a personalized grocery incentive intervention, participants were divided into 3 categories [high (n = 47), moderate (n = 50), and unresponsive (n = 95)] based on percentage changes in their Grocery Purchase Quality Index scores during the intervention versus control period calculated from sales data. We tested whether participant characteristics, including individual, household, and intervention-related factors, differed across responsiveness groups using ANOVA and whether they predicted the likelihood of being high responsive versus unresponsive or moderate responsive using logistic regression. RESULTS Participants had a mean (SD) age of 56.0 (13.8) y and were 89% female. Education, self-reported BMI, income, diet-related medical condition, food insecurity, cooking adequacy, and value consciousness differed across responsiveness categories (P < 0.1). High versus moderate and unresponsive participants increased their percentage of spending on targeted foods (P < 0.0001) and purchased fewer unique items (P = 0.01). In multinomial adjusted models, the odds of being high versus unresponsive or moderate responsive were lower for participants with a BMI (in kg/m2) <25 versus ≥25 (OR: 0.41; 95% CI: 0.19, 0.90) and higher with a diet-related medical condition present (OR: 3.75; 95% CI: 1.20, 11.8). Other characteristics were not associated with responsiveness. CONCLUSIONS Findings demonstrated that a BMI ≥25 and having a diet-related medical condition within the household predicted high responsiveness to a personalized grocery purchasing intervention, suggesting that personalized dietary interventions may be particularly effective for households with higher health risk. This trial is registered at www.clinicaltrials.gov as NCT03748056.
Collapse
Affiliation(s)
- Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
Vadiveloo MK, Thorndike AN, Lichtenstein AH. Integrating Diet Screening Into Routine Clinical Care: The Time Is Now. J Am Heart Assoc 2022; 12:e028583. [PMID: 36583426 PMCID: PMC9973602 DOI: 10.1161/jaha.122.028583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Maya K. Vadiveloo
- Department of Nutrition and Food Sciences, College of Health SciencesUniversity of Rhode IslandKingstonRI
| | - Anne N. Thorndike
- Harvard Medical SchoolBostonMA,Division of General Internal Medicine, Department of MedicineMassachusetts General HospitalBostonMA
| | - Alice H. Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMA
| |
Collapse
|
32
|
Sonnenblick R, Reilly A, Roye K, McCurley JL, Levy DE, Fung V, McGovern SH, Clark CR, Thorndike AN. Social Determinants of Health and Hypertension Control in Adults with Medicaid. J Prim Care Community Health 2022; 13:21501319221142426. [PMID: 36475934 PMCID: PMC9742683 DOI: 10.1177/21501319221142426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Social determinants of health (SDOH) are associated with cardiovascular disease, but little is known about mechanisms underlying those relationships. We hypothesized that SDOH would be associated with uncontrolled hypertension (HTN) in adults with Medicaid. METHODS This was a retrospective analysis of adults in a Medicaid accountable care organization who had HTN diagnoses, received regular care at community health centers, and enrolled in a cohort study between December 2019 and December 2020. Baseline surveys collected demographics and SDOH, including food insecurity, unstable housing, cost-related medication underuse, and financial stress. Blood pressure (BP) measurements over 12 months after survey completion were obtained from the electronic health record. Participants were categorized as: uncontrolled HTN (mean systolic BP ≥ 140 mm Hg and/or mean diastolic BP ≥ 90 mm Hg), controlled HTN, or unknown HTN control (no BP documented). We examined the association of individual and cumulative (count, 0-4) SDOH with uncontrolled HTN and unknown HTN control using multivariable logistic regression adjusting for demographics, smoking, diabetes, and HTN medication. RESULTS Participants (n = 245) were mean (SD) age 51.3 (8.6) years, 66.1% female, 43.7% Hispanic, 34.3% White, and 18.0% Black. Overall, 58.0% had food insecurity, 38.0% had unstable housing, 29.4% had financial stress, and 20.0% reported cost-related medication underuse. BP was documented for 180 participants; 44 (24.4%) had uncontrolled HTN. In multivariable models, neither individual nor cumulative SDOH were associated with uncontrolled HTN or unknown HTN control. CONCLUSIONS In a Medicaid-insured population receiving care at community health centers, adverse SDOH were prevalent but were not associated with HTN control.
Collapse
Affiliation(s)
| | | | - Karina Roye
- Massachusetts General Hospital, Boston, MA, USA
| | - Jessica L. McCurley
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Douglas E. Levy
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Vicki Fung
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Cheryl R. Clark
- Harvard Medical School, Boston, MA, USA,Brigham and Women’s Hospital, Boston, MA, USA
| | - Anne N. Thorndike
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Anne N. Thorndike, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St., 16 floor, Boston, MA 02114, USA.
| |
Collapse
|
33
|
Schiavoni KH, Helscel K, Vogeli C, Thorndike AN, Cash RE, Camargo CA, Samuels-Kalow ME. Prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO). BMC Health Serv Res 2022; 22:1375. [PMID: 36403024 PMCID: PMC9675191 DOI: 10.1186/s12913-022-08721-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Health-related social needs (HRSN) are associated with higher chronic disease prevalence and healthcare utilization. Health systems increasingly screen for HRSN during routine care. In this study, we compare the differential prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO) and identify the patient and practice characteristics associated with reporting social needs in a different domain from social risks. Methods Cross-sectional study of patient responses to HRSN screening February 2019-February 2020. HRSN screening occurred as part of routine primary care and assessed social risk factors in eight domains and social needs by requesting resources in these domains. Participants included adult and pediatric patients from 114 primary care practices. We measured patient-reported social risk factors and social needs from the HRSN screening, and performed multivariable regression to evaluate patient and practice characteristics associated with reporting social needs and concordance to social risks. Covariates included patient age, sex, race, ethnicity, language, and practice proportion of patients with Medicaid and/or Limited English Proficiency (LEP). Results Twenty-seven thousand four hundred thirteen individuals completed 30,703 screenings, including 15,205 (55.5%) caregivers of pediatric patients. Among completed screenings, 13,692 (44.6%) were positive for ≥ 1 social risk factor and 2,944 (9.6%) for ≥ 3 risks; 5,861 (19.1%) were positive for social needs and 4,848 (35.4%) for both. Notably, 1,013 (6.0%) were negative for social risks but positive for social needs. Patients who did not identify as non-Hispanic White or were in higher proportion LEP or Medicaid practices were more likely to report social needs, with or without social risks. Patients who were non-Hispanic Black, Hispanic, preferred non-English languages or were in higher LEP or Medicaid practices were more likely to report social needs without accompanying social risks. Conclusions Half of Medicaid ACO patients screened for HRSN reported social risk factors or social needs, with incomplete overlap between groups. Screening for both social risks and social needs can identify more individuals with HRSN and increase opportunities to mitigate negative health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08721-9.
Collapse
|
34
|
Evins AE, Cather C, Maravic MC, Reyering S, Pachas GN, Thorndike AN, Levy DE, Fung V, Fischer MA, Schnitzer K, Pratt S, Fetters MD, Deeb B, Potter K, Schoenfeld DA. A Pragmatic Cluster-Randomized Trial of Provider Education and Community Health Worker Support for Tobacco Cessation. Psychiatr Serv 2022; 74:365-373. [PMID: 36349498 DOI: 10.1176/appi.ps.20220187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Individuals with serious mental illness have a high prevalence of tobacco use disorder and related early mortality but underutilize smoking cessation medication. The authors determined whether clinician-delivered education to primary care providers regarding safety, efficacy, and importance of cessation medication (provider education [PE]) alone or combined with community health worker (CHW) support would increase tobacco abstinence in this population, compared with usual care. METHODS All adult current tobacco smokers receiving psychiatric rehabilitation for serious mental illness through two community agencies in Greater Boston were eligible, regardless of readiness to quit smoking. Primary care clinics were cluster randomized to PE or usual care, with a nested, participant-level randomization to CHW or no CHW in PE-assigned clinics. The primary outcome was blindly assessed, biochemically verified tobacco abstinence at year 2. RESULTS Overall, 1,010 eligible participants were enrolled. PE was delivered to providers in 53 of 55 assigned clinics; 220 of 336 CHW-assigned participants consented to CHW support. Year 2 abstinence rates were significantly higher among participants assigned to PE+CHW versus usual care (12% vs. 5%; adjusted odds ratio [AOR]=2.40, 95% confidence interval [CI]=1.20-4.79) or PE alone (12% vs. 7%; AOR=1.84, 95% CI=1.04-3.24). No effect of PE alone on abstinence was detected. Compared with participants assigned to usual care, those assigned to PE+CHW had greater odds of varenicline use (OR=2.77, 95% CI=1.61-4.75), which was associated with higher year 2 abstinence (OR=1.97, 95% CI=1.16-3.33). CONCLUSIONS Combined PE and CHW tobacco cessation support increased tobacco abstinence rates among adults with serious mental illness.
Collapse
Affiliation(s)
- A Eden Evins
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Corinne Cather
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Melissa Culhane Maravic
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sally Reyering
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Gladys N Pachas
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Anne N Thorndike
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Douglas E Levy
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Vicki Fung
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael A Fischer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kristina Schnitzer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sarah Pratt
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael D Fetters
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Bianca Deeb
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kevin Potter
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - David A Schoenfeld
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| |
Collapse
|
35
|
Carter J, Donelan K, Thorndike AN. Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. J Prim Care Community Health 2022; 13:21501319221133672. [PMID: 36305386 PMCID: PMC9619261 DOI: 10.1177/21501319221133672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As individual interventions, home-based care and remote monitoring have been shown to help prevent hospitalizations for those with heart failure (HF) although both interventions have been limited by scalability and technical constraints, respectively. Few qualitative studies have explored patient perspectives, including acceptability, barriers, and facilitators of HF care inclusive of both interventions. The objective of this study is to explore patient perceptions on HF management at home, the use of home-based remote monitoring, and the value of home-based care. METHODS Qualitative interviews (N = 27) were conducted via phone (12/2020-3/2021) with adults with HF. A framework analysis was used to identify main themes along with verbatim transcription for coding and analyses. There were 5 key interview domains: general HF knowledge, perceptions of the value of home-based care, unmet needs related to the social determinants of health (SDOH), experience with healthcare technology and remote monitoring, and challenges in HF home management. RESULTS Five major themes emerged. Patients reported: (1) home-based care plan instructions are understood; (2) following medication, diet, and fluid management instructions are challenging due to difficult adherence to and implementation at home; (3) financial limitations serve as barriers to acquiring healthy food; (4) home-based support is a valuable component of managing medications, diet, and fluid; (5) despite limited use of technology, strong willingness to use remote monitoring is present amongst most. CONCLUSIONS Participants reported understanding of care plan instructions and challenges adhering to care plans at home. Barriers included needing more home-based support for medications, diet, and fluid management and requiring additional assistance with financial barriers related to unmet social needs. A combined intervention inclusive of remote monitoring and home-based support has potential to improve home-based strategies and clinical outcomes for HF patients.
Collapse
Affiliation(s)
- Jocelyn Carter
- Massachusetts General Hospital, Boston, MA, USA,Jocelyn Carter, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Blake 15, Boston, MA 02114, USA.
| | | | | |
Collapse
|
36
|
Feig EH, Harnedy LE, Thorndike AN, Psaros C, Healy BC, Huffman JC. A Positive Emotion-Focused Intervention to Increase Physical Activity After Bariatric Surgery: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e39856. [PMID: 36201380 PMCID: PMC9585441 DOI: 10.2196/39856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement. Objective The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting. Methods The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology–motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures. Results This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention. Conclusions Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial. Trial Registration ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032 International Registered Report Identifier (IRRID) PRR1-10.2196/39856
Collapse
Affiliation(s)
- Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, United States.,Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Brian C Healy
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| |
Collapse
|
37
|
Hua SV, Musicus AA, Thorndike AN, Kenney EL, Rimm EB. Child-Directed Marketing, Health Claims, and Nutrients in Popular Beverages. Am J Prev Med 2022; 63:354-361. [PMID: 35393144 PMCID: PMC9398955 DOI: 10.1016/j.amepre.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Fruit drinks are a major source of added sugar in children's diets. This study describes the associations between front-of-package child-directed marketing (i.e., sports, fantasy, or child-directed imagery; child-directed text) and (1) health-related claims and (2) nutrient content of fruit drinks, 100% juices, and flavored waters. METHODS Beverage purchase data from a national sample of 1,048 households with children aged 0-5 years were linked with front-of-package label and nutrition data to conduct a content analysis on fruit drinks (n=510), 100% juices (n=337), and noncarbonated flavored waters (n=40) in 2019-2020. Unstratified and stratified regression models assessed the differences in the prevalence of claims (macronutrient, micronutrient, natural/healthy, and fruit and juice), non-nutritive sweeteners, and nutrient content (calories, total sugar, and percent daily value of vitamin C) between drinks with and those without child-directed marketing in 2021. RESULTS Fruit drinks with child-directed marketing were more likely to show front-of-package micronutrient claims (OR=2.1, 95% CI=1.5, 3.1) and contained more vitamin C (18.5% daily value, 95% CI=1.6, 35.5) than fruit drinks without child-directed marketing. 100% juices with child-directed marketing contained less vitamin C (-35.6% daily value, 95% CI= -57.5, -13.8) and 3.0 (95% CI= -5.5, -0.4) fewer grams of sugar than 100% juices without child-directed marketing. Flavored waters with child-directed marketing contained less vitamin C (-37.9% daily value, 95% CI= -68.1, -7.6) than flavored waters without child-directed marketing. CONCLUSIONS The combination of child-directed marketing with health-related claims may mislead parents into believing that fruit drinks are healthy and appealing to their children, highlighting the need for government regulation of sugary drink marketing.
Collapse
Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
38
|
Jia J, Levy DE, McCurley JL, Anderson E, Gelsomin ED, Porneala B, Thorndike AN. Health Literacy, Numeracy, and Health Promotion: A Secondary Analysis of the Choosewell 365 Workplace Trial. Am J Prev Med 2022; 63:93-101. [PMID: 35282955 PMCID: PMC9232847 DOI: 10.1016/j.amepre.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Health literacy and numeracy are linked to obesity and dietary behaviors. This study investigates whether the effect of a workplace behavioral intervention to prevent weight gain and improve diet differed by employee health literacy and numeracy. METHODS ChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using nudges and feedback to promote healthier choices, building on existing cafeteria traffic light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were measured with the Newest Vital Sign (range=0-6) and General Numeracy Scale (range=0-3). Mixed-effects linear models examined if intervention effects on cafeteria purchases, diet quality (Healthy Eating Index 2015, range=0-100), and weight change over 24 months differed by higher versus lower health literacy or numeracy. Data were collected in 2016-2020 and analyzed in 2020-2021. RESULTS In 12 months, 510 participants completed the Newest Vital Sign and General Numerancy Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases over 24 months compared with controls in both higher and lower health literacy and numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54) but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy. CONCLUSIONS A behavioral intervention improved cafeteria food choices of hospital employees of varying health literacy and numeracy levels and improved diet quality among employees with lower health literacy, suggesting this group also improved food choices outside of work.
Collapse
Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jessica L McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emma Anderson
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily D Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
39
|
Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
Collapse
|
40
|
Franckle RL, Boulos RJ, Thorndike AN, Moran AJ, Khandpur N, Blue D, Greene J, Block JP, Rimm EB, Polacsek M. Implementation of a 2-for-1 Price Incentive for Fruits and Vegetables in a Grocery Retail Setting. Health Promot Pract 2022:15248399221086880. [PMID: 35414293 DOI: 10.1177/15248399221086880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE There is growing interest in expanding healthy eating interventions in the retail setting. The purpose of this study was to evaluate the implementation of a successful 2-for-1 price incentive for fruits and vegetables (F&V), including frozen and canned, that took place in partnership with a large chain grocery retailer in Maine. Intervention Approach. A randomized controlled trial (RCT) pilot study was conducted in 2015-2016, followed by a larger RCT in 2016-2017, to assess whether a supermarket double-dollar F&V incentive increased purchases of these items. EVALUATION METHODS A convergent, parallel mixed-methods design was used to examine barriers and facilitators to implementing the interventions, using six implementation outcomes: acceptability, adoption, appropriateness, feasibility, implementation fidelity, and perceived cost. RESULTS The intervention was deemed highly acceptable, appropriate, and feasible by shoppers, retailers, and researchers. The F&V discount had a high rate of initial adoption. There was a moderate degree of fidelity, which improved over time based on lessons learned from the pilot and applied to the subsequent RCT. Specific costs associated with implementation from the research perspective are reported. Implications for Practice, Policy, and Research. Partnerships between academic researchers and retailers can be an effective model for improving healthful purchases among shoppers. These findings are relevant for investigators, public health advocates, and retailers interested in implementing similar grocery retail-based interventions.
Collapse
Affiliation(s)
| | - R J Boulos
- Maine Public Health Association, Augusta, ME, USA
| | - A N Thorndike
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - A J Moran
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Khandpur
- University of Sao Paulo, Sao Paulo, Brazil
| | - D Blue
- Hannaford Supermarkets, Scarborough, ME, USA
| | - J Greene
- Guiding Stars Licensing Company LLC, Ahold Delhaize, USA
| | - J P Block
- Harvard Medical School, Boston, MA, USA
- Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - E B Rimm
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M Polacsek
- University of New England, Portland, ME, USA
| |
Collapse
|
41
|
Thorndike AN, Fung V, McCurley JL, Clark CR, Howard S, Levy DE. COVID-19 stressors and one-year changes in depression and anxiety in a longitudinal cohort of low-income adults in the United States. Prev Med Rep 2022; 26:101730. [PMID: 35155086 PMCID: PMC8824255 DOI: 10.1016/j.pmedr.2022.101730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/23/2021] [Accepted: 02/06/2022] [Indexed: 11/17/2022] Open
Abstract
Emerging data suggest that adults with low income are at highest risk for COVID-19-related stressors and mental health disorders. This study aimed to determine if COVID-19-related stressors were associated with worsening depression and anxiety in a cohort of low-income adults one year after the start of the pandemic. Participants included 253 Medicaid and commercial accountable care organization recipients from 5 community health centers around Boston, MA who enrolled December 2019-March 2020 in a larger longitudinal study of a Medicaid program. Participants completed surveys at baseline and one-year follow-up that measured depression (Patient Health Questionnaire-8 [PHQ-8]) and anxiety (Generalized Anxiety Disorder-7 [GAD-7]) symptoms. Follow-up surveys assessed COVID-19-related stressors experienced over the prior 12 months. A stressor score included COVID-19-related infectious, social, and economic stressors categorized into tertiles (low, 0–3; medium, 4–6; high, 7–19). Mean age (SD) was 45.2 (11.5) years; 71.2% were female, 42.3% Hispanic and 14.6% Black. At baseline, 126 (49.8%) had moderate or severe depression (PHQ-8 ≥ 10), and 109 (43.1%) had moderate or severe anxiety (GAD-7 ≥ 10). The mean (SD) number of COVID-19 stressors was 4.9 (3.1); the most frequent were food insecurity (52.2%) and job or income loss (43.9%). Compared to the low tertile, those in high and medium tertiles had significantly greater one-year increases in depression and anxiety symptoms. Low-income adults facing multiple COVID-19-related stressors, particularly health-related social needs, had worsening mental health symptoms over one year. Interventions are urgently needed to address the dual burden of health-related social needs and poor mental health exacerbated by COVID-19.
Collapse
|
42
|
Carrillo A, Feig EH, Harnedy LE, Huffman JC, Park ER, Thorndike AN, Kim S, Millstein RA. The role of positive psychological constructs in diet and eating behavior among people with metabolic syndrome: A qualitative study. Health Psychol Open 2022; 9:20551029211055264. [PMID: 35024156 PMCID: PMC8744179 DOI: 10.1177/20551029211055264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.
Collapse
Affiliation(s)
- Alba Carrillo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine,
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine,
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonia Kim
- Harvard Medical School, Boston, MA, USA
| | - Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Rachel A. Millstein, Department of Psychiatry,
Massachusetts General Hospital, 5 Longfellow Place, Suite 215, Boston, MA 02114, USA.
| |
Collapse
|
43
|
McCurley JL, Levy DE, Dashti HS, Gelsomin E, Anderson E, Sonnenblick R, Rimm EB, Thorndike AN. Association of Employees' Meal Skipping Patterns with Workplace Food Purchases, Dietary Quality, and Cardiometabolic Risk: A Secondary Analysis from the ChooseWell 365 Trial. J Acad Nutr Diet 2022; 122:110-120.e2. [PMID: 34478879 PMCID: PMC9115715 DOI: 10.1016/j.jand.2021.08.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Employed adults may skip meals due to time or financial constraints, challenging work schedules, or limited workplace food choices. Little is known about the relationship between employees' meal skipping patterns and workplace dietary choices and health. OBJECTIVE To examine whether hospital employees' meal skipping patterns were associated with workplace food purchases, dietary quality, and cardiometabolic risk factors (ie, obesity, hypertension, and prediabetes/diabetes). DESIGN This is a secondary cross-sectional analysis of baseline data from the ChooseWell 365 randomized controlled trial. Employees reported meal-skipping frequency in a baseline survey. The healthfulness of workplace food purchases was determined with a validated Healthy Purchasing Score (HPS) (range = 0 to 100 where higher scores = healthier purchases) calculated using sales data for participants' purchases in the 3 months before study enrollment. Dietary quality was measured with the 2015 Healthy Eating Index (range = 0 to 100 where higher score = healthier diet) from two 24-hour recalls. Cardiometabolic risk factors were ascertained from clinic measurements. PARTICIPANTS/SETTING Participants were 602 hospital employees who regularly visited workplace cafeterias and enrolled in ChooseWell 365, a workplace health promotion study in Boston, MA, during 2016-2018. MAIN OUTCOME MEASURES Primary outcomes were HPS, 2015 Healthy Eating Index, and cardiometabolic risk factors. STATISTICAL ANALYSES Regression analyses examined differences in HPS, 2015 Healthy Eating Index, and cardiometabolic variables by meal skipping frequency, adjusting for demographic characteristics. RESULTS Participants' mean (standard deviation) age was 43.6 (12.2) years and 478 (79%) were women. Overall, 45.8% skipped breakfast, 36.2% skipped lunch, and 24.9% skipped dinner ≥ 1 day/week. Employees who skipped breakfast ≥ 3 days/week (n = 102) had lower HPS (65.1 vs 70.4; P < 0.01) and 2015 Healthy Eating Index score (55.9 vs 62.8; P < 0.001) compared with those who never skipped. Skipping lunch ≥ 3 days/week and dinner ≥ 1 day/week were associated with significantly lower HPS compared with never skipping. Employees who worked nonstandard shifts skipped more meals than those who worked standard shifts. Meal skipping was not associated with obesity or other cardiometabolic variables. CONCLUSIONS Skipping meals was associated with less healthy food purchases at work, and skipping breakfast was associated with lower dietary quality. Future research to understand employees' reasons for skipping meals may inform how employers could support healthier dietary intake at work.
Collapse
Affiliation(s)
- Jessica L McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hassan S Dashti
- Center for Genomic Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emily Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Emma Anderson
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ross Sonnenblick
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Channing Division of Network Medicine, Department of Medicine, Brigham and Woman’s Hospital, Boston, Massachusetts
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, Sacks FM, Thorndike AN, Van Horn L, Wylie-Rosett J. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e472-e487. [PMID: 34724806 DOI: 10.1161/cir.0000000000001031] [Citation(s) in RCA: 298] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.
Collapse
|
45
|
Musicus AA, Thorndike AN, Block JP, Rimm EB, Bleich SN. Prevalence and nutritional quality of free food and beverage acquisitions at school and work by SNAP status. PLoS One 2021; 16:e0257879. [PMID: 34644334 PMCID: PMC8514130 DOI: 10.1371/journal.pone.0257879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 09/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The dual burden of poor diet quality and food insecurity makes free food-food acquired at no cost-a very important part of the nutrition safety net for low-income families. The goal of this study was to determine the national prevalence and nutritional quality of free food acquired separately in two settings: 1) by children at school; and 2) by employees at work; both stratified by participation in the Supplemental Nutrition Assistance Program (SNAP). METHODS Using National Household Food Acquisition and Purchase Survey data (2012; n = 4,826 U.S. households containing 5,382 employed adults and 3,338 school-aged children), we used survey-weighted proportions to describe free food acquisition and linear regression to compare the 2010 Healthy Eating Index (HEI-2010) for free/non-free food acquisition events (i.e., meals) by SNAP status. Analyses were conducted in 2019-2020. RESULTS SNAP households had more free acquisition events (29.6%) compared to non-SNAP households (<185% federal poverty level (FPL) = 22.3%; ≥185%FPL = 21.0%, p's<0.001). For SNAP-participant children, free acquisition events at school had a higher mean HEI-2010 compared to non-free acquisition events at school (50.3 vs. 43.8, p = 0.033) and free acquisition events by SNAP-non-participant children ≥185%FPL at school (50.3 vs. 38.0, p = 0.001). Free and non-free acquisition events at work had relatively low HEI-2010s, with no differences by SNAP status. CONCLUSIONS Over one fifth of all food acquisition events were free, but free food acquisitions at school and work were relatively unhealthy. For children participating in SNAP, free food acquired at school had higher nutritional quality. Improving the dietary quality of free foods could improve the health of families, especially those participating in SNAP.
Collapse
Affiliation(s)
- Aviva A. Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anne N. Thorndike
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason P. Block
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eric B. Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
46
|
Levy DE, Pachucki MC, O'Malley AJ, Porneala B, Yaqubi A, Thorndike AN. Social connections and the healthfulness of food choices in an employee population. Nat Hum Behav 2021; 5:1349-1357. [PMID: 33888881 PMCID: PMC8530824 DOI: 10.1038/s41562-021-01103-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
Unhealthy food choice is an important driver of obesity, but research examining the relationship of food choices and social influence has been limited. We sought to assess associations in the healthfulness of workplace food choices among a large population of diverse employees whose food-related social connections were identified using passively collected data in a validated model. Data were drawn from 3 million encounters where pairs of employees made purchases together in 2015-2016. The healthfulness of food items was defined by 'traffic light' labels. Cross-sectional simultaneously autoregressive models revealed that proportions of both healthy and unhealthy items purchased were positively associated between connected employees. Longitudinal generalized estimating equation models also found positive associations between an employee's current food purchase and the most recent previous food purchase a coworker made together with the employee. These data indicate that workplace interventions to promote healthy eating and reduce obesity should test peer-based strategies.
Collapse
Affiliation(s)
- Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Mark C Pachucki
- Department of Sociology & Computational Social Science Institute, University of Massachusetts, Amherst, Amherst, MA, USA
| | - A James O'Malley
- Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Awesta Yaqubi
- Boston University School of Medicine, Boston, MA, USA
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
47
|
Dashti HS, Levy DE, Hivert MF, Alimenti K, McCurley JL, Saxena R, Thorndike AN. Genetic risk for obesity and the effectiveness of the ChooseWell 365 workplace intervention to prevent weight gain and improve dietary choices. Am J Clin Nutr 2021; 115:180-188. [PMID: 34581769 PMCID: PMC8755032 DOI: 10.1093/ajcn/nqab303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is unknown whether behavioral interventions to improve diet are effective in people with a genetic predisposition to obesity. OBJECTIVES To examine associations between BMI genetic risk and changes in weight and workplace purchases by employees participating in a randomized controlled trial of an automated behavioral workplace intervention to promote healthy food choices. METHODS Participants were hospital employees enrolled in a 12-mo intervention followed by a 12-mo follow-up. Hospital cafeterias utilized a traffic-light labeling system (e.g., green = healthy, red = unhealthy) that was used to calculate a validated Healthy Purchasing Score (HPS; higher = healthier). A weighted genome-wide BMI genetic score was generated by summing BMI-increasing alleles. RESULTS The study included 397 adults of European ancestry (mean age, 44.9 y; 80.9% female). Participants in the highest genetic quartile (Q4) had a lower HPS and higher purchases of red-labeled items relative to participants in the lowest quartile (Q1) at baseline [Q4-Q1 Beta HPS, -4.66 (95% CI, -8.01 to -1.32); red-labeled items, 4.26% (95% CI, 1.45%-7.07%)] and at the 12-mo [HPS, -3.96 (95% CI, -7.5 to -0.41); red-labeled items, 3.20% (95% CI, 0.31%-6.09%)] and 24-mo [HPS, -3.70 (95% CI, -7.40 to 0.00); red-labeled items, 3.48% (95% CI, 0.54%-6.41%)] follow-up periods. In the intervention group, increases in HPS were similar in Q4 and Q1 at 12 mo (Q4-Q1 Beta, 1.04; 95% CI, -2.42 to 4.50). At the 24-mo follow-up, the change in BMI from baseline was similar between Q4 and Q1 (0.17 kg/m2; 95% CI, -0.55 to 0.89 kg/m2) in the intervention group, but higher in Q4 than Q1 (1.20 kg/m2; 95% CI, 0.26-2.13 kg/m2) in the control group. No interaction was evident between the treatment arm and genetic score for BMI or HPS. CONCLUSIONS Having a high BMI genetic risk was associated with greater increases in BMI and lower quality purchases over 2 y. The 12-mo behavioral intervention improved employees' food choices, regardless of the genetic burden, and may have attenuated weight gain conferred by having the genetic risk.
Collapse
Affiliation(s)
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA,Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kaitlyn Alimenti
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica L McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Medical and Population Genetics, Broad Institute, Cambridge, MA, USA,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
48
|
Calitz C, Pratt C, Pronk NP, Fulton JE, Jinnett K, Thorndike AN, Addou E, Arena R, Brown AGM, Chang C, Latts L, Lerner D, Majors M, Mancuso M, Mills D, Sanchez E, Goff D. Cardiovascular Health Research in the Workplace: A Workshop Report. J Am Heart Assoc 2021; 10:e019016. [PMID: 34459251 PMCID: PMC8649235 DOI: 10.1161/jaha.120.019016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart disease and stroke are the first and fifth leading causes of death in the United States, respectively. Employers have a unique opportunity to promote cardiovascular health, because >60% of US adults are employed, and most spend half of their waking hours at work. Despite the scope of the opportunity, <1 in 5 businesses implement evidence-based, comprehensive workplace health programs, policies, and practices. Integrated, systems-based workplace health approaches that harness data science and technology may have the potential to reach more employees and be cost-effective for employers. To evaluate the role of the workplace in promoting cardiovascular health across the lifespan, the National Heart, Lung, and Blood Institute, the National Institute for Occupational Safety and Health, and the American Heart Association convened a workshop on March 7, 2019, to share best practices, and to discuss current evidence and knowledge gaps, practical application, and dissemination of the evidence, and the need for innovation in workplace health research and practice. This report presents the broad themes discussed at the workshop and considerations for promoting worker cardiovascular health, including opportunities for future research.
Collapse
Affiliation(s)
| | | | | | | | - Kimberly Jinnett
- University of California San Francisco and GenentechSan FranciscoCA
| | | | - Ebyan Addou
- National Heart Lung and Blood InstituteBethesdaMD
| | - Ross Arena
- University of Illinois at ChicagoIL
- Healthy Living for Pandemic Event Protection NetworkChicagoIL
| | | | - Chia‐Chia Chang
- National Institute for Occupational Safety and Health/Centers for Disease Control and PreventionWashingtonDC
| | - Lisa Latts
- Colorado Department of Health Care Policy and FinancingDenverCO
| | | | | | | | | | | | - David Goff
- National Heart Lung and Blood InstituteBethesdaMD
| |
Collapse
|
49
|
Schiavoni KH, Helscel K, Vogeli C, Thorndike AN, Camargo CA, Samuels‐Kalow ME. Prevalence of Social Risk and Social Need in a Medicaid Accountable Care Organization. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katherine H. Schiavoni
- Mass General Brigham Somerville Massachusetts USA
- Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | | | - Christine Vogeli
- Mass General Brigham Somerville Massachusetts USA
- Massachusetts General Hospital Boston Massachusetts USA
| | - Anne N. Thorndike
- Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Carlos A. Camargo
- Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Margaret E. Samuels‐Kalow
- Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| |
Collapse
|
50
|
Jia J, Fung V, Meigs JB, Thorndike AN. Food Insecurity, Dietary Quality, and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study. J Acad Nutr Diet 2021; 121:2177-2186.e3. [PMID: 34247978 DOI: 10.1016/j.jand.2021.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities. OBJECTIVE Our aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults. DESIGN This was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Participants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States. MAIN OUTCOME MEASURES Self-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization. STATISTICAL ANALYSES Multiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality. RESULTS In a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44). CONCLUSIONS Adults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.
Collapse
Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - James B Meigs
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Harvard University, Boston, MA
| |
Collapse
|