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Morris EJ, Quinn EL, Rose CM, Spiker M, O’Leary J, Otten JJ. Insights from Washington State's COVID-19 Response: A Mixed-Methods Evaluation of WIC Remote Services and Expanded Food Options Using the RE-AIM Framework. J Acad Nutr Diet 2022; 122:2228-2242.e7. [PMID: 35339719 PMCID: PMC8940760 DOI: 10.1016/j.jand.2022.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 10/31/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, Washington State's Supplemental Nutrition Program for Women, Infants, and Children (WA WIC) adopted federal waivers to transition to remote service delivery for certification and education appointments. WA WIC also expanded the approved food list without using federal waivers, adding more than 600 new items to offset challenges participants experienced accessing foods in stores. OBJECTIVE This study aimed to assess the reach and effectiveness of the programmatic changes instituted by WA WIC during the COVID-19 pandemic; the processes, facilitators, and challenges involved in their implementation; and considerations for their continuation in the future. DESIGN A mixed-methods design, guided by the RE-AIM framework, including virtual, semi-structured focus groups and interviews with WA WIC staff and participants, and quantitative programmatic data from WIC agencies across the state. PARTICIPANTS/SETTING This study included data from 52 state and local WIC staff and 40 WIC participants across the state of Washington and from various WA WIC programmatic records (2017-2021). The research team collected data and conducted analyses between January 2021 and August 2021. ANALYSIS An inductive thematic analysis approach with Dedoose software was used to code qualitative data, generate themes, and interpret qualitative data. Descriptive statistics were calculated for quantitative programmatic data, including total participant count, percent increase and decrease in participation, percent of food benefits redeemed monthly, and appointment completion rates. RESULTS All WA WIC participants (n = 125,279 in May 2020) experienced the programmatic changes. Participation increased by 2% from March to December 2020 after WA WIC adopted programmatic changes in response to the COVID-19 pandemic. Certification and nutrition education completion rates increased by 5% and 18% in a comparison of June 2019 with June 2020. Food benefit redemption also increased immediately after the food list was expanded in April 2020. Staff and participants were highly satisfied with remote service delivery, predominantly via the phone, and participants appreciated the expanded food options. Staff and participants want a remote service option to continue and suggested various changes to improve service quality. CONCLUSIONS Participation in WIC and appointment completion rates increased after WA WIC implemented service changes in response to the COVID-19 pandemic. Staff and participants were highly satisfied with remote services, and both desire a continued hybrid model of remote and in-person WIC appointments. Some of the suggested changes to WIC, especially the continuation of remote services, would require federal policy change, and others could be implemented under existing federal regulations.
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Affiliation(s)
- Evelyn J. Morris
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA
| | - Emilee L. Quinn
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Chelsea M. Rose
- Center for Public Health Nutrition, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Marie Spiker
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Jean O’Leary
- Washington State Department of Health, Olympia, WA
| | - Jennifer J. Otten
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA,Center for Public Health Nutrition, University of Washington, Seattle, WA,Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA,Address correspondence to: Jennifer J. Otten, PhD, MS, RD, Nutritional Sciences Program, Center for Public Health Nutrition, and Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Box 353410, Seattle, WA 98195
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Higgins M, Strother H, Burkhart S, Carlsson L, Meyer N, Spiker M, Wegener J. Sustainable Food Systems and Diets in Dietetic Training Standards: An International Content Analysis. J Hum Nutr Diet 2022; 36:957-966. [PMID: 36458377 DOI: 10.1111/jhn.13122] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Low professional confidence and perceived competence create tangible barriers to integrating sustainable food systems (SFS) and diets into dietetic practice. One opportunity to facilitate more systemic integration into dietetic education and training is to include these concepts in professional standards. To better understand the barrier of low professional confidence and perceived competence for engagement with SFS-related practice, the purpose of this research was to investigate dietetic training standards for SFS content and to highlight opportunities for growth within the profession. Questions posed by this research are: (1) how, if at all, are SFS and diets articulated in dietetic training standards, and (2) to what level of cognitive complexity? METHODS A content analysis of dietetic training standards documents was conducted between 15 April and 15 September 2021. Search terms included 'sustain*' or 'sustainable', 'food systems' and/or 'diets'. Extracted data with applicable SFS content were analysed for level of cognitive complexity requirements. RESULTS Of 47 National Dietetics Associations, researchers obtained 23 dietetic training standards documents, of which 16 included SFS-related content. The majority of documents used broad descriptors of the concepts, with little granularity and at a lower level of cognitive complexity. CONCLUSIONS Adoption of more robust frameworks for sustainability with specific learning outcomes that can be adapted to regional contexts would strengthen higher education curricula and thus the profession's ability to contribute more meaningfully to SFSs and diets.
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Affiliation(s)
- Madalyn Higgins
- School of Nutrition and DieteticsAcadia UniversityPO Box 68, 12 University AvenueWolfvilleNova ScotiaCanadaB4P 2R1
| | - Heather Strother
- School of Nutrition and DieteticsAcadia UniversityPO Box 68, 12 University AvenueWolfvilleNova ScotiaCanadaB4P 2R1
| | - Sarah Burkhart
- School of Health & Behavioural Sciences, Australian Centre for Pacific Islands ResearchUniversity of the Sunshine CoastSippy DownsQueenslandAustralia
| | - Liesel Carlsson
- School of Nutrition and DieteticsAcadia UniversityPO Box 68, 12 University AvenueWolfvilleNova ScotiaCanadaB4P 2R1
| | - Nanna Meyer
- Faculty of Human Physiology and NutritionUniversity of Colorado. Colorado SpringsColoradoUSA
| | - Marie Spiker
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
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Hege A, Giddens J, Bergquist E, Stadler D, Gayer Campbell C, Cummings J, Goetze A, Steinmetz J, Combs E, Schwartz A, Prange N, Brown K, Sauer K, Spiker M. Integration of a Sustainable Food Systems Curriculum in Nutrition and Dietetics Education: Assessment from the First Year of Implementation. J Acad Nutr Diet 2021; 121:2536-2548. [PMID: 33775620 DOI: 10.1016/j.jand.2021.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Amanda Hege
- (1)Academy of Nutrition and Dietetics Foundation, Chicago, IL, and Nutrition and Health Care Management, Appalachian State University, Boone, NC.
| | | | - Erin Bergquist
- (3)Department of Food Science and Human Nutrition, Iowa State University, Ames
| | - Diane Stadler
- (4)Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland
| | | | - Joanna Cummings
- (4)Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland
| | - Anne Goetze
- (5)Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, and is senior director, Nutrition and Business Development, Oregon Dairy and Nutrition Council, Portland
| | - Jasia Steinmetz
- (6)School of Health Sciences and Wellness, University of Wisconsin-Stevens Point, Stevens Point
| | - Elizabeth Combs
- (6)School of Health Sciences and Wellness, University of Wisconsin-Stevens Point, Stevens Point
| | - Aaron Schwartz
- (6)School of Health Sciences and Wellness, University of Wisconsin-Stevens Point, Stevens Point
| | - Nancy Prange
- (8)School of Health Studies, Northern Illinois University, DeKalb
| | | | - Kevin Sauer
- (9)Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan
| | - Marie Spiker
- Academy of Nutrition and Dietetics Foundation, Chicago, IL, and Nutritional Sciences Program and Department of Epidemiology, University of Washington, School of Public Health, Seattle
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Spiker M, Hege A, Giddens J, Cummings J, Steinmetz J, Tagtow A, Bergquist E, Burns L, Campbell C, Stadler D, Combs E, Prange N, Schwartz A, Brown K, Sauer K. Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education. Front Nutr 2021; 8:623336. [PMID: 33816539 PMCID: PMC8012755 DOI: 10.3389/fnut.2021.623336] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022] Open
Abstract
Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.
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Affiliation(s)
- Marie Spiker
- Academy of Nutrition and Dietetics Foundation, Chicago, IL, United States.,Nutritional Sciences Program and Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
| | - Amanda Hege
- Academy of Nutrition and Dietetics Foundation, Chicago, IL, United States.,Nutrition and Health Care Management, Appalachian State University, Boone, NC, United States
| | | | - Joanna Cummings
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, United States
| | - Jasia Steinmetz
- School of Health Sciences and Wellness, University of Wisconsin-Stevens Point, Stevens Point, WI, United States
| | - Angie Tagtow
- Äkta Strategies, LLC, Elkhart, IA, United States
| | - Erin Bergquist
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Lauren Burns
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, United States
| | - Christina Campbell
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Diane Stadler
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, United States
| | - Elizabeth Combs
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, United States
| | - Nancy Prange
- School of Health Studies, Northern Illinois University, DeKalb, IL, United States
| | - Aaron Schwartz
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, United States
| | - Katie Brown
- National Dairy Council, Chicago, IL, United States
| | - Kevin Sauer
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, United States
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Neff RA, Spiker M, Rice C, Schklair A, Greenberg S, Leib EB. Misunderstood food date labels and reported food discards: A survey of U.S. consumer attitudes and behaviors. Waste Manag 2019; 86:123-132. [PMID: 30770169 DOI: 10.1016/j.wasman.2019.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/22/2018] [Accepted: 01/13/2019] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Food date labels such as "best before" and "sell by" are largely unregulated in the United States (U.S.), although new voluntary standards are coming into effect. A U.S. consumer survey was performed in April 2016 to inform policy and education activities related to date labels. METHODS The survey was administered online to a nationally representative sample of 1029 adults as part of a biweekly omnibus survey. Survey questions assessed the frequency of discarding food based on date labels by food type, interpretation of label language variations, and knowledge of whether date labels are currently regulated by the federal government. RESULTS 84% of consumers discard food near the package date at least occasionally. Among date labels assessed, "best if used by" was most frequently perceived as communicating quality, and both "expires on" and "use by" as communicating safety. Over 1/3 of participants incorrectly thought that date labeling was federally regulated, and 26% more were unsure. Respondents ages 18-34 and those with misunderstanding about date labels reported discarding food based on label dates with significantly more frequency than others. CONCLUSIONS Misunderstanding the meaning of food date labels is strongly associated with reports of more frequent food discards. This survey provides new and policy-relevant insights about how Americans use and perceive date labels, and about language used in labeling that may be most effective at communicating desired messages to consumers. As date labeling becomes standardized, this research underlines the need for a strong accompanying communications campaign, and highlights a particular need to reach those ages 18-34.
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Affiliation(s)
- Roni A Neff
- Department of Environmental Health & Engineering and Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., W7010, Baltimore, MD 21205, USA.
| | - Marie Spiker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Christina Rice
- Food Law and Policy Clinic, Harvard University Law School, 1607 Massachusetts Avenue, Cambridge, MA 02138, USA.
| | - Alexandra Schklair
- National Consumers' League, 1701 K Street NW, Washington, DC 20006, USA.
| | - Sally Greenberg
- National Consumers' League, 1701 K Street NW, Washington, DC 20006, USA.
| | - Emily Broad Leib
- Food Law and Policy Clinic, Harvard University Law School, 1607 Massachusetts Avenue, Cambridge, MA 02138, USA.
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Haidari LA, Brown ST, Wedlock P, Connor DL, Spiker M, Lee BY. When are solar refrigerators less costly than on-grid refrigerators: A simulation modeling study. Vaccine 2017; 35:2224-2228. [PMID: 28364935 PMCID: PMC5548121 DOI: 10.1016/j.vaccine.2016.11.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 06/14/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gavi recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and WHO guidelines are more conservative. The question remains: Can solar refrigerators provide value where electrical outages are less frequent? METHODS Using a HERMES-generated computational model of the Mozambique routine immunization supply chain, we simulated the use of solar versus electric mains-powered refrigerators (hereafter referred to as "electric refrigerators") at different locations in the supply chain under various circumstances. RESULTS At their current price premium, the annual cost of each solar refrigerator is 132% more than each electric refrigerator at the district level and 241% more at health facilities. Solar refrigerators provided savings over electric refrigerators when one-day electrical outages occurred more than five times per year at either the district level or the health facilities, even when the electric refrigerator holdover time exceeded the duration of the outage. Two-day outages occurring more than three times per year at the district level or more than twice per year at the health facilities also caused solar refrigerators to be cost saving. Lowering the annual cost of a solar refrigerator to 75% more than an electric refrigerator allowed solar refrigerators to be cost saving at either level when one-day outages occurred more than once per year, or when two-day outages occurred more than once per year at the district level or even once per year at the health facilities. CONCLUSION Our study supports WHO and Gavi guidelines. In fact, solar refrigerators may provide savings in total cost per dose administered over electrical refrigerators when electrical outages are less frequent. Our study identified the frequency and duration at which electrical outages need to occur for solar refrigerators to provide savings in total cost per dose administered over electric refrigerators at different solar refrigerator prices.
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Affiliation(s)
- Leila A Haidari
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Shawn T Brown
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Patrick Wedlock
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Public Health Computational and Operations Research (PHICOR) and Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Diana L Connor
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Public Health Computational and Operations Research (PHICOR) and Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marie Spiker
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Public Health Computational and Operations Research (PHICOR) and Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Y Lee
- HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Public Health Computational and Operations Research (PHICOR) and Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Haidari LA, Brown ST, Ferguson M, Bancroft E, Spiker M, Wilcox A, Ambikapathi R, Sampath V, Connor DL, Lee BY. The economic and operational value of using drones to transport vaccines. Vaccine 2016; 34:4062-7. [PMID: 27340098 DOI: 10.1016/j.vaccine.2016.06.022] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [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: 01/27/2016] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immunization programs in low and middle income countries (LMICs) face numerous challenges in getting life-saving vaccines to the people who need them. As unmanned aerial vehicle (UAV) technology has progressed in recent years, potential use cases for UAVs have proliferated due to their ability to traverse difficult terrains, reduce labor, and replace fleets of vehicles that require costly maintenance. METHODS Using a HERMES-generated simulation model, we performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances reflecting variations in geography, population, road conditions, and vaccine schedules. We also identified the UAV payload and UAS costs necessary for a UAS to be favorable over a traditional multi-tiered land transport system (TMLTS). RESULTS Implementing the UAS in the baseline scenario improved vaccine availability (96% versus 94%) and produced logistics cost savings of $0.08 per dose administered as compared to the TMLTS. The UAS maintained cost savings in all sensitivity analyses, ranging from $0.05 to $0.21 per dose administered. The minimum UAV payloads necessary to achieve cost savings over the TMLTS, for the various vaccine schedules and UAS costs and lifetimes tested, were substantially smaller (up to 0.40L) than the currently assumed UAV payload of 1.5L. Similarly, the maximum UAS costs that could achieve savings over the TMLTS were greater than the currently assumed costs under realistic flight conditions. CONCLUSION Implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system. Our computational model showed that major drivers of costs savings from using UAS are road speed of traditional land vehicles, the number of people needing to be vaccinated, and the distance that needs to be traveled.
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Affiliation(s)
- Leila A Haidari
- HERMES Logistics Modeling Team, Baltimore, MD, United States; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Shawn T Brown
- HERMES Logistics Modeling Team, Baltimore, MD, United States; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Marie Ferguson
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States; Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Marie Spiker
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States; Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Ramya Ambikapathi
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States; Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Diana L Connor
- HERMES Logistics Modeling Team, Baltimore, MD, United States; Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | - Bruce Y Lee
- HERMES Logistics Modeling Team, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States; Department of International Health, Johns Hopkins University, Baltimore, MD, United States.
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