Publications by authors named "Darin J Erickson"

114 Publications

Association of Delaying School Start Time With Sleep-Wake Behaviors Among Adolescents.

J Adolesc Health 2021 Jun 5. Epub 2021 Jun 5.

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Purpose: Few adolescents spend enough time asleep on school nights. This problem could be addressed by delaying high school start times, but does this translate to reduced prevalence of sleep-wake problems like awakening too early or feeling sleepy during the day?

Methods: The START study (n = 2,414) followed a cohort of students from five Minnesota high schools to evaluate impacts of school start time delays. Participants were enrolled in ninth grade (Baseline) when all schools started early (7:30 or 7:45 a.m.). At Follow-Up 1 (10th grade) and Follow-Up 2 (11th grade), two schools had delayed their start times by 50 and 65 minutes while three comparison schools started at 7:30 a.m. Six sleep-wake behaviors were assessed at all three time points via survey. Generalized estimating equation models were used to investigate changes in sleep-wake problems between policy change and comparison schools.

Results: The prevalence of sleep-wake problems at Baseline ranged from 11% for being late to class due to oversleeping to 48% for needing to be told to wake multiple times in the morning. Compared to students from comparison schools, students at policy change schools reported smaller increases in the prevalence of feeling sleepy daily and oversleeping and being late to class between 9th and 11th grade. After implementation of the delayed start, awakening too early was more common among students at policy change schools compared to the comparison schools.

Conclusions: This longitudinal study provides evidence that delaying high school start times reduces daytime sleepiness and school tardiness.
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http://dx.doi.org/10.1016/j.jadohealth.2021.04.030DOI Listing
June 2021

Intimate partner violence and social connection among married women in rural Bangladesh.

J Epidemiol Community Health 2021 May 28. Epub 2021 May 28.

Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.

Background: Intimate partner violence (IPV) is high among married women in Bangladesh. Social isolation is a well-established correlate of women's exposure to IPV, but the role of such factors in low-income and middle-income countries is not well understood. In this study, we explore whether social connection is protective against IPV among married women in rural Bangladesh.

Methods: Data were drawn from a multistage, stratified, population-based longitudinal sample of 3355 married women in rural Bangladesh, who were surveyed on individual and contextual risk factors of IPV. Negative binomial regression models were used to estimate the association between three different domains of social connection (natal family contact, female companionship and instrumental social support), measured at baseline in 2013, and the risk of three different forms of IPV (psychological, physical and sexual), approximately 10 months later, adjusted for woman's level of education, spouse's level of education, level of household wealth, age and age of marriage.

Results: Adjusted models showed that instrumental social support was associated with a lower risk of past year psychological IPV (risk ratio (RR)=0.84, 95% CI 0.769 to 0.914), sexual IPV (RR=0.90, 95% CI 0.822 to 0.997) and physical IPV (RR=0.81, 95% CI 0.718 to 0.937). Natal family contact was also associated with a lower risk of each type of IPV, but not in a graded fashion. Less consistent associations were observed with female companionship.

Conclusion: Our findings suggest that social connection, particularly in the form of instrumental support, may protect married women in rural Bangladesh from experiencing IPV.
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http://dx.doi.org/10.1136/jech-2020-214843DOI Listing
May 2021

Evaluation of the Minnesota Safe Patient Handling Act: trends in workers' compensation indemnity claims in nursing home workers before and after enactment of the law.

Occup Environ Med 2021 01 7;78(1):22-28. Epub 2020 Sep 7.

Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.

Objectives: The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.

Methods: Workers' compensation indemnity claims for years 2005-2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.

Results: The patient handling indemnity claim rate declined by 25% in years 4-6 and 38% in years 7-9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7-9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.

Conclusions: Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.
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http://dx.doi.org/10.1136/oemed-2020-106575DOI Listing
January 2021

Longitudinal Fruit and Vegetable Sales in Small Food Retailers: Response to a Novel Local Food Policy and Variation by Neighborhood Socioeconomic Status.

Int J Environ Res Public Health 2020 07 29;17(15). Epub 2020 Jul 29.

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA.

Small food retailers, including corner/convenience stores, pharmacies, gas-marts, and dollar stores, have historically stocked limited fruits and vegetables, though this may be changing. We examined increases in sales, customer purchasing, and stocking of fresh and/or frozen fruits and vegetables in small food stores over time and in relation to: (a) a local food policy (the Minneapolis Staple Foods Ordinance) and (b) neighborhood socioeconomic status (SES). We used longitudinal data (2014-2017) from 147 randomly-sampled stores in Minneapolis/St. Paul, USA, collected using interviewer-administered manager surveys (measuring sales and stocking) and customer intercepts/observations (measuring purchasing, = 3039). The local policy required Minneapolis stores to meet minimum stocking standards for fresh/frozen produce and other healthy foods. No ordinance existed in St. Paul. Mixed regression models examined overall change over time and change by city and neighborhood SES. We observed significant increases over time ( < 0.05) in sales and purchasing of fresh fruit and in stocking of fresh fruit, frozen fruit, and frozen vegetables. We did not identify consistent statistical evidence for differential change in sales, purchasing, or stocking by city or neighborhood SES. Key study findings suggest limited differential effects of the local ordinance and/or neighborhood SES. However, findings also indicate significant time trends for some products, including consistent improvements in sales, customer purchasing, and stocking of fresh fruit. Given the ready-to-eat convenience of many fresh fruits and their broad appeal, fresh fruit appears a promising target for advancing the healthfulness of small food retailers.
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http://dx.doi.org/10.3390/ijerph17155480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432731PMC
July 2020

Changes in association between school foods and child and adolescent dietary quality during implementation of the Healthy, Hunger-Free Kids Act of 2010.

Ann Epidemiol 2020 07 3;47:30-36. Epub 2020 Jun 3.

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.

Purpose: The purposes of the study were to estimate the effect of Healthy, Hunger-Free Kids Act of 2010 (HHFKA) implementation on dietary quality of all U.S. school-aged children and adolescents and examine whether those effects differed by the demographic group.

Methods: We used survey regression on 2007-2016 National Health and Nutrition Examination Survey data to estimate the proportion of energy intake from school foods and the association between school food intake and dietary quality, before and after HHFKA passage/implementation. To account for demographic changes in the U.S. population over time, inverse probability weighting was used. The product of the proportion of energy from school foods and the association between school food intake and dietary quality estimated the effect of HHFKA implementation on dietary quality.

Results: School food intake quantity remained stable during the study period. HHFKA implementation improved students' dietary quality by 4.3 Healthy Eating Index-2010 points (95% confidence interval: 2.5, 6.1) on days when school foods were eaten and by 1.3 Healthy Eating Index-2010 points (95% confidence interval: 0.73, 1.8) averaged over all days annually.

Conclusions: HHFKA implementation improved the total dietary quality of U.S. school students. U.S. students would benefit from eating school meals in the post-HHFKA era, and HHFKA regulations should not be relaxed.
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http://dx.doi.org/10.1016/j.annepidem.2020.05.013DOI Listing
July 2020

Small food store retailers' views on healthy food retail policy in response to a local staple foods ordinance.

Public Health Nutr 2021 May 10;24(7):1934-1940. Epub 2020 Jun 10.

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.

Objective: Our objectives were to explore attitudes regarding food retail policy and government regulation among managers of small food stores and examine whether manager views changed due to the 2014 Minneapolis Staple Foods Ordinance, a city policy requiring retailers to stock specific healthy products.

Design: Manager interviewer-administered surveys were used to assess views on food retail policy four times from 2014 to 2017. We examined baseline views across manager and store and neighbourhood characteristics using cross-sectional regression analyses and examined changes over time using mixed regression models. In 2017, open-ended survey questions asked about manager insights on the Minneapolis Staple Foods Ordinance.

Setting: Minneapolis, MN, where the ordinance was enacted, and St. Paul, MN, a control community, USA.

Participants: Managers from 147 small food retail stores.

Results: At baseline, 48 % of managers were likely to support a policy requiring stores to stock healthy foods/beverages, 67·5 % of managers were likely to support voluntary programmes to help retailers stock healthy foods and 23·7 % agreed government regulation of business is good/necessary. There was a significant increase in overall support for food retail policies and voluntary programmes from 2014 to 2017 (P < 0·01); however, neither increase differed by city, suggesting no differential impact from the ordinance. Minneapolis store managers reported some challenges with ordinance compliance and offered suggestions for how local government could provide support.

Conclusions: Findings suggest that managers of small food retail stores are becoming increasingly amenable to healthy food policies; yet, challenges need to be addressed to ensure healthy food is available to all customers.
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http://dx.doi.org/10.1017/S1368980020000580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726034PMC
May 2021

Serious Mental Illness and Smoking Cessation Treatment Utilization: the Role of Healthcare Providers.

J Behav Health Serv Res 2021 01;48(1):63-76

VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.

Healthcare provider barriers to cessation resources may be undercutting quit rates for smokers with serious mental illness (SMI). The study aim was to examine how providers influence cessation treatment utilization among smokers with SMI. Data were taken from a trial conducted among smokers in Minnesota Health Care Programs. The sample was split into groups of participants with SMI (n = 939) and without SMI (n = 1382). Analyses assessed whether the association between SMI and treatment utilization was mediated by healthcare provider-delivered treatment advice and healthcare provider bias. Results revealed higher rates of treatment utilization among smokers with SMI than those without SMI (45.9% vs 31.7%, p < 0.001); treatment advice and provider bias did not mediate this association. Subsequent individual regression analyses revealed positive associations between treatment advice and treatment utilization (β 0.21-0.25, p < 0.05), independent of SMI status. Strategies to increase low-income smokers' contacts with providers may reduce treatment utilization barriers among these smokers.
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http://dx.doi.org/10.1007/s11414-020-09707-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644603PMC
January 2021

Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents.

JAMA Pediatr 2020 07;174(7):697-704

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis.

Importance: Sleep is a resource that has been associated with health and well-being; however, sleep insufficiency is common among adolescents.

Objective: To examine how delaying school start time is associated with objectively assessed sleep duration, timing, and quality in a cohort of adolescents.

Design, Setting, And Participants: This observational cohort study took advantage of district-initiated modifications in the starting times of 5 public high schools in the metropolitan area of Minneapolis and St Paul, Minnesota. A total of 455 students were followed up from grade 9 (May 3 to June 3, 2016) through grade 11 (March 15 to May 21, 2018). Data were analyzed from February 1 to July 24, 2019.

Exposures: All 5 participating schools started early (7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), 2 schools delayed their start times by 50 and 65 minutes, whereas 3 comparison schools started at 7:30 am throughout the observation period.

Main Outcomes And Measures: Wrist actigraphy was used to derive indices of sleep duration, timing, and quality. With a difference-in-difference design, linear mixed-effects models were used to estimate differences in changes in sleep time between delayed-start and comparison schools.

Results: A total of 455 students were included in the analysis (among those identifying sex, 225 girls [49.5%] and 219 boys [48.1%]; mean [SD] age at baseline, 15.2 [0.3] years). Relative to the change observed in the comparison schools, students who attended delayed-start schools had an additional mean 41 (95% CI, 25-57) objectively measured minutes of night sleep at follow-up 1 and 43 (95% CI, 25-61) at follow-up 2. Delayed start times were not associated with falling asleep later on school nights at follow-ups, and students attending these schools had a mean difference-in-differences change in weekend night sleep of -24 (95% CI, -51 to 2) minutes from baseline to follow-up 1 and -34 (95% CI, -65 to -3) minutes from baseline to follow-up 2, relative to comparison school participants. Differences in differences for school night sleep onset, weekend sleep onset latency, sleep midpoints, sleep efficiency, and the sleep fragmentation index between the 2 conditions were minimal.

Conclusions And Relevance: This study found that delaying high school start times could extend adolescent school night sleep duration and lessen their need for catch-up sleep on weekends. These findings suggest that later start times could be a durable strategy for addressing population-wide adolescent sleep deficits.
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http://dx.doi.org/10.1001/jamapediatrics.2020.0344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186915PMC
July 2020

Occupational differences in workers' compensation indemnity claims among direct care workers in Minnesota nursing homes, 2005-2016.

Am J Ind Med 2020 06 13;63(6):517-526. Epub 2020 Mar 13.

Division of Environmental Health Sciences, School of Public Health, University of Minnesota Twin Cities, Minneapolis-Saint Paul, Minnesota.

Background: Nursing assistants have one of the highest injury rates in the U.S., but few population-based studies assess differential injury risk by occupation in nursing homes. This statewide study assessed differences in musculoskeletal disorders (MSDs) and patient handling injuries among direct care workers in Minnesota nursing homes.

Methods: Indemnity claims from the Minnesota workers' compensation database were matched to time at risk from the Minnesota Nursing Home Report Card to estimate 2005 to 2016 injury and illness claim rates for certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Associations between occupation and claim characteristics were assessed using multivariable regression modeling.

Results: Indemnity claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers for CNAs, LPNs, and RNs, respectively. Patient handling injuries comprised 62% of claims. Compared to RNs, CNAs had higher odds of an indemnity claim resulting from an MSD (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.31-2.14) or patient handling injury (OR = 1.89; 95% CI, 1.47-2.45) as opposed to another type of injury or illness. CNAs had lower odds of receiving temporary and permanent partial disability benefits and higher odds of receiving a stipulation settlement.

Conclusions: CNAs in Minnesota nursing homes are at heightened risk for lost time MSDs and patient handling injuries. Claims filed by CNAs are more frequently settled outside the regular workers' compensation benefit structure, an indication that the workers' compensation system is not providing adequate and timely benefits to these workers.
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http://dx.doi.org/10.1002/ajim.23102DOI Listing
June 2020

Store and neighborhood differences in retailer compliance with a local staple foods ordinance.

BMC Public Health 2020 Feb 4;20(1):172. Epub 2020 Feb 4.

Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA.

Background: Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics.

Methods: In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018.

Results: All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics.

Conclusions: Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance.

Study Registration: ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.
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http://dx.doi.org/10.1186/s12889-020-8174-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001202PMC
February 2020

The START study: An evaluation to study the impact of a natural experiment in high school start times on adolescent weight and related behaviors.

Obs Stud 2020 7;6:66-86. Epub 2020 Feb 7.

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA.

Background: Research has shown that early high school start times, which are asynchronous with adolescent biology, are one of the most significant obstacles to youth being able to net sufficient sleep. Given that adolescence is a critical period that sets the stage for long-term obesity risk behavior patterns, there is an need to understand the obesity-related implications of increased sleep as a result of intervention and policy changes.

Methods: We evaluated a community-based natural experiment in school start time policy modification when several Minneapolis-St. Paul, MN metro area school districts shifted to later school start times in Fall 2016. We collected data on student weight and related risks (via paper survey, objective weight and height measurement, dietary recall, and sleep actigraphy) before and after two districts (two high schools) shifted their start times later and in a comparison district (three high schools) which kept their start times early (7:30am) through the course of the study. Our specific aims were: 1) Determine how a shift to a later high school start time relates to objectively measured weight change over time. 2) Identify the relationship between school start times and obesity-related behaviors over time.At baseline we had 2,133 returned surveys (93% participation) and 2,037 (86% participation) objective height/weight measurements from 9 grade students (class of 2019) in the five schools. The sample was 87.7% white, 12.8% reported qualifying for free/reduced price lunch (a measure of lower socio-economic status), and the mean age was 15.2 (SD=0.35) years.

Discussion: The products of this research will clarify causal connections between sleep and obesity among adolescents as well as provide evidence for whether a school start time policy can minimize unhealthy weight gain.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109619PMC
February 2020

Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores.

J Hunger Environ Nutr 2019 23;14(6):741-761. Epub 2018 Nov 23.

University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454.

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.
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http://dx.doi.org/10.1080/19320248.2018.1549518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886741PMC
November 2018

Correlates of short sleep duration among adolescents.

J Adolesc 2019 12 15;77:163-167. Epub 2019 Nov 15.

Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, USA.

Introduction: Short sleep duration is exceedingly common among adolescents and has implications for healthy youth development. We sought to document associations between adolescents' sleep duration and characteristics of their schedules, behaviors, and wellbeing.

Methods: We used data from the baseline wave (9th grade year) of the START study, a cohort of 2134 students in five Minnesota high schools to assess how self-reported sleep duration was associated with the prevalence of time-use characteristics (i.e. activity schedules, screen use), sleep-wake problems (i.e. trouble waking in the morning, falling asleep in class, etc.), and risk of depression.

Results: Shorter sleep duration was associated with various behaviors including greater computer/screen time and screen use after bed, a lower probability of doing homework, participation in sports doing chores on school nights, and reporting that it takes at least 20 min to fall asleep on school days (p < 0.05). Suboptimal sleep duration was also associated with a higher probability of all reported sleep-wake problems as well as higher risk of depressive symptoms (p < 0.05).

Conclusions: Given that getting an optimal amount of sleep can protect youth from risk and promote healthy youth development, it is critical that we gain a greater understanding of correlates and consequences of short sleep duration in order to develop a sleep-friendly culture for youth.
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http://dx.doi.org/10.1016/j.adolescence.2019.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015268PMC
December 2019

College Climate and Sexual Orientation Differences in Weight Status.

Prev Sci 2020 04;21(3):422-433

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA.

Previous research has identified significant sexual orientation disparities in obesity. Contextual factors, like lack of anti-discrimination policies and gay-straight alliances, have been shown to be associated with health outcomes like poor mental health and substance use for lesbian, gay, and bisexual (LGB) individuals moreso than their heterosexual counterparts; however, little work to date has explored the role of contextual factors on sexual orientation disparities in obesity. Individual-level, serial cross-sectional data from the 2009-2013 College Student Health Survey, which includes 2- and 4-year college students (n = 29,118) attending 46 Minnesota colleges, were used. College-level data on LGB context were primarily collected through college websites. Multinomial logistic regression models were fit to examine associations between LGB college climate scores (including non-discrimination policies, presence of LGB or diversity-related student groups, LGB courses offered, LGB housing accommodations, and prevalence of LGB students) and students' weight status (underweight, healthy weight, overweight, and obese), based on self-reported height and weight. Higher LGB climate scores (i.e., more supportive environments) were associated with lower risk of overweight and obesity among all students. Sexual orientation-stratified findings among female students suggested that the association between LGB climate scores and weight status was similar to the overall female sample. Sexual orientation-stratified findings among male students showed a more complex relationship between LGB climate scores and weight status. More work is needed to disentangle the observed associations, and to investigate other contextual factors, like state- and city-level policies, social networks and norms, and individual resiliency within these contexts to better understand the contextual influences on sexual orientation disparities in obesity.
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http://dx.doi.org/10.1007/s11121-019-01061-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058494PMC
April 2020

Evaluation of the first U.S. staple foods ordinance: impact on nutritional quality of food store offerings, customer purchases and home food environments.

Int J Behav Nutr Phys Act 2019 09 18;16(1):83. Epub 2019 Sep 18.

School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454, USA.

Background: Many lower-income and racially diverse communities in the U.S. have limited access to healthy foods, with few supermarkets and many small convenience stores, which tend to stock limited quantities and varieties of healthy foods. To address food access, in 2015 the Minneapolis Staple Foods Ordinance became the first policy requiring food stores to stock minimum quantities and varieties of 10 categories of healthy foods/beverages, including fruits, vegetables, whole grains and other staples, through licensing. This study examined whether: (a) stores complied, (b) overall healthfulness of store environments improved, (c) healthy customer purchases increased, and (d) healthfulness of home food environments improved among frequent small store shoppers.

Methods: Data for this natural (or quasi) experiment were collected at four times: pre-policy (2014), implementation only (no enforcement, 2015), enforcement initiation (2016) and continued monitoring (2017). In-person store assessments were conducted to evaluate food availability, price, quality, marketing and placement in randomly sampled food retailers in Minneapolis (n = 84) and compared to those in a nearby control city, St. Paul, Minnesota (n = 71). Stores were excluded that were: supermarkets, authorized through WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), and specialty stores (e.g., spice shops). Customer intercept interviews were conducted with 3,039 customers exiting stores. Home visits, including administration of home food inventories, were conducted with a sub-sample of frequent shoppers (n = 88).

Results: Overall, findings indicated significant improvements in healthy food offerings by retailers over time in both Minneapolis and St. Paul, with no significant differences in change between the two cities. Compliance was low; in 2017 only 10% of Minneapolis retailers in the sample were fully compliant, and 51% of participating Minneapolis retailers met at least 8 of the 10 required standards. Few changes were observed in the healthfulness of customer purchases or the healthfulness of home food environments among frequent shoppers, and changes were not different between cities.

Conclusions: This study is the first evaluation a local staple foods ordinance in the U.S. and reflects the challenges and time required for implementing such policies.

Trial Registration: NCT02774330 .
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http://dx.doi.org/10.1186/s12966-019-0818-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751624PMC
September 2019

Supportive Community Resources Are Associated with Lower Risk of Substance Use among Lesbian, Gay, Bisexual, and Questioning Adolescents in Minnesota.

J Youth Adolesc 2020 Apr 24;49(4):836-848. Epub 2019 Aug 24.

Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.

Research has indicated that lesbian, gay, bisexual, and queer/questioning (LGBQ) adolescents have disproportionately high rates of substance use compared to heterosexual peers; yet certain features of schools and communities have been associated with lower substance use rates in this population. To advance this field, research examining multiple levels of influence using measures developed with youth input is needed. With community, school, and student data, this study tested hypotheses that LGBQ students attending high schools and living in communities with more LGBQ-supportive environments (assessed with a novel inventory tool) have lower odds of substance use behaviors (cigarette smoking, alcohol use, marijuana use, prescription drug misuse, and other drug use) than their peers in less supportive LGBQ environments. Multilevel models using data from 2454 LGBQ students (54.0% female, 63.9% non-Hispanic white) in 81 communities and adjusting for student and school covariates found that LGBQ adolescents who lived in areas with more community support had lower odds of frequent substance use, particularly among females. Expanding and strengthening community resources (e.g., LGBQ youth-serving organizations, LGBQ events such as a Pride parade, and LGBQ-friendly services) is recommended to further support LGBQ adolescents and reduce substance use disparities.
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http://dx.doi.org/10.1007/s10964-019-01100-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036329PMC
April 2020

Proactive outreach tobacco treatment for socioeconomically disadvantaged smokers with serious mental illness.

J Behav Med 2020 06 30;43(3):493-502. Epub 2019 Jul 30.

VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA.

Smokers with serious mental illness (SMI) face individual, interpersonal, and healthcare provider barriers to cessation treatment utilization and smoking abstinence. Proactive outreach strategies are designed to address these barriers by promoting heightened contact with smokers and facilitating access to evidence-based treatments. The present study examined the effect of proactive outreach among smokers with SMI (n = 939) who were enrolled in the publicly subsidized Minnesota Health Care Programs (MHCP) and compared this effect to that observed among MHCP smokers without SMI (n = 1382). Relative to usual care, the intervention increased treatment utilization among those with SMI (52.1% vs 40.0%, p = 0.002) and without SMI (39.3% vs 25.4%, p < 0.001). The intervention also increased prolonged smoking abstinence among those with SMI (14.9% vs 9.4%, p = 0.010) and without SMI (17.7% vs 13.6%, p = 0.09). Findings suggest that implementation of proactive outreach within publicly subsidized healthcare systems may alleviate the burden of smoking in this vulnerable population. Trial Registration ClinicalTrials.gov identifier: NCT01123967.
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http://dx.doi.org/10.1007/s10865-019-00083-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525931PMC
June 2020

The LGBTQ Supportive Environments Inventory: Methods for Quantifying Supportive Environments for LGBTQ Youth.

J Gay Lesbian Soc Serv 2019 17;31(3):314-331. Epub 2019 Jun 17.

University of Minnesota, Division of General Pediatrics and Adolescent Health, 717 Delaware St. SE, Minneapolis, MN, 55414, USA.

The social environment in which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth live influences health and wellbeing. We describe the development of the LGBTQ Supportive Environments Inventory (LGBTQ SEI), designed to quantify the LGBTQ-inclusiveness of social environments in the US and Canada. We quantify aspects of the social environment: 1) Presence/quality of LGBTQ youth-serving organizations; 2) LGBTQ-inclusive Community Resources; 3) Socioeconomic and Political environment. Using GIS tools, we aggregated data to buffers around 397 schools in 3 regions. The LGBTQ SEI can be used to assess the role of the social environment in reducing health disparities for LGBTQ youth.
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http://dx.doi.org/10.1080/10538720.2019.1616023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6640865PMC
June 2019

Sleep Duration and Weight-Related Behaviors among Adolescents.

Child Obes 2019 10 10;15(7):434-442. Epub 2019 Jul 10.

Department of Organizational Leadership, Policy, and Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN.

Insufficient sleep is widespread among adolescents and has consequences that extend far beyond hampering day-to-day functioning. It may influence eating and physical activity patterns and be an important determinant of adolescent overweight/obesity status. We assessed how self-reported sleep duration on school nights was associated with weight-related behaviors (eating, diet, and physical activity) and overweight/obesity at the baseline wave (ninth grade year) of the START study ( = 2134). Fifteen percent of our sample reported optimal sleep duration (8.5-10.0 hours); nonwhites, participants of lower socioeconomic status, and girls were at greater risk for insufficient sleep. Suboptimal sleep was associated with various poor weight-related behaviors such as increased sugar-sweetened beverage consumption, decreased vegetable consumption, and decreased breakfast eating ( < 0.001). Fewer hours of sleep were also associated with less physical activity and an increased likelihood of obesity ( = 0.02 for both associations). The influence of adolescent sleep insufficiency on diet and activity could impact childhood obesity and following chronic disease risk especially if lack of sleep sets the stage for enduring, lifelong, poor, weight-related behavior patterns.
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http://dx.doi.org/10.1089/chi.2018.0362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761589PMC
October 2019

What Affects College Students' Decision to Intervene or Not Intervene When Someone Is Drinking Too Much?

J Stud Alcohol Drugs 2019 05;80(3):310-313

Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Objective: Medical amnesty policies aim to encourage individuals to help their peers who have been drinking too much by providing immunity for alcohol policy violations. We examined college students' decisions to intervene or not intervene when someone was drinking too much and reasons for not intervening.

Method: We conducted secondary analyses using data from college students ages 18-25 who participated in the Healthy Minds Study, a national survey of mental health and substance use (N = 30,785; 65% female). We examined the prevalence of reasons for not intervening and estimated a multilevel multinomial logistic regression to answer our research questions.

Results: Nearly half (46.5%) of students reported being in at least one situation in the past year when someone was drinking too much. Among these students, 46.7% consistently intervened, 27.7% inconsistently intervened, and 25.6% did not intervene in these situations. The most common reasons for not intervening were: "I felt it was none of my business" and "I didn't know what to do." "I was afraid I'd get in trouble" was the least common reason for not intervening. Intervening differed by student characteristics, including age, gender, race/ethnicity, residence, international student status, and binge drinking.

Conclusions: Fear of getting in trouble, the basis for amnesty policies, was not a major barrier preventing intervention behavior in our study. Our findings suggest that implementing amnesty policies may not lead to intervention behavior. Strategies that empower and compel students to help their peers and provide them with skills needed to help may lead to more intervention behavior.
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May 2019

Variation in the food environment of small and non-traditional stores across racial segregation and corporate status.

Public Health Nutr 2019 06 8;22(9):1624-1634. Epub 2019 Mar 8.

1Division of Epidemiology and Community Health,School of Public Health,University of Minnesota,1300 South 2nd Street,Minneapolis,MN 55454,USA.

Objective: We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned).

Design: Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.

Setting: Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.ParticipantsOne hundred and thirty-nine stores; seventy-eight managers.

Results: Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (<30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05).

Conclusions: Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.
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http://dx.doi.org/10.1017/S1368980019000132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494699PMC
June 2019

The relationship between smoking cessation and binge drinking, depression, and anxiety symptoms among smokers with serious mental illness.

Drug Alcohol Depend 2019 01 2;194:128-135. Epub 2018 Nov 2.

Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR and D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA.

Introduction: Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI.

Methods: The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups.

Results: Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI.

Conclusion: Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.08.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363348PMC
January 2019

Law enforcement practices in the first two states in U.S. to legalize recreational marijuana.

Int J Drug Policy 2018 11 26;61:38-43. Epub 2018 Oct 26.

Division of Epidemiology and Community Health School of Public Health, University of Minnesota, United States.

Background: There is a lack of research regarding law enforcement practices where recreational marijuana sales are legal. Given that legalization of recreational marijuana is expanding, lessons learned from areas with existing legalization can help inform future practices. This pilot study is an evaluation of enforcement of marijuana laws in the first two states in the U.S. to legalize sales of recreational marijuana, Colorado and Washington, several years post legalization.

Methods: We surveyed a random sample of local law enforcement agencies in the two states (25 agencies per state). We also attempted to survey the state-level marijuana enforcement agency but only Washington responded. Surveys focused on youth marijuana use, youth access to marijuana, and impaired driving but included other topics. Chi-square tests assessed differences between states (p < .05).

Results: All local agencies reported underage use was somewhat or very common in their jurisdictions. Thirty percent of local agencies conducted enforcement targeting underage use/possession. Twenty percent of agencies overall conducted underage compliance checks at licensed stores, with more agencies conducting checks in Colorado (32%) than Washington (8%; p = .03). Most agencies in both states reported marijuana-impaired driving was somewhat or very common in their jurisdictions. One local agency in each state specifically targeted marijuana-impaired driving. The state-level agency in Washington reported that their agency is the one primarily responsible for enforcing marijuana retail laws and they conducted routine underage compliance checks at all licensed marijuana stores three times per year.

Conclusion: Our findings indicate that marijuana enforcement can be improved regarding sales/provision to underage youth and impaired driving in these states, particularly given that underage use and impaired driving are perceived to be common. Larger studies with additional jurisdictions and types of agencies (e.g., highway patrol) are warranted.
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http://dx.doi.org/10.1016/j.drugpo.2018.08.018DOI Listing
November 2018

Alcohol Service Practices: A Survey of Bar and Restaurant Managers.

J Drug Educ 2016 Dec 11;46(3-4):64-81. Epub 2017 Aug 11.

1 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA.

Excessive alcohol consumption can result from illegal sales to intoxicated patrons at bars and restaurants. We surveyed bar/restaurant managers about their practices in reducing illegal sales to intoxicated patrons. We found that managers were confident that they could refuse service to intoxicated customers but were less likely to have communicated necessary information to their staff on how to refuse such sales. Managers who agreed that a business in their community would be cited for overservice were more likely to be confident that they could handle customers who had been cut off from alcohol service. Our study suggests that bar/restaurant managers may need training to improve their communication with staff and that increased enforcement may lead to an increase in manager confidence in handling intoxicated patrons.
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http://dx.doi.org/10.1177/0047237917724408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877466PMC
December 2016

Trajectories of Cigarette Smoking From Teens to Young Adulthood: 2000 to 2013.

Am J Health Promot 2018 06 6;32(5):1214-1220. Epub 2017 Mar 6.

1 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

Purpose: To identify trajectories of smoking behaviors of a cohort of youth followed through young adulthood from 2000 to 2013.

Design: The Minnesota Adolescent Community Cohort study, a population-based cohort study.

Setting: Nationwide, originating in the Midwestern United States.

Participants: Cohort of youth surveyed for 14 years beginning at ages 12 to 16 (N = 4241 at baseline; 59% recruitment rate).

Measures: Main variable of interest was the number of days smoked in the past 30 days. Also included time-varying and time-invariant covariates.

Analysis: We utilized growth mixture modeling to group individuals into trajectories over time.

Results: We identified 5 distinct trajectories: nonsmokers (59.5%), early-onset regular smokers (14.2%), occasional smokers (11.5%), late-onset regular smokers (9.4%), and quitters (5.3%). Adjusted models showed that early- and late-onset regular smokers (compared to nonsmokers) had lower odds of attending or graduating from a 4-year college ( P < .05). Participants in all smoking classes compared to nonsmokers had greater odds of having more close friends who smoked ( P < .05).

Conclusion: Our results show that individuals in their teens through young adulthood can be classified into 5 smoking trajectories. More people in this age range remained abstainers than found in most previous studies; however, a sizable group was identified as regular smokers by the time they reached young adulthood. Interventions targeted at teens, including those that address social and environmental influences, are clearly still needed to prevent escalation of smoking as they move toward young adulthood.
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http://dx.doi.org/10.1177/0890117117696358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725264PMC
June 2018

Changes in alcohol policies and practices in bars and restaurants after completion of manager-focused responsible service training.

Drug Alcohol Rev 2018 03 19;37(3):356-364. Epub 2017 Nov 19.

School of Public Health, University of Minnesota, Minneapolis, USA.

Introduction And Aims: Irresponsible and illegal serving practices at bars and restaurants, such as sales to obviously intoxicated patrons, can lead to various public health harms. Training managers of bars and restaurants in the development and promotion of responsible alcohol policies may help prevent risky and illegal alcohol serving practices.

Design And Methods: We implemented a training program for managers of bars/restaurants designed to establish and promote responsible beverage service policies/practices. The program included online and in-person components. Bars/restaurants were randomised to intervention (n = 171) and control (n = 163) groups. To assess changes in policies/practices, we surveyed managers prior to and at 1 and 6 months post-training. Logistic regression models assessed changes in policies/practices across time points.

Results: The proportion in the intervention group that had written alcohol policies increased from 62% to 95% by 6 months post-training while the control group increased from 65% to 79% (P < 0.05). Similarly, by 6 months post-training 70% of managers in the intervention group reported they had communicated to their staff how to cut off intoxicated patrons, a significant increase from baseline (37%) and from the change observed in the control group (43%-56%). Prevalence of other policies/practices also increased post-training but differences between intervention and control groups were not statistically significant.

Discussion And Conclusions: Our training program appears to have led to implementation of some policies/practices. Additional studies are needed to determine how training can be combined with other strategies to further improve establishment policies and ultimately reduce alcohol-related harms.
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http://dx.doi.org/10.1111/dar.12629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839952PMC
March 2018

Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT.

Addict Behav 2018 03 2;78:43-50. Epub 2017 Nov 2.

University of Utah, Department of Family and Preventive Medicine, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA. Electronic address:

Introduction: In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics.

Methods: Homeless smokers (n=430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group.

Results: Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites.

Conclusions: White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.
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http://dx.doi.org/10.1016/j.addbeh.2017.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783755PMC
March 2018

Pricing of Staple Foods at Supermarkets versus Small Food Stores.

Int J Environ Res Public Health 2017 08 15;14(8). Epub 2017 Aug 15.

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA.

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10-54% more expensive in smaller stores than in supermarkets ( < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.
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http://dx.doi.org/10.3390/ijerph14080915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580618PMC
August 2017

Cessation-related weight concern among homeless male and female smokers.

Prev Med Rep 2017 Sep 20;7:77-85. Epub 2017 May 20.

University of Minnesota, Program in Health Disparities Research, 717 Delaware St. SE Suite 166, Minneapolis, MN 55414, USA.

Concern about post-cessation weight gain is a barrier to making attempts to quit smoking; however, its effect on smoking cessation is unclear. In this study we examine cessation-related weight concern among the homeless, which hasn't been studied. Homeless males (n = 320) and females (n = 110) participating in a smoking cessation RCT in the Twin Cities, Minnesota from 2009 to 2011 completed surveys on cessation-related weight concern, smoking status, and components from the Behavioral Model for Vulnerable Populations. Generalized estimating equations were used to examine baseline predictors of cessation-related weight concern at baseline, the end of treatment, and 26-weeks follow-up. Logistic regression models were used to examine the relationship between cessation-related weight concern and smoking status at the end of treatment and follow-up. Females had higher cessation-related weight concern than males. Among males, older age, Black race, higher BMI, depression, and having health insurance were associated with higher cessation-related weight concern. Among females, nicotine dependence, greater cigarette consumption, indicating quitting is more important, older age of smoking initiation, and less support to quit from family were associated with higher cessation-related weight concern. In multivariate analyses, cessation-related weight concern decreased over time among females. Cessation-related weight concern wasn't associated with smoking cessation. Although several types of characteristics predicted cessation-related weight concern among males, only smoking characteristics predicted cessation-related weight concern among females. Given the small proportion of quitters in this study (8% of males and 5% of females), further research on the impact of cessation-related weight concern on smoking cessation among the homeless is warranted.
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http://dx.doi.org/10.1016/j.pmedr.2017.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458131PMC
September 2017

Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores.

Int J Behav Nutr Phys Act 2017 06 5;14(1):76. Epub 2017 Jun 5.

Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, 55454, USA.

Background: Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases.

Methods: In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type.

Results: Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2-12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases.

Conclusions: Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases.

Trial Registration: ClinialTrials.gov: NCT02774330 . Registered May 4, 2016 (retrospectively registered).
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http://dx.doi.org/10.1186/s12966-017-0531-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460502PMC
June 2017