Publications by authors named "Hannah G Lawman"

43 Publications

Association of a Sweetened Beverage Tax With Purchases of Beverages and High-Sugar Foods at Independent Stores in Philadelphia.

JAMA Netw Open 2021 Jun 1;4(6):e2113527. Epub 2021 Jun 1.

Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.

Importance: The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items.

Objective: To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores.

Design, Setting, And Participants: This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties.

Main Outcomes And Measures: Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods.

Results: Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001).

Conclusions And Relevance: This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.13527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207239PMC
June 2021

No Evidence of Food or Alcohol Substitution in Response to a Sweetened Beverage Tax.

Am J Prev Med 2021 02;60(2):e49-e57

Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Introduction: Evidence suggests real-world beverage taxes reduce sweetened beverage purchases, but it is unknown if consumers consequently increase food or alcohol purchases. This study examines whether Philadelphia's 1.5 cents/ounce beverage tax was associated with substitution to 3 kinds of hypothesized substitutes: snacks, nontaxed beverage concentrates, and alcohol.

Methods: Using commercial retail sales data and a difference-in-differences approach, analyses compared logged volume and dollar sales of snacks and beverage concentrates between 2016 (pretax) and 2017 (post-tax) at chain food retail stores in Philadelphia (n=180) and Baltimore (nontaxed control city; n=60), and logged volume and dollar sales of wine and spirits at liquor stores in Philadelphia (n=44) and nearby Pennsylvania counties (alternate control; n=66). Additional food analyses examined change in logged volume sales of hypothesized products compared to control products (other foods). Analyses were conducted in 2020.

Results: Across store types, analyses showed no statistically significant increases in logged volume or dollar sales of snacks or spirits in Philadelphia stores compared to control sites (decreased, ranging from -10% to 0%). Supermarket analyses showed substitution to nontaxed beverage concentrates (27% increase in volume, 36% increase relative to other food) but remained a relatively small percentage of overall beverage dollar sales (12% at baseline, 15% at post).

Conclusions: At the population level, there is no evidence that Philadelphia's decline in taxed beverage purchases is offset by increases in snacks or spirits purchasing, but there is evidence of substitution to beverage concentrates in supermarkets. Future studies should explore individual-level purchasing changes.
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http://dx.doi.org/10.1016/j.amepre.2020.08.021DOI Listing
February 2021

The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores.

Health Aff (Millwood) 2020 07;39(7):1130-1139

Christina A. Roberto is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.

In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore, Maryland. Our sample included 134 stores with price data and 4,584 customer purchases. Compared with Baltimore, Philadelphia experienced significantly greater increases in the price of taxed beverages (1.81 cents per ounce, or 120.4 percent of the tax) and significantly larger declines in the volume of taxed beverages sold (5.76 ounces, or 38.9 percent) after tax implementation. Beverage excise taxes may be an effective policy tool for decreasing the purchase of sweetened drinks in small independent stores, particularly among populations at higher risk for sugar-sweetened beverage consumption.
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http://dx.doi.org/10.1377/hlthaff.2019.01058DOI Listing
July 2020

One-year changes in sugar-sweetened beverage consumers' purchases following implementation of a beverage tax: a longitudinal quasi-experiment.

Am J Clin Nutr 2020 09;112(3):644-651

Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

Background: Few longitudinal studies examine the response to beverage taxes, especially among regular sugar-sweetened beverage (SSB) consumers.

Objective: This study aimed to examine changes in objectively measured beverage purchases associated with the Philadelphia beverage tax on sugar-sweetened and artificially sweetened beverages.

Methods: A longitudinal quasi-experiment was conducted with adult sugar-sweetened beverage (SSB) consumers in Philadelphia (n = 306) and Baltimore (n = 297; a nontaxed comparison city). From 2016 to 2017 participants submitted all food and beverage receipts during a 2-wk period at: baseline (pretax) and 3, 6, and 12 mo posttax (91.0% retention; data analyzed in 2019). Linear mixed effects models were used to assess the difference-in-differences in total purchased ounces (fl oz) of taxed beverages in a 2-wk period in Philadelphia compared with Baltimore. Secondary analyses: 1) excluded weeks that contained major holidays at baseline and 12 mo (42% of measured weeks at baseline and 12 mo) because policy implementation timing necessitated data collection during holidays when SSB demand may be more inelastic, and 2) aggregated posttax time points to address serial correlation and low power.

Results: There were no statistically significant changes in purchased ounces of taxed beverages in Philadelphia compared with Baltimore in the primary analysis. After excluding holiday purchasing, the tax was associated with statistically significant reductions of taxed beverage purchases at 3 and 6 mo (-157.1 ounces, 95% CI: -310.1, -4.1 and -175.1 ounces, 95% CI: -328.0, -22.3, respectively) but not 12 mo. Analyses aggregating all 6 wk of posttax time points showed statistically significant reductions (-203.7 ounces, 95% CI: -399.6, -7.8).

Conclusions: A sweetened beverage tax was not associated with reduced taxed beverage purchases among SSB consumers 12 mo posttax in the full sample. Both secondary analyses excluding holiday purchasing or aggregating posttax time periods found reductions in taxed beverage purchases ranging from -4.9 to -12.5 ounces per day. Larger longitudinal studies are needed to further understand tax effects.
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http://dx.doi.org/10.1093/ajcn/nqaa158DOI Listing
September 2020

Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers.

Prev Chronic Dis 2020 02 20;17:E15. Epub 2020 Feb 20.

School of Medicine, Stanford University, Stanford, California.

Introduction: Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp.

Methods: Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance.

Results: Results showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30-day SSB consumption frequency decreased (b = -34.8, 95% CI, -67.7 to -1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites.

Conclusion: Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
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http://dx.doi.org/10.5888/pcd17.190277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085906PMC
February 2020

Tobacco Retail Licensing and Density 3 Years After License Regulations in Philadelphia, Pennsylvania (2012-2019).

Am J Public Health 2020 04 20;110(4):547-553. Epub 2020 Feb 20.

Hannah G. Lawman, Annaka Scheeres, Amory Hillengas, and Ryan Coffman are with the Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA. Kevin A. Henry is with the Department of Geography and Urban Studies, Temple University, Philadelphia. Andrew A. Strasser is with the Tobacco Center of Regulatory Science and Department of Psychiatry, University of Pennsylvania, Philadelphia.

To evaluate changes in licensed tobacco retailers and retailer density 5 years before and 3 years after novel tobacco retailer licensing regulations were implemented in a large, urban area. We used administrative tobacco license data (n = 23 806 licenses, 2012-2019) to calculate (1) annual retailer density by district (n = 18), (2) density by district and school income status, and (3) retailers within 500 feet of schools (n = 673) before and after regulations. Observed tobacco retailer density declined by 20.3% (from 1.97 to 1.57 per 1000 daytime residents) 3 years after regulation implementation. Regression results showed a decline in the trend of retailers per 1000 daytime population (b = -0.19; 95% confidence interval[CI] = -0.23, -0.14) that was modestly but significantly greater in low-income districts (interaction b = -0.18; 95% CI = -0.25, -0.11) and a 12% decline in the rates of retailers near schools (rate ratio = 0.88; 95% CI = 0.85, 0.92) following implementation of the regulations. We did not observe similar density changes in comparable cities. Tobacco retailer licensing strategies can be an effective policy approach to reduce the availability of tobacco and tobacco marketing, lessen socioeconomic disparities in tobacco retailer density, and decrease the number of tobacco outlets near schools.
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http://dx.doi.org/10.2105/AJPH.2019.305512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067070PMC
April 2020

Online Randomized Controlled Trials of Restaurant Sodium Warning Labels.

Am J Prev Med 2019 12;57(6):e181-e193

Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Introduction: Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers' hypothetical choices, meal perceptions, and knowledge.

Study Design: Four sequential, randomized, controlled online experiments were conducted.

Setting/participants: Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk.

Intervention: Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., "sodium warning" versus "high sodium"), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016-2019.

Main Outcome Measures: The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge.

Results: In Experiments 1-3, all warning labels reduced average sodium ordered across both restaurants (by 19-81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (-68 mg, p=0.002 and -46 mg, p=0.049, respectively). Warnings also significantly increased participants' knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label.

Conclusions: Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
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http://dx.doi.org/10.1016/j.amepre.2019.06.024DOI Listing
December 2019

Association of a Beverage Tax on Sugar-Sweetened and Artificially Sweetened Beverages With Changes in Beverage Prices and Sales at Chain Retailers in a Large Urban Setting.

JAMA 2019 05;321(18):1799-1810

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Importance: Policy makers have implemented beverage taxes to generate revenue and reduce consumption of sweetened drinks. In January 2017, Philadelphia, Pennsylvania, became the second US city to implement a beverage excise tax (1.5 cents per ounce).

Objectives: To compare changes in beverage prices and sales following the implementation of the tax in Philadelphia compared with Baltimore, Maryland (a control city without a tax) and to assess potential cross-border shopping to avoid the tax in neighboring zip codes.

Design, Setting, And Participants: This study used a difference-in-differences approach and analyzed sales data to compare changes between January 1, 2016, before the tax, and December 31, 2017, after the tax. Differences by store type, beverage sweetener status, and beverage size were examined. The commercial retailer sales data included large chain store sales in Philadelphia, Baltimore, and the Pennsylvania zip codes bordering Philadelphia. These data reflect approximately 25% of the ounces of taxed beverages sold in Philadelphia.

Exposures: Philadelphia's tax on sugar-sweetened and artificially sweetened beverages.

Main Outcomes And Measures: Change in taxed beverage prices and volume sales.

Results: A total of 291 stores (54 supermarkets, 20 mass merchandise stores, 217 pharmacies) were analyzed. The mean price per ounce of taxed beverages in Philadelphia increased from 5.43 cents in 2016 to 6.24 cents in 2017 at supermarkets; from 5.28 cents to 6.24 cents at mass merchandise stores, and from 6.60 cents to 8.28 cents at pharmacies. The mean price per ounce in Baltimore increased from 5.33 cents in 2016 to 5.50 cents in 2017 at supermarkets, from 6.34 cents to 6.52 cents at mass merchandise stores, and from 6.76 cents to 6.93 cents at pharmacies. The mean per-ounce difference in price between the 2 cities was 0.65 cents (95% CI, 0.60 cents-0.69 cents; P<.001) at supermarkets; 0.87 cents (95 % CI, 0.72 cents-1.02 cents; P<.001) at mass merchandise stores, and 1.56 cents (95% CI, 1.50 cents-1.62 cents; P<.001) at pharmacies. Total volume sales of taxed beverages in Philadelphia decreased by 1.3 billion ounces (from 2.475 billion to 1.214 billion) or by 51.0% after tax implementation. Volume sales in the Pennsylvania border zip codes, however, increased by 308.2 million ounces (from 713.1 million to 1.021 billion), offsetting the decrease in Philadelphia's volume sales by 24.4%. In Philadelphia, beverage volume sales in ounces per 4-week period between before and after tax periods decreased from 4.85 million to 1.99 million at supermarkets, from 2.98 million to 1.72 million at mass merchandise stores, and from 0.16 million to 0.13 million at pharmacies. In Baltimore, the beverage volume sales in ounces decreased from 2.83 million to 2.81 million at supermarkets, from 1.05 million to 1.00 million at mass merchandise stores, and from 0.14 million to 0.13 million at pharmacies. This was a 58.7% reduction at supermarkets (difference-in-differences, -2.85 million ounces; 95% CI, -4.10 million to -1.60 million ounces; P < .001), 40.4% reduction at mass merchandise stores (difference-in-differences, -1.20 million ounces; 95% CI, -2.04 million to -0.36 million ounces; P = .001), and 12.6% reduction in pharmacies (difference-in-differences, -0.02 million ounces; 95% CI, -0.03 million to -0.01 million ounces; P < .001).

Conclusions And Relevance: In Philadelphia in 2017, the implementation of a beverage excise tax on sugar-sweetened and artificially sweetened beverages was associated with significantly higher beverage prices and a significant and substantial decline in volume of taxed beverages sold. This decrease in taxed beverage sales volume was partially offset by increases in volume of sales in bordering areas.
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http://dx.doi.org/10.1001/jama.2019.4249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518342PMC
May 2019

Association of a Beverage Tax on Sugar-Sweetened and Artificially Sweetened Beverages With Changes in Beverage Prices and Sales at Chain Retailers in a Large Urban Setting.

JAMA 2019 05;321(18):1799-1810

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Importance: Policy makers have implemented beverage taxes to generate revenue and reduce consumption of sweetened drinks. In January 2017, Philadelphia, Pennsylvania, became the second US city to implement a beverage excise tax (1.5 cents per ounce).

Objectives: To compare changes in beverage prices and sales following the implementation of the tax in Philadelphia compared with Baltimore, Maryland (a control city without a tax) and to assess potential cross-border shopping to avoid the tax in neighboring zip codes.

Design, Setting, And Participants: This study used a difference-in-differences approach and analyzed sales data to compare changes between January 1, 2016, before the tax, and December 31, 2017, after the tax. Differences by store type, beverage sweetener status, and beverage size were examined. The commercial retailer sales data included large chain store sales in Philadelphia, Baltimore, and the Pennsylvania zip codes bordering Philadelphia. These data reflect approximately 25% of the ounces of taxed beverages sold in Philadelphia.

Exposures: Philadelphia's tax on sugar-sweetened and artificially sweetened beverages.

Main Outcomes And Measures: Change in taxed beverage prices and volume sales.

Results: A total of 291 stores (54 supermarkets, 20 mass merchandise stores, 217 pharmacies) were analyzed. The mean price per ounce of taxed beverages in Philadelphia increased from 5.43 cents in 2016 to 6.24 cents in 2017 at supermarkets; from 5.28 cents to 6.24 cents at mass merchandise stores, and from 6.60 cents to 8.28 cents at pharmacies. The mean price per ounce in Baltimore increased from 5.33 cents in 2016 to 5.50 cents in 2017 at supermarkets, from 6.34 cents to 6.52 cents at mass merchandise stores, and from 6.76 cents to 6.93 cents at pharmacies. The mean per-ounce difference in price between the 2 cities was 0.65 cents (95% CI, 0.60 cents-0.69 cents; P<.001) at supermarkets; 0.87 cents (95 % CI, 0.72 cents-1.02 cents; P<.001) at mass merchandise stores, and 1.56 cents (95% CI, 1.50 cents-1.62 cents; P<.001) at pharmacies. Total volume sales of taxed beverages in Philadelphia decreased by 1.3 billion ounces (from 2.475 billion to 1.214 billion) or by 51.0% after tax implementation. Volume sales in the Pennsylvania border zip codes, however, increased by 308.2 million ounces (from 713.1 million to 1.021 billion), offsetting the decrease in Philadelphia's volume sales by 24.4%. In Philadelphia, beverage volume sales in ounces per 4-week period between before and after tax periods decreased from 4.85 million to 1.99 million at supermarkets, from 2.98 million to 1.72 million at mass merchandise stores, and from 0.16 million to 0.13 million at pharmacies. In Baltimore, the beverage volume sales in ounces decreased from 2.83 million to 2.81 million at supermarkets, from 1.05 million to 1.00 million at mass merchandise stores, and from 0.14 million to 0.13 million at pharmacies. This was a 58.7% reduction at supermarkets (difference-in-differences, -2.85 million ounces; 95% CI, -4.10 million to -1.60 million ounces; P < .001), 40.4% reduction at mass merchandise stores (difference-in-differences, -1.20 million ounces; 95% CI, -2.04 million to -0.36 million ounces; P = .001), and 12.6% reduction in pharmacies (difference-in-differences, -0.02 million ounces; 95% CI, -0.03 million to -0.01 million ounces; P < .001).

Conclusions And Relevance: In Philadelphia in 2017, the implementation of a beverage excise tax on sugar-sweetened and artificially sweetened beverages was associated with significantly higher beverage prices and a significant and substantial decline in volume of taxed beverages sold. This decrease in taxed beverage sales volume was partially offset by increases in volume of sales in bordering areas.
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http://dx.doi.org/10.1001/jama.2019.4249DOI Listing
May 2019

Unemployment claims in Philadelphia one year after implementation of the sweetened beverage tax.

PLoS One 2019 27;14(3):e0213218. Epub 2019 Mar 27.

Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.

Objectives: Possible adverse economic impacts of sweetened drink taxes are a key concern for numerous stakeholders. This study examined changes in unemployment benefit claims filings in Philadelphia compared to its neighboring counties two years prior to and 14 months post implementation of a 1.5 cents per ounce excise tax on sugar- and artificially-sweetened beverages.

Methods: Data were obtained from the Pennsylvania Department of Labor. Interrupted time series analysis was used to determine if there was a change in new monthly unemployment claims filings post-tax implementation in Philadelphia compared to surrounding counties in supermarkets, select potentially affected industries, and in total claims filings across all industries combined.

Results: Results showed there were no statistically significant changes to unemployment claims in Philadelphia compared to neighboring counties for supermarkets (ß = -9.45, 95% CI = -98.11, 79.22), soft drink manufacturers (ß = -0.13, 95% CI = -9.13, 8.88), across other potentially affected industries (ß = 9.16, 95% CI = -488.29, 506.60), or across all industries (ß = -445.85, 95% CI = -4272.39, 3380.68) following implementation of the beverage tax. Unemployment declined similarly in Philadelphia compared to surrounding counties.

Conclusions: Public reports of increased unemployment within the first year following the implementation of the Philadelphia beverage tax are not supported by this analysis. Future work should examine employment outcomes and include longer follow-up periods.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213218PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436769PMC
December 2019

A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers.

Contemp Clin Trials 2019 04 13;79:14-20. Epub 2019 Feb 13.

School of Medicine, Stanford University, Stanford, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

Introduction: Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods.

Methods: The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption.

Discussion: Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.
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http://dx.doi.org/10.1016/j.cct.2019.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499604PMC
April 2019

The Pro-Equity Potential of Tobacco Retailer Licensing Regulations in Philadelphia.

Authors:
Hannah G Lawman

Am J Public Health 2019 03;109(3):427-428

Hannah G. Lawman is with the Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, PA.

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http://dx.doi.org/10.2105/AJPH.2018.304909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366506PMC
March 2019

Title: efficacy of a food parenting intervention for mothers with low income to reduce preschooler's solid fat and added sugar intakes: a randomized controlled trial.

Int J Behav Nutr Phys Act 2019 01 17;16(1). Epub 2019 Jan 17.

Providence Health and Services, Center for Outcomes Research & Education, 5251 NE Gilsan Street, Bldg A, Portland, OR, 97213, USA.

Background: Few interventions have shown efficacy to influence key energy balance behaviors during the preschool years.

Objective: A randomized controlled trial (RCT) was used to evaluate the efficacy of Food, Fun, and Families (FFF), a 12 week authoritative food parenting intervention for mothers with low-income levels, to reduce preschool-aged children's intake of calories from solid fat and added sugar (SoFAS).

Methods: Mothers were randomly assigned to receive FFF (n = 59) or to a delayed treatment control (n = 60). The primary outcome was children's daily energy intake from SoFAS at the end of the 12 week intervention, controlling for baseline levels, assessed by 24-h dietary recalls. Secondary outcomes included children's daily energy intake, children's BMI z-scores, and meal observations of maternal food parenting practices targeted in FFF (e.g. providing guided choices).

Results: Participating mothers were predominantly African American (91%), with 39% educated beyond high school and 66% unemployed. Baseline demographics and child SoFAS intakes did not differ by group. Lost to follow-up was 13% and did not differ between groups. At post-intervention, FFF children consumed ~ 94 kcal or 23% less daily energy from SoFAS than children in the control group, adjusting for baseline levels (307.8 (95%CI = 274.1, 341.5) kcal vs. 401.9 (95%CI = 369.8, 433.9) kcal, FFF vs. control; p < 0.001). FFF mothers also displayed a greater number of authoritative parenting practices when observed post-intervention with their child at a buffet-style meal (Wilcoxon z = - 2.54, p = 0.012). Neither child total daily energy intake nor BMI z-scores differed between groups post-intervention.

Conclusions: Findings demonstrate the initial efficacy of an authoritative food parenting intervention for families with low-income to reduce SoFAS intake in early childhood. Additional research is needed to evaluate longer-term effects on diet and growth.

Trial Registration: Retrospectively registered at ClinicalTrials.gov : #NCT03646201.
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http://dx.doi.org/10.1186/s12966-018-0764-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335764PMC
January 2019

Tracking and Variability in Childhood Levels of BMI: The Bogalusa Heart Study.

Obesity (Silver Spring) 2018 07 11;26(7):1197-1202. Epub 2018 Jun 11.

Division of Cardiology, LSU Health New Orleans Medical Center, New Orleans, Louisiana, USA.

Objective: Although the tracking of BMI levels from childhood to adulthood has been examined, there is little information on the within-person variability of BMI.

Methods: Longitudinal data from 11,591 schoolchildren, 3,096 of whom were reexamined as adults, were used to explore the tracking and variability of BMI levels. This article focuses on changes in age-adjusted levels of BMI.

Results: There was strong tracking of BMI levels. The correlation of adjusted BMI levels was r = 0.88, and 78% of children with severe obesity at one examination had severe obesity at the next examination (mean interval, 2.7 years). Further, an increase in adjusted BMI from +5 kg/m (above the median) to + 10 increased the risk for adult BMI ≥ 40 by 2.7-fold. However, BMI levels among children and adolescents were variable. Over a 9- to 15-month interval, the SD of adjusted BMI change was 0.9 kg/m , and 0.7% of children had an absolute change ≥ 3.5. This variability was associated with the interval between examinations and with the initial BMI.

Conclusions: Despite the high degree of tracking of BMI, annual changes of 3.5 kg/m or more are plausible. Knowledge of this variability is important when following a child over time.
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http://dx.doi.org/10.1002/oby.22199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014905PMC
July 2018

Characteristics of tobacco purchases in urban corner stores.

Tob Control 2018 09 10;27(5):592-595. Epub 2017 Aug 10.

Weight Watchers International, New York, USA.

Introduction: To examine the prevalence and patterns of tobacco purchases at low-income, urban corner stores.

Methods: Data on tobacco products and other purchases were collected through direct observation of customers' purchases (n=6369) at 120 urban corner stores in Philadelphia, Pennsylvania, from April to September 2012.

Results: Overall 13% of corner store purchases included tobacco products. The majority (61%) of tobacco purchases did not include any other products, and 5.1% of all purchases from corner stores included a food or beverage and tobacco product. Approximately 24% of tobacco purchases were for lower-cost tobacco products such as cigars and cigarillos, and nearly 5% of tobacco purchases were an illegal purchase of a single, unpackaged tobacco product that is not intended for individual sale (ie, loosies). There was no difference in the average amount spent on food or beverages when purchased with (US$2.55, 95% CI: 2.21 to 2.88) or without (US$2.55, 95% CI: 2.48 to 2.63) tobacco products.

Conclusions: In low-income, urban corner store settings, 87% of purchases did not include tobacco; most tobacco purchases did not include the sale of non-tobacco items and spending on non-tobacco items was similar whether or not tobacco was purchased. These findings can help inform retail-level tobacco sales decisions, such as voluntary discontinuation of tobacco products or future public health policies that target tobacco sales. The results challenge prevailing assumptions that tobacco sales are associated with sales of other products in corner stores, such as food and beverages.
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http://dx.doi.org/10.1136/tobaccocontrol-2017-053815DOI Listing
September 2018

The role of obesity in the relation between total water intake and urine osmolality in US adults, 2009-2012.

Am J Clin Nutr 2016 12 9;104(6):1554-1561. Epub 2016 Nov 9.

Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD; and.

Background: Adequate water intake is critical to physiologic and cognitive functioning. Although water requirements increase with body size, it remains unclear whether weight status modifies the relation between water intake and hydration status.

Objective: We examined how the association between water intake and urine osmolality, which is a hydration biomarker, varied by weight status.

Design: NHANES cross-sectional data (2009-2012) were analyzed in 9601 nonpregnant adults aged ≥20 y who did not have kidney failure. Weight status was categorized with the use of body mass index on the basis of measured height and weight (underweight or normal weight, overweight, and obesity). Urine osmolality was determined with the use of freezing-point depression osmometry. Hypohydration was classified according to the following age-dependent formula: ≥831 mOsm/kg - [3.4 × (age - 20 y)]. Total water intake was determined with the use of a 24-h dietary recall and was dichotomized as adequate or low on the basis of the Institute of Medicine's adequate intake recommendations for men and women (men: ≥3.7 or <3.7 L; nonlactating women: ≥2.7 or <2.7 L; lactating women: ≥3.8 or <3.8 L for adequate or low intakes, respectively). We tested interactions and conducted linear and log-binomial regressions.

Results: Total water intake (P = 0.002), urine osmolality (P < 0.001), and hypohydration prevalence (P < 0.001) all increased with higher weight status. Interactions between weight status and water intake status were significant in linear (P = 0.005) and log-binomial (P = 0.015) models, which were then stratified. The prevalence ratio of hypohydration between subjects with adequate water intake and those with low water intake was 0.56 (95% CI: 0.43, 0.73) in adults who were underweight or normal weight, 0.67 (95% CI: 0.57, 0.79) in adults who were overweight, and 0.78 (95% CI: 0.70, 0.88) in adults who were obese.

Conclusion: On a population level, obesity modifies the association between water intake and hydration status.
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http://dx.doi.org/10.3945/ajcn.116.137414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392307PMC
December 2016

The role of prescription medications in the association of self-reported sleep duration and obesity in U.S. adults, 2007-2012.

Obesity (Silver Spring) 2016 10 7;24(10):2210-6. Epub 2016 Sep 7.

Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA.

Objective: Previous research has not investigated the role of prescription medication in sleep-obesity associations despite the fact that 56% of U.S. adults take at least one prescription medication.

Methods: Data from n = 16,622 adults in the National Health and Nutrition Examination Survey (2007-2012) were used to examine how the association between obesity and self-reported sleep duration varied by total number of prescription medications used in the past 30 days and by select classes of prescription medications including anxiolytics/sedatives/hypnotics, antidepressants, sleep aids, anticonvulsants, thyroid agents, and metabolic agents.

Results: Logistic regression analyses showed a significant inverse linear association of sleep duration and obesity, regardless of the total number of prescription medications individuals were taking. Each additional hour of sleep was associated with a 10% decrease in the odds of obesity. Results suggest that increased sleep duration is associated with lower odds of having obesity overall, even for long-duration sleepers (≥9 h), and this association does not differ for those taking antidepressants, thyroid agents, metabolic agents, and multiple prescription medications.

Conclusions: The relationship between sleep duration and obesity was similar among all prescription medication users and nonusers. The potential for a nonlinear association between sleep duration and obesity may be important to examine in some specific prescription medication classes.
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http://dx.doi.org/10.1002/oby.21600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467537PMC
October 2016

Reliability of 24-Hour Dietary Recalls as a Measure of Diet in African-American Youth.

J Acad Nutr Diet 2016 10 6;116(10):1551-1559. Epub 2016 Jul 6.

Background: Although it is a common practice to estimate dietary intake using three random 24-hour dietary recalls, some studies have suggested up to nine may be necessary to reliably estimate usual intake in youth. Given the resulting increase in resources and participant burden, more research is needed to determine whether this method is reliable, particularly in African-American youth at increased risk for obesity and other chronic diseases.

Objective: This study estimated the reliability with which 24-hour dietary recalls measure energy, fat, fruit, and vegetable intake in African-American youth and examined how reliability changes as a function of the number of recalls.

Design: This study used cross-sectional data collection across three studies.

Participants/setting: Participants were African-American youth (n=456, mean±standard deviation age 13.28±1.86 years, 64% were girls, mean±standard deviation body mass index [calculated as kg/m(2)] 31.45±7.94) who completed random 24-hour dietary recalls (67% completed three) conducted by research assistants using the Automated Self-Administered 24-Hour recall system (n=258) or registered dietitian nutritionists using the Nutrition Data System for Research (n=198).

Main Outcome Measures/statistical Analyses: Estimates provided by multilevel models were used to calculate the proportion of variance accounted for between individuals and the reliability of means within individuals as a function of the number of recalls.

Results: Reliability estimates for assessing dietary outcomes using one to three recalls ranged from 11% to 62%. To achieve 80% reliability, the following number of recalls would need to be conducted: 8 for energy intake, 13 for fat intake, 21 to 32 for fruit intake, and 21 to 25 for vegetable intake.

Conclusions: The common practice of assessing dietary intake with three recalls does so with low reliability in African-American youth. Until more objective methods for reliably estimating usual intake are developed, researchers who choose to use 24-hour dietary recalls are encouraged to include estimates of the measure's reliability in a priori power calculations for improved decision making regarding the number of observations and/or sample size.
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http://dx.doi.org/10.1016/j.jand.2016.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039054PMC
October 2016

Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014.

JAMA 2016 Jun;315(21):2292-9

National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, Maryland.

Importance: Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years.

Objectives: To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014.

Design, Setting, And Participants: Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys.

Exposures: Survey period.

Main Outcomes And Measures: Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted.

Results: Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87).

Conclusions And Relevance: In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.
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http://dx.doi.org/10.1001/jama.2016.6361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361521PMC
June 2016

The prevalence and validity of high, biologically implausible values of weight, height, and BMI among 8.8 million children.

Obesity (Silver Spring) 2016 05 17;24(5):1132-9. Epub 2016 Mar 17.

Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: This study assessed the prevalence and consistency of high values of weight, height, and BMI considered to be biologically implausible (BIV) using cut points proposed by WHO among 8.8 million low-income children (13.7 million observations).

Methods: Cross-sectional and longitudinal analyses were performed among 2- to 4-year-olds who were examined from 2008 through 2011.

Results: Overall, 2.7% of the body size measurements were classified as BIVs; 95% of these BIVs were very high. Among the subset of children (3.6 million) examined more than once, most of those who initially had a high weight or BMI BIV also had a high BIV at the second examination; odds ratios were >250. Based on several alternative classifications of BIVs, the current cut points likely underestimate the prevalence of obesity by about 1%.

Conclusions: Many of the extremely high values of body size currently flagged as BIVs are unlikely to be errors. Increasing the z-score cut points or using a percentage of the maximum values in the National Health and Nutrition Examination Survey, could improve the balance between removing probable errors and retaining those that are likely correct.
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http://dx.doi.org/10.1002/oby.21446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846478PMC
May 2016

Associations of Relative Handgrip Strength and Cardiovascular Disease Biomarkers in U.S. Adults, 2011-2012.

Am J Prev Med 2016 06 11;50(6):677-683. Epub 2015 Dec 11.

CDC, National Center for Health Statistics, Hyattsville, Maryland.

Introduction: Although decline in muscle mass and quality and resulting declines in muscle strength are associated with aging, more research is needed in general populations to assess the utility of handgrip strength as an indicator of muscle strength and cardiovascular disease risk.

Methods: Data from 4,221 participants aged ≥20 years in the 2011-2012 cycle of National Health and Nutrition Examination Survey were analyzed during 2014-2015. Standing isometric relative handgrip strength (calculated as maximal absolute handgrip strength from both hands divided by BMI) was used to predict cardiovascular biomarkers, including blood pressure (measured systolic and diastolic blood pressure); serum lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides); and plasma insulin and glucose.

Results: Results from regression analyses showed that higher relative grip strength was significantly associated with lower systolic blood pressure, triglycerides, and plasma insulin and glucose, and higher high-density lipoprotein cholesterol in male and female participants (p<0.05 for all). Secondary descriptive analyses found that absolute handgrip strength increased significantly with increasing weight status, but relative handgrip strength decreased significantly with increasing weight status.

Conclusions: Results suggest that increased relative handgrip strength may be associated with a better profile of cardiovascular health biomarkers among U.S. adults. Relative grip strength, which both adjusts for the confounding of mass and assesses concomitant health risks of increased body size and low muscle strength, may be a useful public health measure of muscle strength.
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http://dx.doi.org/10.1016/j.amepre.2015.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337414PMC
June 2016

Validity of the WHO cutoffs for biologically implausible values of weight, height, and BMI in children and adolescents in NHANES from 1999 through 2012.

Am J Clin Nutr 2015 Nov 16;102(5):1000-6. Epub 2015 Sep 16.

National Center for Health Statistics, CDC, Hyattsville, MD;

Background: The WHO cutoffs to classify biologically implausible values (BIVs) for weight, height, and weight-for-height in children and adolescents are widely used in data cleaning.

Objectives: We assess 1) the prevalence of these BIVs, 2) whether they were consistent with information on waist circumference, arm circumference, and leg lengths, and 3) the effect of their exclusion on the estimated prevalence of obesity in 2- to 19-y-olds in the NHANES, which is a study in which extreme values were verified when recorded.

Design: We conducted cross-sectional analyses in 26,480 children and adolescents in the NHANES from 1999-2000 through 2011-2012.

Results: The overall prevalence for a BIV for any body-size measure was 0.9% (n = 277), and almost all BIVs were due to extremely high, rather than low, values. Of 186 subjects who had a high BIV for weight or body mass index (BMI), all but one subject had both arm and waist circumferences that were greater than the sex- and age-specific 95th percentiles; 75% of subjects had circumferences greater than the 99th percentile. Of 63 subjects with a high height BIV, 75% of them had a leg length that was greater than the 95th percentile. The exclusion of children and adolescents with a BIV reduced the overall prevalence of obesity by ∼0.5 percentage points and by 1.7% in non-Hispanic blacks.

Conclusions: Most of the extremely high values of weight, height, and BMI flagged as BIVs in the NHANES are very likely correct. The increase of z score cutoffs or the use of an alternative method to detect possible errors could improve the balance between removing incorrect values and retaining extremely high, but accurate, values in other data sets.
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http://dx.doi.org/10.3945/ajcn.115.115576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631693PMC
November 2015

Muscular Grip Strength Estimates of the U.S. Population from the National Health and Nutrition Examination Survey 2011-2012.

J Strength Cond Res 2016 Mar;30(3):867-74

1National Cancer Institute, Bethesda, Maryland; 2Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland; 3University of Maryland, Maryland, Silver Spring, Maryland; 4Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York; 5Department of Kinesiology and Sport Sciences, University of South Dakota, Vermillion, South Dakota; and 6Department of Human Sciences, The Ohio State University, Columbus, Ohio.

The purposes of this study were to use the National Health and Nutrition Examination Study (2011-12) data to determine nationally representative combined handgrip strength ranges and percentile information by sex and age group, examine trends in strength across age by sex, and to determine the relative proportion of children and adults falling into established health benefit zones (HBZ). Results indicate that mean strength was greater among men than women and increased linearly for children and in a quadratic fashion among adults for both sexes. Grip strength peaked in the 30- to 39-year age group for both men (216.4 lbs) and women (136.5 lbs) with subsequent age groups showing gradual decline, p < 0.0001. Relative and absolute increases in grip strength were greater for men than for women, but relative decrease from peak strength was less among women than men. Although absolute strength was greater among men than women, HBZ data indicated that a higher percentage of men than women overall and at each age group fell into the needs improvement zone, with differences particularly pronounced during adolescence and older adulthood. These data provide the first nationally representative population estimates of combined handgrip strength and percentile information from childhood through senescence and suggest consideration of HBZ information in conjunction with grip strength to improve surveillance data interpretation and intervention planning.
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http://dx.doi.org/10.1519/JSC.0000000000001104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197498PMC
March 2016

Comparing Methods for Identifying Biologically Implausible Values in Height, Weight, and Body Mass Index Among Youth.

Am J Epidemiol 2015 Aug 15;182(4):359-65. Epub 2015 Jul 15.

As more epidemiologic data on childhood obesity become available, researchers are faced with decisions regarding how to determine biologically implausible values (BIVs) in height, weight, and body mass index. The purpose of the current study was 1) to track how often large, epidemiologic studies address BIVs, 2) to review BIV identification methods, and 3) to apply those methods to a large data set of youth to determine the effects on obesity and BIV prevalence estimates. Studies with large samples of anthropometric data (n > 1,000) were reviewed to track whether and how BIVs were defined. Identified methods were then applied to a longitudinal sample of 13,662 students (65% African American, 52% male) in 55 urban, low-income schools that enroll students from kindergarten through eighth grade (ages 5-13 years) in Philadelphia, Pennsylvania, during 2011-2012. Using measured weight and height at baseline and 1-year follow-up, we compared descriptive statistics, weight status prevalence, and BIV prevalence estimates. Eleven different BIV methods were identified. When these methods were applied to a large data set, severe obesity and BIV prevalence ranged from 7.2% to 8.6% and from 0.04% to 1.68%, respectively. Approximately 41% of large epidemiologic studies did not address BIV identification, and existing identification methods varied considerably. Increased standardization of the identification and treatment of BIVs may aid in the comparability of study results and accurate monitoring of obesity trends.
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http://dx.doi.org/10.1093/aje/kwv057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528955PMC
August 2015

Changes in quantity, spending, and nutritional characteristics of adult, adolescent and child urban corner store purchases after an environmental intervention.

Prev Med 2015 May 9;74:81-5. Epub 2014 Dec 9.

Center for Obesity Research and Education, Temple University School of Medicine, USA.

Objectives: The purpose of this study was to assess one-year changes in corner store purchases (nutritional characteristics, amount spent) of children, adolescents, and adults in a low-income urban environment before and after implementing an environmental intervention to increase the availability of healthier products.

Methods: Corner store owners were provided tools (trainings, signage, refrigeration) to increase the promotion and availability of several healthy foods. Based on the degree of support provided, stores were classified as "basic" or "high-intensity" intervention stores. Data on purchases and their nutrient content were gathered (n = 8671 at baseline, n = 5949 at follow-up) through customer purchase assessment interviews and direct observation outside of 192 corner stores in Philadelphia from March 2011 to August 2012.

Results: At baseline, shoppers spent $2.81 ± 3.52 for 643 ± 1065 kcal. Energy, select nutrients, and the total amount spent did not significantly change in the overall sample from baseline to follow-up. Similarly, there was no effect on energy and nutrient content when comparing changes over time between basic and high-intensity stores.

Conclusions: There were no significant changes in the energy or nutrient content of corner store purchases one year after implementation of environmental changes to increase the availability of healthier products.
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http://dx.doi.org/10.1016/j.ypmed.2014.12.003DOI Listing
May 2015

The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities.

Ann Behav Med 2015 Jun;49(3):398-410

Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA,

Background: The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities.

Methods: Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months.

Results: There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community.

Conclusions: Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).
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http://dx.doi.org/10.1007/s12160-014-9664-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426390PMC
June 2015

Trends in relative weight over 1 year in low-income urban youth.

Obesity (Silver Spring) 2015 Feb 30;23(2):436-42. Epub 2014 Oct 30.

Center for Obesity Research and Education, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.

Objectives: Recent cross-sectional data indicate the rates of childhood obesity are plateauing. Few large-scale longitudinal data sets exist, particularly in low-income and minority youth. The purpose of this study was to describe longitudinal changes in relative weight among a large sample of low-income, minority youth over 1 year.

Methods: Participants were students from 56 schools in urban, low-income environments. There were 17,727 first- to sixth-graders (64% African-American, 52% male) assessed at baseline, and 13,305 youth (75.1%) were reassessed 1 year later at follow-up. Measured height and weight were used to assess categorical (overweight, obesity, severe obesity) and continuous (BMI, percentile, z-score) measures of relative weight.

Results: Longitudinal data showed that over 1 year, BMI percentile (95% CI.64--0.32, P<0.001) and BMI z-score (95% CI: -0.02--0.01, P<0.001) were significantly lower compared to baseline. The prevalence of overweight and obesity was stable over 1 year. Most (86.0%) youth remained in the same weight category as baseline, 6.8% improved weight category, and 7.2% worsened weight category over 1 year.

Conclusions: These longitudinal data indicate that the relative weight of low-income, urban youth is showing signs of a small improvement over a 1-year follow-up period. The rates of childhood obesity, however, remain remarkably high and require continued, creative public health efforts.
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http://dx.doi.org/10.1002/oby.20928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348033PMC
February 2015

A multilevel approach to examining time-specific effects in accelerometer-assessed physical activity.

J Sci Med Sport 2015 Nov 6;18(6):667-72. Epub 2014 Sep 6.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, USA.

Objectives: Popular methods for analyzing accelerometer data often use a single physical activity outcome variable such as average-weekly or total physical activity. These approaches limit the types of research questions that can be answered and fail to utilize the detailed, time-specific information available from accelerometers. This study proposes the use of multilevel modeling, which tested intervention effects at specific time periods.

Design: The motivating example was the Active by Choice Today trial. Simulations were used to test whether the application of time-specific hypotheses about when physical activity intervention treatment effects were expected to occur (e.g., after-school hours) increased power to detect effects compared to traditional methods.

Methods: Six simulation conditions were tested: (1) no treatment effects (to test the type 1 error rate), (2) time-specific effects, but no traditionally-tested effects, (3) traditionally-tested effects, but no time-specific effects, and (4) combinations of traditional and time-specific effects in 3 proportions.

Results: Results showed the proposed multilevel approach demonstrated appropriate type 1 error rates and increased power to detect treatment effects during hypothesized times by 31-38 percentage points compared to traditional approaches. This was consistent across varying proportions of traditional versus time-specific effects, and there was no loss of power using the multilevel approach when only traditional effects were present.

Conclusions: The current study showed potential advantages of testing time-specific hypotheses about intervention effects using a multilevel time-specific approach. This approach may show intervention effects when traditional approaches do not. Future research should explore the application of this additional analytic tool for accelerometer physical activity estimates.
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http://dx.doi.org/10.1016/j.jsams.2014.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362866PMC
November 2015

Associations of social and environmental supports with sedentary behavior, light and moderate-to-vigorous physical activity in obese underserved adolescents.

Int J Behav Nutr Phys Act 2014 Aug 15;11:92. Epub 2014 Aug 15.

Center for Obesity Research and Education, Temple University, 3223 N, Broad Street suite 175, Philadelphia 19140, PA, USA.

Background: Evidence to support differential health impacts of sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) is building. However, few studies have examined individual, social, and environmental supports across the full range of sedentary and physical activities, including key influences such as self-efficacy, parenting factors, and home and neighborhood resources. This may be particularly important in underserved (low-income, minority), overweight/obese adolescents due to the social and environmental challenges (lack of resources, etc.) associated with increasing MVPA. This study evaluated a range of bioecological factors including individual (self-efficacy), parental (parental support, monitoring, limit-setting, and nurturance), and environmental (perceived home resources for PA and neighborhood support for PA) predictors of SB, LPA and MVPA in overweight/obese adolescents.

Methods: Overweight/obese and predominantly minority adolescents and caregivers (n = 181) completed measures in 2010 in the US including surveys assessing self-efficacy for PA, parenting variables related to PA and home and neighborhood supports for PA. Outcomes included 7-day accelerometer estimates of SB, LPA, and MVPA.

Results: Regression analyses showed parental social support and neighborhood support were significantly associated with LPA. No significant associations were found for SB or MVPA.

Conclusions: Results emphasized the importance of examining a range of sedentary and PA intensities and highlighted the role of parental and neighborhood social supports for LPA. These results have important implications that suggest that health promotion efforts should target social and environmental supports for increasing LPA in youth who are overweight/obese.
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http://dx.doi.org/10.1186/s12966-014-0092-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145237PMC
August 2014

Corner store purchases made by adults, adolescents and children: items, nutritional characteristics and amount spent.

Public Health Nutr 2015 Jun 13;18(9):1706-12. Epub 2014 Aug 13.

1Center for Obesity Research and Education,Temple University,3223 N. Broad Street,Suite 175,Philadelphia,PA 19140USA.

Objective: Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment.

Design: Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases.

Setting: Intercepts were collected at 192 corner stores in Philadelphia, PA, USA.

Subjects: Participants were adult, adolescent and child corner store shoppers.

Results: Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2.2 (sd 2.1) items (1.3 (sd 2.0) foods and 0.9 (sd 0.9) beverages) that cost $US 2.74 (sd $US 3.52) and contained 2786.5 (sd 4454.2) kJ (666.0 (sd 1064.6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65.9% of intercepts and accounted for 39.2% of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66.2 g of sugar, 921.1 mg of sodium and 2.5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy.

Conclusions: Urban corner store shoppers spent almost $US 3.00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.
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http://dx.doi.org/10.1017/S1368980014001670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720486PMC
June 2015
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