Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Query Trace: Onufrak SJ[original query] |
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A qualitative exploration of barriers, facilitators and best practices for implementing environmental sustainability standards and reducing food waste in veterans affairs hospitals
Williams BD , Pitts SJ , Onufrak SJ , Sirois E , Utech A , Wood M , Silverman J , Ajenikoko F , Murphy M , Lowry Warnock A . J Hum Nutr Diet 2024 BACKGROUND: To improve the healthfulness of foods offered while accelerating the use of environmental sustainability practices, it is important to engage hospital food service operators in the adoption of such practices. The purpose of this study was to explore barriers, facilitators and best practices for implementing environmental sustainability standards in food service among veterans affairs (VA) hospitals in the United States. METHODS: We conducted an online survey with 14 VA hospital food service directors and then 11 qualitative interviews. The survey assessed motivations for initiating sustainability standards and included a self-rating of implementation for each of five standards: increasing plant-forward dishes, procuring and serving sustainable foods that meet organic/fair trade and other certifications, procuring and serving locally produced foods, reducing food waste and reducing energy consumption. Interviews were transcribed verbatim. Qualitative analysis, including coding of themes and subthemes, was conducted by two coders to determine barriers, facilitators and best practices for each of these five standards. Quantitative methods (counts and frequencies) were used to analyse the survey data. RESULTS: Participants had an average of 5 years of experience implementing sustainability standards. The top three motivators cited were reducing food waste, serving healthier foods and increasing efficiency or cost savings. Barriers revolved around patient preferences, contractual difficulties and costs related to reducing waste. Facilitators included taste testing new recipes that include more sustainable food options and easy access to sustainable products from the prime vendor. Best practices included making familiar dishes plant-forward and plate waste studies to prevent overproduction. CONCLUSIONS: Although there were many barriers to implementation, food service directors had solutions for overcoming challenges and implementing food service sustainability standards, which can be tested in future sustainability initiatives. |
Characteristics associated with purchasing sugar-sweetened beverages and bottled water among U.S. households, 2015
Ghazaryan A , Park S , Onufrak SJ , Carlson AC , Rhone A , Roy K . J Acad Nutr Diet 2023 124 (1) 28-41 BACKGROUND: Frequent intake of sugar-sweetened beverages (SSBs) among U.S. adults is a public health concern, because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among U.S. households. OBJECTIVE: This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of U.S. households. DESIGN: This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc. [IRI]) Consumer Network Panel (CNP) data, which were merged with the USDA nutrition data using the USDA Purchase-to-Plate Crosswalk-2015 (PPC) dataset (the latest available version of the PPC at the time the study began), and the Child Opportunity Index 2.0 (COI) data. PARTICIPANTS/SETTINGS: A total of 63,610 households, representative of the contiguous U.S. population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. EXPLANATORY VARIABLES: The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. Additionally, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. MAIN OUTCOME MEASURES: Annual per capita spending (USD) on SSB and bottled water and daily per capita SSB calories purchased. STATISTICAL ANALYSIS: Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. RESULTS: Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range [IQR]: $20) per person per year on SSBs, which corresponded to 211 kcal (IQR: 125 kcal) of SSBs per person per day. About 7 in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (IQR: $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40-59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least one non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least one head had less than a high school degree, households with at least one Hispanic or married head, and households with children or those living in the Midwest. CONCLUSIONS: These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status. |
Changes in policy supports for healthy food retailers, farmers markets, and breastfeeding among US municipalities, 2014-2021: National survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS-HEAL)
Onufrak SJ , Moore LV , Pierce SL , MacGowan CA , Galuska DA . Prev Chronic Dis 2023 20 E73 INTRODUCTION: Policies and practices at the local level can help reduce chronic disease risk by providing environments that facilitate healthy decision-making about diet. METHODS: We used data from the 2014 and 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living to examine prevalence among US municipalities of policies to support access to healthier food in supermarkets, convenience stores, and farmers markets, as well as policies to support breastfeeding among government employees. Chi-square tests were conducted to compare prevalence estimates from 2021 to 2014 overall and according to municipal characteristics. RESULTS: In 2021, 29% of municipalities had at least 1 policy to encourage full-service grocery stores to open stores, which was not significantly different from 31% in 2014. Prevalence of having at least 1 policy to help corner stores sell healthier foods declined significantly from 13% in 2014 to 9% in 2021. Prevalence of policies providing all local government employees who were breastfeeding breaktime and space to pump breast milk increased significantly from 25% in 2014 to 52% in 2021. The percentage of municipalities that provided 8 or more weeks of paid maternity leave for employees increased significantly from 16% in 2014 to 19% in 2021. CONCLUSION: Prevalence of supports for supermarkets, convenience stores, and farmers markets generally did not increase among US municipalities from 2014 to 2021, while some supports for breastfeeding among municipal employees increased during this time. Opportunities exist to improve municipal-level policies that support healthy eating and breastfeeding among community residents and employees. |
Perceptions of water safety and tap water taste and their associations with beverage intake among U.S. Adults
Park S , Onufrak SJ , Cradock AL , Patel A , Hecht C , Blanck HM . Am J Health Promot 2023 37 (5) 8901171221150093 OBJECTIVES: Examine differences in perceptions of tap water (TW) and bottled water (BW) safety and TW taste and their associations with plain water (PW) and sugar-sweetened beverage (SSB) intake. DESIGN: Quantitative, cross-sectional study. SETTING: United States. SUBJECTS: 4,041 U.S. adults (≥18 years) in the 2018 SummerStyles survey data. MEASURES: Outcomes were intake of TW, BW, PW (tap and bottled water), and SSB. Exposures were perceptions of TW and BW safety and TW taste (disagree, neutral, or agree). Covariates included sociodemographics. ANALYSIS: We used chi-square analysis to examine sociodemographic differences in perceptions and multivariable logistic regressions to estimate adjusted odds ratios (AOR) for consuming TW ≤ 1 cup/day, BW > 1 cup/day, PW ≤ 3 cups/day, and SSB ≥ 1 time/day by water perceptions. RESULTS: One in 7 (15.1%) of adults did not think their home TW was safe to drink, 39.0% thought BW was safer than TW, and 25.9% did not think their local TW tasted good. Adults who did not think local TW was safe to drink had higher odds of drinking TW ≤ 1 cup/day (AOR = 3.12) and BW >1 cup/day (AOR = 2.69). Adults who thought BW was safer than TW had higher odds of drinking TW ≤1 cup/day (AOR = 2.38), BW > 1 cup/day (AOR = 5.80), and SSB ≥ 1 time/day (AOR = 1.39). Adults who did not think TW tasted good had higher odds of drinking TW ≤ 1 cup/day (AOR = 4.39) and BW > 1 cup/day (AOR = 2.91). CONCLUSIONS: Negative perceptions of TW safety and taste and a belief BW is safer than TW were common and associated with low TW intake. Perceiving BW is safer than TW increased the likelihood of daily SSB intake. These findings can guide programs and services to support water quality to improve perceptions of TW safety and taste, which might increase TW intake and decrease SSB intake. |
Factors related to water filter use for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages among U.S. Adults
Park S , Onufrak SJ , Cradock AL , Hecht C , Patel A , Chevinsky JR , Blanck HM . Am J Health Promot 2022 36 (5) 8901171211073304 OBJECTIVE: To examine factors associated with water filter use (WFU) for drinking tap water at home and its association with consuming plain water and sugar-sweetened beverages (SSBs). DESIGN: Quantitative, cross-sectional study. SETTING: The 2018 SummerStyles survey data. SUBJECTS: U.S. adults (≥18 years; N=4042). MEASURES: Outcomes were intake of plain water (tap/bottled water) and SSBs. Exposure was WFU (yes, no, not drinking tap water at home). Covariates included sociodemographics, weight status, Census regions, and home ownership status. ANALYSIS: We used multivariable logistic regressions to estimate adjusted odds ratios (AOR) and 95% confidence interval (CI) for consuming tap water, bottled water, or total plain water >3 cups/day (vs. ≤3 cups) and SSBs ≥1 time/day (vs. <1 time) by WFU. RESULTS: Overall, 36% of adults reported using a filter for drinking tap water at home; 14% did not drink tap water at home. Hispanics had significantly higher odds of using a water filter (AOR=1.50, 95% CI=1.14-1.98) vs non-Hispanic White. Factors significantly associated with lower odds of WFU were lower education (AOR=.69, 95% CI=.55-.86 for ≤high school; AOR=.78, 95% CI=.64-.95 for some college, vs college graduate), not being married (AOR=.81, 95% CI=.66-.98, vs married/domestic partnership), and lower household income (AOR=.68, 95% CI=.68-.90 for <$35,000, vs ≥$100,000). Using a water filter was associated with higher odds of drinking >3 cups/day of tap water (AOR=1.33, 95% CI=1.13-1.56) and lower odds of SSBs ≥1 time/day (AOR=.76, 95% CI=.62-.92). Not drinking tap water at home was associated with higher odds of drinking >3 cups/day bottled water (AOR=3.46, 95% CI=2.70-4.44). CONCLUSIONS: WFU was associated with higher tap water intake and lower SSB intake among U.S. adults. WFU was higher among Hispanics, but lower among those with lower education and income and not married adults. Although WFU was associated with healthful beverage habits, additional considerations for WFU may include source water quality, oral health, cost, and proper use. |
Prevalence of Municipal-Level Policies Dedicated to Transportation That Consider Food Access
Dumas BL , Harris DM , McMahon JM , Daymude TJ , Warnock AL , Moore LV , Onufrak SJ . Prev Chronic Dis 2021 18 E97 INTRODUCTION: Local governments can address access to healthy food and transportation through policy and planning. This study is the first to examine municipal-level transportation supports for food access. METHODS: We used a nationally representative sample of US municipalities with 1,000 or more persons from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (N = 2,029) to assess 3 outcomes: public transit availability, consideration of food access in transportation planning, and presence of demand-responsive transportation (DRT). We used χ(2) tests to compare prevalences by municipal characteristics including population size, rurality, census region, median educational attainment, poverty prevalence, racial and ethnic population distribution, and low-income low-access to food (LILA) status. RESULTS: Among municipalities, 33.7% reported no public transit and 14.8% reported having DRT. Both public transit and DRT differed by population size (both P < .001) and census region (both P < .001) and were least commonly reported among municipalities with populations less than 2,500 (46.9% without public transit; 6.6% with DRT) and in the South (40.0% without public transit; 11.1% with DRT). Of those with public transit, 33.8% considered food access in transportation planning; this was more common with greater population size (55.9% among municipalities of ≥50,000 persons vs 16.8% among municipalities of <2,500 persons; P < .001), in the West (43.1% vs 26.8% in the Northeast, 33.7% in the Midwest, 32.2% in the South; P = .003), and municipalities with 20% or more of the population living below federal poverty guidelines (37.4% vs 32.2% among municipalities with less than 20% living in poverty; P = .07). CONCLUSION: Results suggest that opportunities exist to improve food access through transportation, especially in smaller and Southern communities, which may improve diet quality and reduce chronic disease. |
Associations between food policy councils and policies that support healthy food access: A national survey of community policy supports
Lange SJ , Calancie L , Onufrak SJ , Reddy KT , Palmer A , Warnock AL . Nutrients 2021 13 (2) 1-13 Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of US municipalities (n = 2029), to examine the prevalence of FPCs and cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help food stores, practices to support farmers markets, transportation-related supports, and community planning documents). Overall, 7.7% of municipalities reported having a local or regional FPC. FPCs were more commonly reported among larger municipalities with ≥50,000 people (29.2%, 95% Confidence Interval (CI): 21.6, 36.8) and western region municipalities (13.2%, 95% CI: 9.6, 16.8). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of supports, compared to those without FPCs (adjusted odds ratio (aOR) range: 2.4–3.4). Among municipalities with FPCs (n = 156), 41% reported having a local government employee or elected official as a member, and 46% had a designated health or public health representative. Although FPCs were uncommon, municipalities that reported having a local or regional FPC were more likely to report having supports for healthy food access for their residents. |
Foods and beverages obtained at worksites in the United States
Onufrak SJ , Zaganjor H , Pan L , Lee-Kwan SH , Park S , Harris DM . J Acad Nutr Diet 2019 119 (6) 999-1008 BACKGROUND: Nutrition interventions are a common component of worksite wellness programs and have been recognized as an effective strategy to change employee dietary behaviors. However, little is known about worksite food behaviors or the foods that are obtained at workplaces at the national level. OBJECTIVE: The aims were to examine the frequency of and the amount of money spent obtaining foods at work among employed US adults, to determine the foods most commonly obtained at work, and to assess the dietary quality of these foods. DESIGN: This is a cross-sectional analysis of data from the US Department of Agriculture Food Acquisition and Purchasing Survey, a nationally representative household survey conducted from April 2012 through January 2013 on food purchases and acquisitions during a 7-day study period. PARTICIPANTS: The study included 5,222 employed adult Americans. MAIN OUTCOME MEASURES: The study assessed the prevalence of obtaining any foods at work overall and according to sociodemographic subgroups, number of acquisitions and calories obtained, most commonly obtained foods and leading food sources of calories, and 2010 Healthy Eating Index (HEI) scores that represent dietary quality. STATISTICAL ANALYSES PERFORMED: Prevalence estimates of obtaining >/=1 foods at work were compared according to sociodemographic characteristic using chi(2) tests. RESULTS: Nearly a quarter (23.4%) of working adults obtained foods at work during the week, and the foods they obtained averaged 1,292 kcal per person per week. The leading food types obtained included foods typically high in solid fat, added sugars, or sodium, such as pizza, regular soft drinks, cookies or brownies, cakes and pies, and candy. HEI scores suggest that work foods are high in empty calories, sodium, and refined grains and low in whole grains and fruit. CONCLUSIONS: Working adults commonly obtain foods at work, and the foods they obtain have limited dietary quality. Future research should examine the role worksites can play to help ensure access to and promote healthier options. |
Foods consumed by US adults from cafeterias and vending machines: NHANES 2005 to 2014
Onufrak SJ , Zaganjor H , Moore LV , Hamner HC , Kimmons JE , Maynard LM , Harris D . Am J Health Promot 2019 33 (5) 890117118821846 PURPOSE:: As part of wellness efforts, employers may seek to improve the nutritional quality of foods offered and consumed in cafeterias and vending machines. However, little is known about who consumes food from these venues and the types and dietary quality of the foods consumed. DESIGN:: Cross-sectional. SETTING:: Nonschool cafeterias and vending machines. PARTICIPANTS:: US adults >/=20 years old. MEASURES:: Prevalence of consuming foods, most common foods eaten, leading calorie sources, 2010 Healthy Eating Index. ANALYSIS:: Using 24-hour dietary recall data from NHANES 2005-2014 (N = 25,549 adults), we estimated the prevalence of consuming foods, assessed the most commonly consumed foods, and calculated dietary quality of foods. RESULTS:: On a given day, 3.1% of adults consumed foods from cafeterias and 3.9% from vending machines. Consumers averaged 692 kcal from cafeterias and 264 kcal from vending machines. Cafeteria consumers had higher income and education, while vending consumers were more likely to be male and younger adults. Common cafeteria foods included vegetables and fruits, but cafeteria foods were generally high in sodium and low in whole grains. Sugar-sweetened beverages and candies accounted for approximately half of all vending calories. CONCLUSION:: Foods chosen from cafeterias and vending machines do not align well with the Dietary Guidelines for Americans. Improving the dietary quality of foods consumed from these venues could impact millions of adults. |
Nutrition standards for food service guidelines for foods served or sold in municipal government buildings or worksites, United States, 2014
Onufrak SJ , Zaganjor H , Moore LV , Carlson S , Kimmons J , Galuska D . Prev Chronic Dis 2016 13 E172 INTRODUCTION: The Institute of Medicine and Centers for Disease Control and Prevention have recommended that government agencies use nutrition standards for foods and beverages sold and provided at their facilities. In this study, we examine written nutrition standards for foods sold or served in local government buildings or worksites among US municipalities. METHODS: We used data from a 2014 national survey of 1,945 municipal governments serving populations of 1,000 or more to assess the presence of written nutrition standards, the food groups or nutrients addressed by standards, and the populations served by facilities where standards are applied. The prevalence of standards was estimated by municipality population size, rural-urban status, census region, poverty prevalence, education level, and racial/ethnic composition. RESULTS: Overall, 3.2% of US municipalities reported nutrition standards with greater prevalence observed among large municipalities (12.8% of municipalities with ≥50,000 people vs 2.2% of municipalities with <2,500 people, P < .001). Prevalence differed by region, and standards were most common in the West (6.6%) and least common in the Midwest (2.0%, P = .003).The most common nutrition topics addressed in standards were offering low-calorie beverages, fruits and vegetables, and free drinking water. Most standards applied to facilities serving government employees (67%) or the general public (66%), with fewer serving institutionalized populations (23%). CONCLUSION: Few municipal governments reported having written nutrition standards for foods and beverages sold in their facilities in 2014. Implementing nutrition standards for foods sold or served by local governments is a strategy for increasing access to healthier foods and beverages among municipal employees and local residents. |
Public perception of quality and support for required access to drinking water in schools and parks
Long MW , Gortmaker SL , Patel AI , Onufrak SJ , Wilking CL , Cradock AL . Am J Health Promot 2016 32 (1) 72-74 PURPOSE: We assessed public support for required water access in schools and parks and perceived safety and taste of water in these settings to inform efforts to increase access to and consumption of tap water. DESIGN: Cross-sectional survey of the US public collected from August to November 2011. SETTING: Random digit-dialed telephone survey. PARTICIPANTS: Participants (n = 1218) aged 17 and older from 1055 US counties in 46 states. MEASURES: Perceived safety and taste of water in schools and parks as well as support for required access to water in these settings. ANALYSIS: Survey-adjusted perceived safety and taste as well as support for required access were estimated. RESULTS: There was broad support for required access to water throughout the day in schools (96%) and parks (89%). Few participants believed water was unsafe in schools (10%) or parks (18%). CONCLUSION: This study provides evidence of public support for efforts to increase access to drinking water in schools and parks and documents overall high levels of perceived taste and safety of water provided in these settings. |
Shared use agreements between municipalities and public schools in the United States, 2014
Omura JD , Carlson SA , Paul P , Sliwa S , Onufrak SJ , Fulton JE . Prev Med 2016 95 Suppl S53-S59 Shared use agreements allow public use of school facilities during non-school hours. Such agreements can cover outdoor facilities alone or may be more comprehensive by also including indoor facilities. Our aim was to: 1) estimate the prevalence of shared use agreements and facility types covered among U.S. municipalities and 2) identify differences in prevalence by municipality characteristics. The 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living is a representative survey of US municipalities (n=2029). Data were analyzed using survey weights to create national estimates. Logistic and multinomial regression models determined odds ratios adjusting for municipality characteristics. Among 1930 municipalities with a school, 41.6% had a shared use agreement as reported by a local official, 45.6% did not, and 12.8% did not know. Significant differences in prevalence existed by population size, rural/urban status, poverty prevalence, median education level, and census region; however, after adjustment for other municipality characteristics significant differences remained only by population size, median education level, and census region. Among municipalities with a shared use agreement, 59.6% covered both outdoor and indoor facilities, 5.5% covered indoor facilities only, and 34.9% covered outdoor facilities only. Opportunities exist to expand the use of shared use agreements particularly in municipalities with small populations, lower education levels, and in the South, and to promote more comprehensive shared use agreements that include both indoor and outdoor facilities. |
Worksite food and physical activity environments and wellness supports reported by employed adults in the United States, 2013
Onufrak SJ , Watson KB , Kimmons J , Pan L , Khan LK , Lee-Kwan SH , Park S . Am J Health Promot 2016 32 (1) 96-105 PURPOSE: To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size. DESIGN: Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA. SETTING: Worksites in the United States. PARTICIPANTS: A total of 2101 adults employed outside the home. MEASURES: Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments. ANALYSIS: Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size. RESULTS: Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers. CONCLUSION: Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers. |
Knowledge of sugar content of sports drinks is not associated with sports drink consumption
Zytnick D , Park S , Onufrak SJ , Kingsley BS , Sherry B . Am J Health Promot 2015 30 (2) 101-8 PURPOSE: To examine U.S. adult knowledge of the sugar content of sports drinks and whether this knowledge and other characteristics are associated with their sports drink consumption. DESIGN: Nonexperimental. SETTING: Nationally representative 2011 Summer ConsumerStyles survey data. SUBJECTS: 3929 U.S. adults. MEASURES: The outcome variable was sports drink consumption in the past 7 days. The main exposure variable was knowledge about sports drinks containing sugar. The covariates were sociodemographic characteristics, physical activity, and weight status. ANALYSIS: Multivariable logistic regression analysis was used to estimate adjusted odds ratios (ORs) for adults consuming sports drinks ≥1 times/wk after controlling for other characteristics. RESULTS: Approximately 22% of adults reported consuming sports drinks ≥1 times/wk. Most adults (71%) agreed that sports drinks contain sugar; however, this agreement was not significantly associated with adults' sports drink consumption. The odds of drinking sports drinks ≥1 times/wk were significantly higher among younger adults aged 18 to 64 years (OR range: 5.46-2.71), males (OR = 2.09), high-school graduates (OR = 1.52), and highly active adults (OR = 2.09). CONCLUSION: There were disparities in sports drink consumption by sociodemographic characteristics and physical activity level; however, knowledge of sports drinks' sugar content was not associated with consumption. Understanding why some population groups are higher consumers may assist in the development of education, providing those groups with a better understanding of sports drinks' nutritional value and health consequences of excessive sugar consumption in any form. |
Child and caregiver attitudes about sports drinks and weekly sports drink intake among U.S. youth
Zytnick D , Park S , Onufrak SJ . Am J Health Promot 2016 30 (3) e110-9 Purpose To examine caregiver and youth attitudes about sports drinks (SDs) and the association of those attitudes with youth SD intake. Design Study design was cross-sectional. The online YouthStyles survey was sent to youth (ages 12-17 years) whose caregivers completed the online Summer ConsumerStyles survey for adults. Setting The 2011 Styles survey data comprised the setting. Subjects The sample was composed of 815 U.S. caregiver-youth dyads. Measures The outcome variable is youth SD consumption, and exposure variables are youth and caregivers' attitudes that SDs are healthy for children, and caregivers' attitude that children need SDs for hydration. Covariates are youth demographic and physical activity variables. Analysis Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for youth SD consumption one or more times per week after controlling for covariates. Results About one in five youth consumed SDs one or more times per week. Caregiver attitudes about the healthfulness of SDs and children's need of SDs for hydration both significantly differed by race and caregiver education level. The odds of youth SD consumption one or more times per week were significantly higher among youth of caregivers who agreed that SDs are good, healthy drinks for children (OR, 2.72 vs. disagreed) and among youth of caregivers who agreed that children need SDs for hydration (OR, 3.15 vs. disagreed). Youth attitude about SD healthfulness was not associated with intake. Conclusion Caregivers, particularly minority and less educated caregivers, may need more education about SD use. |
Electronic health records to support obesity-related patient care: results from a survey of United States physicians
Bronder KL , Dooyema CA , Onufrak SJ , Foltz JL . Prev Med 2015 77 41-7 OBJECTIVE: Obesity-related electronic health record (EHR) functions increase the rates of measuring BMI, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related EHR functions in clinical practice and analyzes characteristics associated with increased obesity-related EHR sophistication. MATERIALS AND METHODS: Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their EHR has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related EHR sophistication. RESULTS: Of the 88% of providers with an EHR, 83% of EHRs calculate BMI, 52% calculate pediatric BMI percentile, and 32% flag patients with abnormal BMI values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated EHR include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. DISCUSSION: Few EHRs optimally supported physician's obesity-related clinical care. The low rates of obesity-related EHR functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. CONCLUSIONS: More work can be done to develop, implement, and promote the effective utilization of obesity-related EHR functions to improve obesity treatment and prevention efforts. |
A church-based pilot study designed to improve dietary quality for rural, lower Mississippi Delta, African American adults
Tussing-Humphreys LM , Thomson JL , Onufrak SJ . J Relig Health 2015 54 (2) 455-69 We piloted a 6-month, church-based, behavioral intervention, Delta Body and Soul (DBS), for African American (AA) adults in the Lower Mississippi Delta (LMD). DBS was designed to improve overall dietary quality in LMD AA adults. The intervention included six once monthly group-based educational sessions implemented by trained church members. Program implementation, session attendance, congregational feedback, and baseline and post-intervention, demographic, health, behavioral, and clinical parameters were assessed. Participants were predominately AA, female, and overweight or obese. Retention rate was 79 %. High adherence, defined as attendance at four or more educational sessions, was associated with dietary quality improvement and reduced blood glucose. Implementation of the DBS pilot intervention was feasible and may result in dietary quality and clinical improvements. |
Student-reported school drinking fountain availability by youth characteristics and state plumbing codes
Onufrak SJ , Park S , Wilking C . Prev Chronic Dis 2014 11 E60 INTRODUCTION: Caloric intake among children could be reduced if sugar-sweetened beverages were replaced by plain water. School drinking water infrastructure is dictated in part by state plumbing codes, which generally require a minimum ratio of drinking fountains to students. Actual availability of drinking fountains in schools and how availability differs according to plumbing codes is unknown. METHODS: We abstracted state plumbing code data and used the 2010 YouthStyles survey data from 1,196 youth aged 9 through 18 years from 47 states. We assessed youth-reported school drinking fountain or dispenser availability and differences in availability according to state plumbing codes, sociodemographic characteristics, and area-level characteristics. RESULTS: Overall, 57.3% of youth reported that drinking fountains or dispensers in their schools were widely available, 40.1% reported there were only a few, and 2.6% reported that there were no working fountains. Reported fountain availability differed significantly (P < .01) by race/ethnicity, census region, the fountain to student ratio specified in plumbing codes, and whether plumbing codes allowed substitution of nonplumbed water sources for plumbed fountains. "Widely available" fountain access ranged from 45.7% in the West to 65.4% in the Midwest and was less common where state plumbing codes required 1 fountain per more than 100 students (45.4%) compared with 1 fountain per 100 students (60.1%) or 1 fountain per fewer than 100 students (57.6%). CONCLUSION: Interventions designed to increase consumption of water may want to consider the role of plumbing codes in availability of school drinking fountains. |
Perceptions of tap water and school water fountains and association with intake of plain water and sugar-sweetened beverages
Onufrak SJ , Park S , Sharkey JR , Merlo C , Dean WR , Sherry B . J Sch Health 2014 84 (3) 195-204 BACKGROUND: Little is known regarding youth perceptions of tap water and school water fountains and how these relate to water and sugar-sweetened beverage (SSB) intake. METHODS: We used national 2010 YouthStyles data to assess perceptions of tap water and school water fountains and associations with water and SSB intake. RESULTS: Nearly 1 in 5 participants disagreed their tap water was safe and nearly 2 in 5 disagreed school water fountains were clean and safe. Perceived tap water risk was more prevalent among non-Hispanic (NH) Blacks (26.4%) and Hispanics (28.3%) compared with NH Whites (14.7%, p < .001) and more prevalent among lower-income youth. Negative water fountain perceptions were more common among high school-aged youth. Perceived tap water risk was not associated with SSB intake (odds ratio [OR] = 1.0, 95% confidence interval [CI]: 0.6, 1.5) or water intake (OR = 1.4, 95% CI: 0.9, 2.1). Negative water fountain perceptions were associated with SSB intake only among Hispanics (race/ethnicity interaction p < .001; OR = 2.9, 95% CI: 1.3, 6.6) but were not associated with water intake. CONCLUSION: Negative perceptions of tap water and water fountains among youth are common and should be considered in efforts to provide water in schools. |
The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults
Onufrak SJ , Park S , Sharkey JR , Sherry B . Public Health Nutr 2012 17 (1) 1-7 OBJECTIVE: Research is limited on whether mistrust of tap water discourages plain water intake and leads to a greater intake of sugar-sweetened beverages (SSB). The objective of the present study was to examine demographic differences in perceptions of tap water safety and determine if these perceptions are associated with intake of SSB and plain water. DESIGN: The study examined perceptions of tap water safety and their cross-sectional association with intake of SSB and plain water. Racial/ethnic differences in the associations of tap water perceptions with SSB and plain water intake were also examined. SETTING: Nationally weighted data from the 2010 HealthStyles Survey (n 4184). SUBJECTS: US adults aged ≥18 years. RESULTS: Overall, 13.0% of participants disagreed that their local tap water was safe to drink and 26.4% of participants agreed that bottled water was safer than tap water. Both mistrust of tap water safety and favouring bottled water differed by region, age, race/ethnicity, income and education. The associations of tap water mistrust with intake of SSB and plain water were modified by race/ethnicity (P < 0.05). Non-white racial/ethnic groups who disagreed that their local tap water was safe to drink were more likely to report low intake of plain water. The odds of consuming ≥1 SSB/d among Hispanics who mistrusted their local tap water was twice that of Hispanics who did not (OR = 2.0; 95% CI 1.2, 3.3). CONCLUSIONS: Public health efforts to promote healthy beverages should recognize the potential impact of tap water perceptions on water and SSB intake among minority populations. |
A simulation study of the potential effects of healthy food and beverage substitutions on diet quality and total energy intake in Lower Mississippi Delta adults
Thomson JL , Tussing-Humphreys LM , Onufrak SJ , Zoellner JM , Connell CL , Bogle ML , Yadrick K . J Nutr 2011 141 (12) 2191-7 The majority of adult diets in the United States, particularly the South, are of poor quality, putting these individuals at increased risk for chronic diseases. In this study, simulation modeling was used to determine the effects of substituting familiar, more healthful foods and beverages for less healthy ones on diet quality and total energy intake in Lower Mississippi Delta (LMD) adults. Dietary data collected in 2000 for 1689 LMD adults who participated in the Foods of Our Delta Study were analyzed. The Healthy Eating Index-2005 (HEI-2005) was used to measure diet quality. The effects of substituting targeted foods and beverages with more healthful items on diet quality were simulated by replacing the targeted items' nutrient profile with their replacements' profile. For the single food and beverage groups, 100% replacement of grain desserts with juice-packed fruit cocktail and sugar-sweetened beverages with water resulted in the largest improvements in diet quality (4.0 and 3.8 points, respectively) and greatest decreases in total energy intake (98 and 215 kcal/d, respectively). The 100% substitution of all food and beverage groups combined resulted in a 12.0-point increase in HEI-2005 score and a decrease of 785 kcal/d in total energy intake. Community interventions designed to improve the diet of LMD adults through the use of familiar, healthy food and beverage substitutions have the potential to improve diet quality and decrease energy intake of this health disparate population. |
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