Background-The purpose of this cross-sectional study was to examine the psychometric properties o... more Background-The purpose of this cross-sectional study was to examine the psychometric properties of two adapted SRQ measures assessing youth with type 1 diabetes motivation internalization for healthful eating and their parents motivation internalization for providing healthy meals for the family. Methods-External validity of the adapted SRQ was evaluated with respect to healthy eating attitudes (healthful eating self-efficacy, barriers, and outcome expectations) assessed by questionnaire, diet quality (Healthy Eating Index-2005, HEI-2005; Nutrient-Rich Foods Index 9.3, NRF9.3; Whole Plant Food Density, WPFD) assessed by 3-day food records, and BMI assessed by measured height and weight in youth with type 1 diabetes (N=136, age 12.3±2.5 years) and their parents. Results-Exploratory factor analysis with varimax rotation yielded a two-factor structure with the expected autonomous and controlled motivation factors for both youth and parents. Internal consistencies of subscales were acceptable (α=0.66-0.84). Youth autonomous and controlled motivation were positively correlated overall (r=0.30, p<0.001); however, in analyses stratified by age (<13 vs. ≥13y), the correlation was not significant for youth ≥13y. Autonomous motivation
American Journal of Preventive Medicine, Dec 1, 2015
Introduction-Youth with Type 1 diabetes and lower family income typically have poorer glycemic co... more Introduction-Youth with Type 1 diabetes and lower family income typically have poorer glycemic control. This post hoc analysis examines whether a family-oriented behavioral intervention for this population is differentially effective across income levels. Methods-Families of youth aged 9-15 years with Type 1 diabetes (N=390; 49.2% female; age, 12.4 [1.7] years; hemoglobin A1c [HbA1c], 8.4 [1.2]; pump, 33.8%) at four U.S. pediatric endocrinology clinics participated in a 2-year RCT (data collected 2006-2011) of a clinicintegrated behavioral intervention designed to improve diabetes management by facilitating problem-solving skills, communication skills, and responsibility sharing. HbA1c was analyzed centrally.
Aims-To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL gene... more Aims-To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL general and diabetes-specific quality of life (QOL) measures regarding psychometric properties and relations to relevant outcomes. Methods-The instruments were completed by 447 children age 9 to 15.5 with type 1 diabetes >1 year from four US paediatric diabetes clinics; parents completed the parallel parent-proxy measures. Principal components factor analysis was used to examine the factor structure of the PedsQL diabetes module. Analyses of the generic and diabetes QOL measures included psychometric properties, parent-child correlations, and correlations with depression, adherence, and A1c. Results-The factor structure of the PedsQL diabetes module did not support the original 5 subscales. Both one and two factor models were supported; however parallel parent and child subscales did not emerge. While the generic and diabetes-specific measures of QOL were moderately to highly correlated with each other, the constructs were differentially associated with relevant diabetes outcomes. Generic QOL was more highly associated with depression than diabetes QOL. Conversely, diabetes QOL was more highly associated with adherence and A1c, though this was seen to a greater extent for parent-proxy report than for child report. Conclusions-Factor analysis of the PedsQL diabetes module supports the use of a total diabetes QOL score. Findings regarding the associations of the generic and diabetes modules with diabetes outcomes underscore the unique contribution provided by both generic and diabetes QOL.
Results: UPF intake accounted for 53 ± 15% energy intake in pregnancy, and was inversely associat... more Results: UPF intake accounted for 53 ± 15% energy intake in pregnancy, and was inversely associated with total HEI (r = −0.55, P < 0.001) and with 9 of 13 component scores (r = −0.16 to −0.50, P < 0.01). Compared to women in the highest quartile of UPF intake, those in the lowest quartile had 19.0 points higher total HEI (95% CI 15.0, 23.1) and consumed 1.8 times more vegetables, 3.4 times more greens and beans, 2.7 times more total fruit, 3.4 times more whole fruit, 1.7 times more whole grain, 1.6 times more total protein, 3.4 times more seafood & plant protein, 0.7 times less refined grains, and 0.5 times less added sugar (P < 0.01 all comparisons). UPF was higher among women in the youngest tertile (< 29 y; UPF 58%, P < 0.001), with less than a bachelor's degree (UPF 59%, P < 0.001), and with poverty-income ratio ≤ 1.85 (UPF 57%, P < 0.01), but did not differ by parity. UPF in postpartum was correlated r = 0.40 (P < 0.001) with UPF in pregnancy. Mean postpartum UPF (51 ± 17%) and associations of UPF with diet quality indicators were consistent with those in pregnancy. Conclusions: UPF accounted for more than half of energy intake during pregnancy and the postpartum period and was associated with poorer diet quality across most HEI components. Reducing processed food intake may represent a singular intervention target with broad impact on adherence to dietary guidelines.
Maximizing data completion and study retention is essential in population research. This study ex... more Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self-reported assessments.
ABSTRACT Objective This study examines the associations of eating-related motivation, perceived n... more ABSTRACT Objective This study examines the associations of eating-related motivation, perceived norms, and their interaction with eating behaviors in emerging adults. Design Data are from the NEXT Generation Health Study, a nationally representative sample of US emerging adults. Binominal logistic regression analyses estimated associations of eating behaviors with self-determined motivation, non-self-determined motivation, and perceived social norms. Multiplicative interaction terms between each motivation construct and perceived social norms were tested in the models. Results Self-determined motivation was positively associated with intake frequency of whole grains, low-fat dairy, and fruit and vegetables. Soda intake frequency was inversely associated with greater non-self-determined motivation, but not self-determined motivation or perceived social norms. Perceived social norms were positively associated with the intake of whole grains, low-fat dairy, and fruit and vegetables. Perceived social norms did not moderate the association of motivation constructs with eating behaviors. Conclusion Self-determined motivation and perceived social norms may be considered in intervention targeting healthful eating behaviors in emerging adults.
Journal of the Academy of Nutrition and Dietetics, 2021
Background Scant research has examined whether laboratory assessments of eating in the absence of... more Background Scant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality. Objective This study investigates the association of EAH with diet quality during pregnancy. Design Pregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester. Participants/setting Data were collected from March 2015 to December 2016 from a subsample of participants (n ¼ 46) enrolled at 12 weeks' gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina. Intervention Participants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments. Main outcome measures Scores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality. Statistical analyses performed Linear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods. Results Lower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2-to 3-point decrease (standard error ¼ 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5-to 7-point decrease (standard error ¼ 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality. Conclusions Greater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.
Objectives Our aim was to qualitatively assess networks describing interrelations among foods con... more Objectives Our aim was to qualitatively assess networks describing interrelations among foods consumed at meals in pregnant women with high and low overall diet quality as defined by the Healthy Eating Index-2015 (HEI). Methods Multiple 24-hour dietary recalls (mean = 3.4) from 365 women in the Pregnancy Eating Attributes Study (PEAS) were collected across pregnancy. Food networks using intakes of 40 food groups were derived for each meal (breakfast, lunch, dinner) for women in the highest (n = 122) and lowest (n = 121) HEI tertiles using semiparametric gaussian copula graphical models (SGCGM). Networks are based on the resulting sparse matrix of partial correlations (edges) between food groups (nodes); communities within the networks were detected using the Louvain method (LM). Results In breakfast networks, 3 communities were detected in the low and 4 communities in the high group. In both groups, breakfast community (BC) 1 included white bread, eggs, cured meat and cheese; whole ...
A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determinat... more A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determination Theories showed an increased intake of whole plant foods. This study examined 1) whether the intervention changed parent diet-related attitudes/beliefs, 2) whether these attitudes/ beliefs were associated with youth diet quality, and 3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.
American Journal of Health Promotion, Feb 10, 2020
Purpose:To investigate relationships of farm-to-school, school meal and competitive food state la... more Purpose:To investigate relationships of farm-to-school, school meal and competitive food state laws with eating behaviors and weight status, and to examine interaction between different types of state laws.Design:Observational cohort studySettings:US adolescentsParticipants:The NEXT study is a nationally representative sample of adolescents assessed annually for seven years. Data (N=2751) from students attending public schools from the first (W1) and third (W3) assessment waves (2010 and 2012), occurring during grades 10 and 12, respectively, of the NEXT Study were included.Measures:Eating behaviors and weight status of adolescents were linked with CLASS scoring for state laws.Analysis:Regression analyses examined associations of laws with intake and weight status, accounting for complex survey design and school-level clustering.ResultsAdolescents in states with strong farm-to-school laws had greater W1 whole fruit, lower soda and snack intakes versus those in states with no laws. Strong school meal laws were associated with lower W1 soda intake. Adolescents in states with strong competitive food laws had lower soda intake and overweight/obesity odds than those in states with no laws in W3. Strong farm-to-school laws were inversely associated with W3 overweight/obesity odds only in states with strong competitive food laws.ConclusionsStronger laws governing school nutrition were related to healthier eating behaviors and optimal weight status in this nationally representative sample of adolescents. Further, farm-to-school laws may be more effective in reducing obesity when combined with strong competitive food legislation.
Background-The purpose of this cross-sectional study was to examine the psychometric properties o... more Background-The purpose of this cross-sectional study was to examine the psychometric properties of two adapted SRQ measures assessing youth with type 1 diabetes motivation internalization for healthful eating and their parents motivation internalization for providing healthy meals for the family. Methods-External validity of the adapted SRQ was evaluated with respect to healthy eating attitudes (healthful eating self-efficacy, barriers, and outcome expectations) assessed by questionnaire, diet quality (Healthy Eating Index-2005, HEI-2005; Nutrient-Rich Foods Index 9.3, NRF9.3; Whole Plant Food Density, WPFD) assessed by 3-day food records, and BMI assessed by measured height and weight in youth with type 1 diabetes (N=136, age 12.3±2.5 years) and their parents. Results-Exploratory factor analysis with varimax rotation yielded a two-factor structure with the expected autonomous and controlled motivation factors for both youth and parents. Internal consistencies of subscales were acceptable (α=0.66-0.84). Youth autonomous and controlled motivation were positively correlated overall (r=0.30, p<0.001); however, in analyses stratified by age (<13 vs. ≥13y), the correlation was not significant for youth ≥13y. Autonomous motivation
American Journal of Preventive Medicine, Dec 1, 2015
Introduction-Youth with Type 1 diabetes and lower family income typically have poorer glycemic co... more Introduction-Youth with Type 1 diabetes and lower family income typically have poorer glycemic control. This post hoc analysis examines whether a family-oriented behavioral intervention for this population is differentially effective across income levels. Methods-Families of youth aged 9-15 years with Type 1 diabetes (N=390; 49.2% female; age, 12.4 [1.7] years; hemoglobin A1c [HbA1c], 8.4 [1.2]; pump, 33.8%) at four U.S. pediatric endocrinology clinics participated in a 2-year RCT (data collected 2006-2011) of a clinicintegrated behavioral intervention designed to improve diabetes management by facilitating problem-solving skills, communication skills, and responsibility sharing. HbA1c was analyzed centrally.
Aims-To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL gene... more Aims-To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL general and diabetes-specific quality of life (QOL) measures regarding psychometric properties and relations to relevant outcomes. Methods-The instruments were completed by 447 children age 9 to 15.5 with type 1 diabetes >1 year from four US paediatric diabetes clinics; parents completed the parallel parent-proxy measures. Principal components factor analysis was used to examine the factor structure of the PedsQL diabetes module. Analyses of the generic and diabetes QOL measures included psychometric properties, parent-child correlations, and correlations with depression, adherence, and A1c. Results-The factor structure of the PedsQL diabetes module did not support the original 5 subscales. Both one and two factor models were supported; however parallel parent and child subscales did not emerge. While the generic and diabetes-specific measures of QOL were moderately to highly correlated with each other, the constructs were differentially associated with relevant diabetes outcomes. Generic QOL was more highly associated with depression than diabetes QOL. Conversely, diabetes QOL was more highly associated with adherence and A1c, though this was seen to a greater extent for parent-proxy report than for child report. Conclusions-Factor analysis of the PedsQL diabetes module supports the use of a total diabetes QOL score. Findings regarding the associations of the generic and diabetes modules with diabetes outcomes underscore the unique contribution provided by both generic and diabetes QOL.
Results: UPF intake accounted for 53 ± 15% energy intake in pregnancy, and was inversely associat... more Results: UPF intake accounted for 53 ± 15% energy intake in pregnancy, and was inversely associated with total HEI (r = −0.55, P < 0.001) and with 9 of 13 component scores (r = −0.16 to −0.50, P < 0.01). Compared to women in the highest quartile of UPF intake, those in the lowest quartile had 19.0 points higher total HEI (95% CI 15.0, 23.1) and consumed 1.8 times more vegetables, 3.4 times more greens and beans, 2.7 times more total fruit, 3.4 times more whole fruit, 1.7 times more whole grain, 1.6 times more total protein, 3.4 times more seafood & plant protein, 0.7 times less refined grains, and 0.5 times less added sugar (P < 0.01 all comparisons). UPF was higher among women in the youngest tertile (< 29 y; UPF 58%, P < 0.001), with less than a bachelor's degree (UPF 59%, P < 0.001), and with poverty-income ratio ≤ 1.85 (UPF 57%, P < 0.01), but did not differ by parity. UPF in postpartum was correlated r = 0.40 (P < 0.001) with UPF in pregnancy. Mean postpartum UPF (51 ± 17%) and associations of UPF with diet quality indicators were consistent with those in pregnancy. Conclusions: UPF accounted for more than half of energy intake during pregnancy and the postpartum period and was associated with poorer diet quality across most HEI components. Reducing processed food intake may represent a singular intervention target with broad impact on adherence to dietary guidelines.
Maximizing data completion and study retention is essential in population research. This study ex... more Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self-reported assessments.
ABSTRACT Objective This study examines the associations of eating-related motivation, perceived n... more ABSTRACT Objective This study examines the associations of eating-related motivation, perceived norms, and their interaction with eating behaviors in emerging adults. Design Data are from the NEXT Generation Health Study, a nationally representative sample of US emerging adults. Binominal logistic regression analyses estimated associations of eating behaviors with self-determined motivation, non-self-determined motivation, and perceived social norms. Multiplicative interaction terms between each motivation construct and perceived social norms were tested in the models. Results Self-determined motivation was positively associated with intake frequency of whole grains, low-fat dairy, and fruit and vegetables. Soda intake frequency was inversely associated with greater non-self-determined motivation, but not self-determined motivation or perceived social norms. Perceived social norms were positively associated with the intake of whole grains, low-fat dairy, and fruit and vegetables. Perceived social norms did not moderate the association of motivation constructs with eating behaviors. Conclusion Self-determined motivation and perceived social norms may be considered in intervention targeting healthful eating behaviors in emerging adults.
Journal of the Academy of Nutrition and Dietetics, 2021
Background Scant research has examined whether laboratory assessments of eating in the absence of... more Background Scant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality. Objective This study investigates the association of EAH with diet quality during pregnancy. Design Pregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester. Participants/setting Data were collected from March 2015 to December 2016 from a subsample of participants (n ¼ 46) enrolled at 12 weeks' gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina. Intervention Participants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments. Main outcome measures Scores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality. Statistical analyses performed Linear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods. Results Lower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2-to 3-point decrease (standard error ¼ 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5-to 7-point decrease (standard error ¼ 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality. Conclusions Greater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.
Objectives Our aim was to qualitatively assess networks describing interrelations among foods con... more Objectives Our aim was to qualitatively assess networks describing interrelations among foods consumed at meals in pregnant women with high and low overall diet quality as defined by the Healthy Eating Index-2015 (HEI). Methods Multiple 24-hour dietary recalls (mean = 3.4) from 365 women in the Pregnancy Eating Attributes Study (PEAS) were collected across pregnancy. Food networks using intakes of 40 food groups were derived for each meal (breakfast, lunch, dinner) for women in the highest (n = 122) and lowest (n = 121) HEI tertiles using semiparametric gaussian copula graphical models (SGCGM). Networks are based on the resulting sparse matrix of partial correlations (edges) between food groups (nodes); communities within the networks were detected using the Louvain method (LM). Results In breakfast networks, 3 communities were detected in the low and 4 communities in the high group. In both groups, breakfast community (BC) 1 included white bread, eggs, cured meat and cheese; whole ...
A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determinat... more A family-based behavioral nutrition intervention grounded in Social Cognitive and Self-Determination Theories showed an increased intake of whole plant foods. This study examined 1) whether the intervention changed parent diet-related attitudes/beliefs, 2) whether these attitudes/ beliefs were associated with youth diet quality, and 3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.
American Journal of Health Promotion, Feb 10, 2020
Purpose:To investigate relationships of farm-to-school, school meal and competitive food state la... more Purpose:To investigate relationships of farm-to-school, school meal and competitive food state laws with eating behaviors and weight status, and to examine interaction between different types of state laws.Design:Observational cohort studySettings:US adolescentsParticipants:The NEXT study is a nationally representative sample of adolescents assessed annually for seven years. Data (N=2751) from students attending public schools from the first (W1) and third (W3) assessment waves (2010 and 2012), occurring during grades 10 and 12, respectively, of the NEXT Study were included.Measures:Eating behaviors and weight status of adolescents were linked with CLASS scoring for state laws.Analysis:Regression analyses examined associations of laws with intake and weight status, accounting for complex survey design and school-level clustering.ResultsAdolescents in states with strong farm-to-school laws had greater W1 whole fruit, lower soda and snack intakes versus those in states with no laws. Strong school meal laws were associated with lower W1 soda intake. Adolescents in states with strong competitive food laws had lower soda intake and overweight/obesity odds than those in states with no laws in W3. Strong farm-to-school laws were inversely associated with W3 overweight/obesity odds only in states with strong competitive food laws.ConclusionsStronger laws governing school nutrition were related to healthier eating behaviors and optimal weight status in this nationally representative sample of adolescents. Further, farm-to-school laws may be more effective in reducing obesity when combined with strong competitive food legislation.
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Papers by Tonja Nansel