Background. Lower-income families in the United States are at increased risk for food insecurity and have higher rates of tobacco use. Many retailers accepting government food assistance benefits also sell tobacco products, whose marketing promotes smoking initiation and undermines quit attempts. We examined the presence of tobacco marketing in authorized retailers in the Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), compared with nonauthorized retailers. Method. A nationally representative sample of tobacco retailers in the contiguous United States (N = 2,054) were audited for tobacco marketing in 2015. Using generalized estimating equations, we examined the association between WIC and SNAP authorization and presence of tobacco marketing, adjusted for store type and neighborhood demographics. Results. Both WIC-authorized (odds ratio [OR] 1.7, 95% confidence interval [CI] [1.1, 2.4]) and SNAP-authorized retailers (OR ...

<div class="abstract" data-abstract-type="normal"><div class='sec'><span class="bold">Objective</span><p>We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- <span class='italic'>v</span>. independently owned).</p></div><div class='sec'><span class="bold">Design</span><p>Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.</p></div><div class='sec'><span class="bold">Setting</span><p>Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.</p></div><div class='sec'><span class="bold">Participants</span><p>One hundred and thirty-nine stores; seventy-eight managers.</p></div><div class='sec'><span class="bold">Results</span><p>Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (<span class='italic'>P</span>≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (&lt;30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (<span class='italic'>P</span>≤0·05).</p></div><div class='sec'><span class="bold">Conclusions</span><p>Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.</p></div></div>

PURPOSE To test the effectiveness of an intervention to increase motivation for physical activity in racially diverse third- through fifth-grade students. DESIGN Natural experiment. SETTING Elementary schools in Minneapolis, Minnesota. PARTICIPANTS Two hundred ninety-one students in 18 Minne-Loppet Ski Program classes and 210 students in 12 control classrooms from the same schools. INTERVENTION The Minne-Loppet Ski Program, an 8-week curriculum in elementary schools that teaches healthy physical activity behaviors through cross-country skiing. MEASURES Pretest and posttest surveys measured self-determination theory outcomes: intrinsic exercise motivation, intrinsic ski motivation, autonomy, competence, and relatedness. ANALYSIS Hierarchical linear regression models tested treatment effects controlled for grade, race, sex, and baseline measures of the outcomes. RESULTS Minne-Loppet program students showed significantly greater motivation to ski (β = 0.95, 95% confidence interval [CI]: 0.15-1.75) and significantly greater perceived competence (β = 0.78, 95% CI: 0.06-1.50) than students in control classrooms. Treatment effects for general exercise motivation and perceived competence differed by race. African American students in Minne-Loppet classes showed significantly greater general exercise motivation (β = 1.08, 95% CI: 0.03-2.14) and perceived competence (β = 1.95, 95% CI: 0.91-2.99) than African American students in control classes. CONCLUSION The Minne-Loppet program promoted perceived competence and motivation to ski. Future improvements to the Minne-Loppet and similar interventions should aim to build general motivation and provide support needed to better engage all participants.

<p>We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being −0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.</p>

Background Social relationships have been proposed as a significant factor shaping obesity risk. The first year of college, a period of major social, behavioral, and weight changes, provides a context well-suited to tracking longitudinally the impact of shifting friendships on weight outcomes. This study sought to identify social mechanisms impacting BMI change among emerging adults. Methods An analytic sample of 276 college students (71.0% female, 52.2% non-White) provided repeated reports of relationships and BMI was measured up to four times during 2015–2016. Stochastic actor-oriented models were used to examine change in BMI through social influence and change in friendships over time, controlling for sex and race/ethnicity. Results At baseline, mean BMI was 24.2±4.5 kg/m2. Overall, mean BMI increased over time; individual decreases in BMI were uncommon. There was a selection effect of BMI: participants with BMIs between 22 and 26 kg/m2 were most likely to be nominated as a friend. While participants did not select friends based on BMI similarity, participants who were reported as friends were more likely to experience convergence in BMI over time relative to the BMIs of non-friends (p = 0.015). An increase in BMI (versus stability or a decrease) was more likely for those whose friends had a higher BMI on average compared to participants whose friends had the same or lower BMI (OR = 2.85, 95% CI = 1.22, 6.71). Conclusion Analyses indicated BMI affected friend selection, not through students selecting friends with similar BMI, but rather, by students avoiding friends with more extreme BMI levels.

BACKGROUND To examine longitudinal associations between food insecurity (FI) and health behaviors/outcomes among a diverse sample of university freshmen. METHODS Freshman students (n = 1138; 65% female; 49% non-white) participating in the Social impact of Physical Activity and nutRition in College study completed surveys on health behaviors and had height/weight measured up to 4 times (T1-T4) in Arizona during 2015-2016. Structural equation models were estimated to determine if, after adjusting for covariates, FI predicted concurrent behaviors/outcomes and subsequent behaviors/outcomes. Analyses reported here were conducted in 2017. RESULTS The prevalence of FI was significantly higher at the end of each semester (35% and 36%, respectively) than at the start of the year (28%). Longitudinally, FI was not related to any health behaviors/outcomes at future time points. However, FI was significantly and inversely associated with concurrent breakfast consumption on most days of the week (OR = 0.67, 99% CI = 0.46, 0.99), daily evening meal consumption (OR = 0.55, 99% CI = 0.36, 0.86) healthy eating habits on campus (OR = 0.68, 99% CI = 0.46, 1.00), healthy physical activity habits on campus (OR = 0.66, 99% CI = 0.44, 1.00), and positively related to the likelihood of experiencing stress (OR = 1.69, 99% CI = 1.16, 2.46) and depressed mood (OR = 1.98, 99% CI = 1.34, 2.91). CONCLUSIONS Compared with US prevalence rates, the sample FI prevalence was high. FI was related to poorer eating patterns, physical activity behaviors, and mental health, even after adjusting for prior levels of behavior.

BACKGROUND Interventions to raise population physical activity generally show modest effects; one possible reason is that trends and determinants of moderate to vigorous physical activity (MVPA) differ between population subgroups. This study examined differences in trends and determinants of reported MVPA by ethnicity/race and sex in a 15-year longitudinal study. METHODS Participants (n = 2092) in the Project Eating and Activity in Teens and Young Adults study were surveyed on MVPA behavior and potential determinants from adolescence to young adulthood. Generalized estimating equations were used to model age trends in MVPA and associations with determinants. RESULTS Mean MVPA declined by 2.1 hours per week over 15 years of follow-up from adolescence to young adulthood. Asian males reported the lowest levels of MVPA at each age. Nonwhite females reported less MVPA than white females at each age. The association of body mass index (BMI) with MVPA differed by sex and ethnicity/race. Asian males and females showed lower levels of MVPA at both low and high BMI. CONCLUSIONS Interventions to increase MVPA may need to begin earlier among Asian men and nonwhite women than among other groups. Asian adolescents with lower BMI show lower MVPA and may benefit from additional intervention efforts compared with Asian adolescents with normal BMI.

OBJECTIVE To determine whether perceived cooking skills in emerging adulthood predicts better nutrition a decade later. METHODS Data were collected as part of the Project Eating and Activity in Teens and Young Adults longitudinal study. Participants reported on adequacy of cooking skills in 2002-2003 (age 18-23 years) and subsequently reported on nutrition-related outcomes in 2015-2016 (age 30-35 years) (n = 1,158). Separate regression models were used to examine associations between cooking skills at age 18-23 years and each subsequent outcome. RESULTS One fourth of participants described their cooking skills as very adequate at 18-23 years, with no statistically significant differences by sociodemographic characteristics. Reports of very adequate cooking skills at age 18-23 years predicted better nutrition-related outcomes 10 years later, such as more frequent preparation of meals including vegetables (P < .001) and less frequent fast food consumption (P < .001). CONCLUSIONS AND IMPLICATIONS Developing adequate cooking skills by emerging adulthood may have long-term benefits for nutrition over a decade later. Ongoing and new interventions to enhance cooking skills during adolescence and emerging adulthood are warranted but require strong evaluation designs that observe young people over a number of years.

BACKGROUND A regular yoga practice may have benefits for young adult health, however, there is limited evidence available to guide yoga interventions targeting weight-related health. The present study explored the relationship between participation in yoga, healthy eating behaviors and physical activity among young adults. METHODS The present mixed-methods study used data collected as part of wave 4 of Project EAT (Eating and Activity in Teens and Young Adults), a population-based cohort study in Minneapolis-St. Paul, Minnesota. Young adults (n = 1820) completed the Project EAT survey and a food frequency questionnaire, and a subset who reported practicing yoga additionally participated in semi-structured interviews (n = 46). Analyses of survey data were used to examine cross-sectional associations between the frequency of yoga practice, dietary behaviors (servings of fruits and vegetables (FV), sugar-sweetened beverages (SSBs) and snack foods and frequency of fast food consumption), and moderate-to-vigorous physical activity (MVPA). Thematic analysis of interview discussions further explored yoga's perceived influence on eating and activity behaviors among interview participants. RESULTS Regular yoga practice was associated with more servings of FV, fewer servings of SSBs and snack foods, less frequent fast food consumption, and more hours of MVPA. Interviews revealed that yoga supported healthy eating through motivation to eat healthfully, greater mindfulness, management of emotional eating, more healthy food cravings, and the influence of the yoga community. Yoga supported physical activity through activity as part of yoga practice, motivation to do other forms of activity, increased capacity to be active, and by complementing an active lifestyle. CONCLUSIONS Young adult yoga practitioners reported healthier eating behaviors and higher levels of physical activity than non-practitioners. Yoga should be investigated as an intervention for young adult health promotion and healthy weight management.

Objective: Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. Design: Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. Setting: Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. Subjects: Customers (n 661) from 105 food retailers. Results: Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. Conclusions: Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Purchases at small/non-traditional food stores tend to have poor nutritional quality, and have been associated with poor health outcomes, including increased obesity risk The purpose of this study was to examine whether customers who shop at small/non-traditional food stores with more health promoting features make healthier purchases. In a cross-sectional design, data collectors assessed store features in a sample of 99 small and non-traditional food stores not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Minneapolis/St. Paul, MN in 2014. Customer intercept interviews (n = 594) collected purchase data from a bag check and demographics from a survey. Store measures included fruit/vegetable and whole grain availability, an overall Healthy Food Supply Score (HFSS), healthy food advertisements and in-store placement, and shelf space of key items. Customer nutritional measures were analyzed using Nutrient Databases System for Research (NDSR), and included the purchase of ≥1 serving of fruits/vegetables; ≥1 serving of whole grains; and overall Healthy Eating Index-2010 (HEI-2010) score for foods/beverages purchased. Associations between store and customer measures were estimated in multilevel linear and logistic regression models, controlling for customer characteristics and store type. Few customers purchased fruits and vegetables (8%) or whole grains (8%). In fully adjusted models, purchase HEI-2010 scores were associated with fruit/vegetable shelf space (p = 0.002) and the ratio of shelf space devoted to healthy vs. less healthy items (p = 0.0002). Offering ≥14 varieties of fruit/vegetables was associated with produce purchases (OR 3.9, 95% CI 1.2–12.3), as was having produce visible from the store entrance (OR 2.3 95% CI 1.0 to 5.8), but whole grain availability measures were not associated with whole grain purchases. Strategies addressing both customer demand and the availability of healthy food may be necessary to improve customer purchases. ClinialTrials.gov: NCT02774330 . Registered May 4, 2016 (retrospectively registered).

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

OBJECTIVE Little is known about the practices for stocking and procuring healthy food in non-traditional food retailers (e.g., gas-marts, pharmacies). The present study aimed to: (i) compare availability of healthy food items across small food store types; and (ii) examine owner/manager perceptions and stocking practices for healthy food across store types. DESIGN Descriptive analyses were conducted among corner/small grocery stores, gas-marts, pharmacies and dollar stores. Data from store inventories were used to examine availability of twelve healthy food types and an overall healthy food supply score. Interviews with managers assessed stocking practices and profitability. SETTING Small stores in Minneapolis and St. Paul, MN, USA, not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. SUBJECTS One hundred and nineteen small food retailers and seventy-one store managers. RESULTS Availability of specific items varied across store type. Only corner/small grocery stores commonly sold fresh vegetables (63% v. 8% of gas-marts, 0% of dollar stores and 23% of pharmacies). More than half of managers stocking produce relied on cash-and-carry practices to stock fresh fruit (53%) and vegetables (55%), instead of direct store delivery. Most healthy foods were perceived by managers to have at least average profitability. CONCLUSIONS Interventions to improve healthy food offerings in small stores should consider the diverse environments, stocking practices and supply mechanisms of small stores, particularly non-traditional food retailers. Improvements may require technical support, customer engagement and innovative distribution practices.

BACKGROUND: The purpose of this study was to describe the workplace environments of young adults and examine associations with diet, physical activity (PA) and body mass index (BMI). METHODS: Cross-sectional data were collected (2008-2009) from 1538 employed young adult participants in Project EAT (Eating and Activity among Teens and Young Adults), a diverse population-based sample. Survey measures assessed height, weight, diet, moderate-to-vigorous PA, transportation-related PA and perceptions of the workplace food and PA environments (eg, soda availability, coworker support). Healthful characteristics were summed to reflect overall workplace healthfulness. Modified Poisson regression analyses conducted in 2015 identified associations between workplace food and PA environments and diet, PA and BMI. RESULTS: The healthfulness of workplace environments was suboptimal. Greater exposure to healthful workplace characteristics was related to more young adults engaged in favourable diet and PA behaviours and a lower prevalence obesity. For example, adjusted rates of obesity were 24% and 17% among those reporting low (/=3 characteristics) exposure to healthful food environments, respectively (p<0.05). Workplace characteristics independently associated with weight-related outcomes included soda availability, proximity to a fast food outlet, living close to work and perceived ease of eating a healthy diet or being active at work. CONCLUSIONS: A more healthful workplace environment overall, including physical attributes and perceived social norms, may contribute to more favourable weight-related behaviours and lower prevalence of obesity among young adults. Employer-initiated and community-initiated policies may represent one way to create healthier workplace environments for young adults.

Objective: Examine relationships between weight-related factors and weight status, body dissatisfaction, chronic health conditions, and quality of life across sexual orientation and gender. Methods: Two- and four-year college students participated in the College Student Health Survey (n = 28,703; 2009–2013). Risk differences were calculated to estimate relationships between behavioral profiles and weight status, body satisfaction, diagnosis of a chronic condition, and quality of life, stratified by gender and sexual orientation. Four behavioral profiles, characterized as “healthier eating habits, more physically active,” “healthier eating habits,” “moderate eating habits,” and “unhealthy weight control,” were utilized based on latent class analyses, estimated from nine weight-related behavioral survey items. Results: Sexual orientation differences in weight and quality of life were identified. For example, sexual minority groups reported significantly poorer quality of life than their heterosexual counterparts (females: 22.5%–38.6% (sexual minority) vs. 19.8% (heterosexual); males: 14.3%–26.7% (sexual minority) vs. 11.8% (heterosexual)). Compared with the “healthier eating habits, more physically active” profile, the “unhealthy weight control” profile was associated with obesity, poor body satisfaction, and poor quality of life in multiple gender/sexual orientation subgroups. Conclusions: Interventions are needed to address obesity, body dissatisfaction, and poor quality of life among sexual minority college students.

Purpose. To identify and describe homogenous classes of male college students based on their weight-related behaviors (e.g., eating habits, physical activity, and unhealthy weight control) and to examine differences by sexual orientation. Design. Study design was a cross-sectional sample of 2- and 4-year college students. Setting. Study setting was forty-six 2- and 4-year colleges in Minnesota. Subjects. Study subjects comprised 10,406 college males. Measures. Measures were five categories of sexual orientation derived from self-reported sexual identity and behavior (heterosexual, discordant heterosexual [identifies as heterosexual and engages in same-sex sexual behavior], gay, bisexual, and unsure) and nine weight-related behaviors (including measures for eating habits, physical activity, and unhealthy weight control). Analysis. Latent class models were fit for each of the five sexual orientation groups, using the nine weight-related behaviors. Results. Overall, four classes were identified: "healthier eating habits" (prevalence range, 39.4%-77.3%), "moderate eating habits" (12.0%-30.2%), "unhealthy weight control" (2.6%-30.4%), and "healthier eating habits, more physically active" (35.8%). Heterosexual males exhibited all four patterns, gay and unsure males exhibited four patterns that included variations on the overall classes identified, discordant heterosexual males exhibited two patterns ("healthier eating habits" and "unhealthy weight control"), and bisexual males exhibited three patterns ("healthier eating habits," "moderate eating habits," and "unhealthy weight control"). Conclusion. Findings highlight the need for multibehavioral interventions for discordant heterosexual, gay, bisexual, and unsure college males, particularly around encouraging physical activity and reducing unhealthy weight control behaviors.