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Journal Publications

J Acad Nutr Diet. 2014 Aug 1.
Food Insecurity Is Inversely Associated with Diet Quality of Lower-Income Adults.
Leung CW, Epel ESRitchie LCrawford PBLaraia BA.


Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.

Madsen KA, Cotterman C, Thompson HR, Rissman Y, Rosen NJ, Ritchie LD. Passive commuting is associated with increased dietary intake in 4th and 5th grader students. Am J Prev Med 2014;(in press).

Fenton K, Rosen NJ, Wakimoto P, Patterson T, Goldstein LH, Ritchie LD. Eat lunch first or play first? Inconsistent associations with fruit and vegetable consumption in elementary school. J Acad Nutr Diet 2014;(in press).

Prev Med. 2014 Mar;60:77-82. doi: 10.1016/j.ypmed.2013.12.018. Epub 2013 Dec 24.
Pregnancy and post-delivery maternal weight changes and overweight in preschool children.
Robinson CA, Cohen AK, Rehkopf DH, Deardorff J, Ritchie L, Jayaweera RT, Coyle JR, Abrams B.


High maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight.

Sample: 4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old.

Exposures: gestational weight gain (GWG) and post-delivery maternal weight change (PDWC).

Outcome: child overweight (body mass index (BMI) ≥85th percentile).

Adjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers.

Increased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.

J Nutr Educ Behav. 2014 May-Jun;46(3 Suppl):S71-8. http://www.sciencedirect.com/science/article/pii/S1499404614000578
Satisfaction of California WIC participants with food package changes
Ritchie LWhaley SE, Crocker NJ.


Assess California Women, Infants, and Children (WIC) participant satisfaction with the 2009 food package revisions and compare satisfaction based on language preference and timing of WIC enrollment relative to the revisions.

Computer-assisted telephone interviews of 2,996 WIC participants in 2010.

Most participants (91.3%) were satisfied with checks for new WIC foods (fruits/vegetables, whole grains, and lower-fat milk) and 82.7% of participants were satisfied with amounts of foods that were reduced in the revised food package (milk, cheese, eggs, and juice). Difficulty using new checks was reported by 13.7% of participants. Compared with English-speaking participants, a higher percentage of Spanish speakers reported satisfaction (P < .01) and a lower percentage reported difficulties using checks (P < .001). A higher percentage of newer enrollees reported satisfaction compared with those participating in WIC before the revisions (P < .01).

Conclusions and Implications:
This research suggests that recent policy change to the WIC food package improves WIC participant access to healthful food options without decreasing satisfaction.

J Acad Nutr Diet. 2014 Sep 11. http://www.sciencedirect.com/science/article/pii/S2212267214011447
Policy Improves What Beverages Are Served to Young Children in Child Care.
Ritchie LSharma S, Gildengorin G, Yoshida S, Braff-Guajardo E, Crawford P.


During 2008, we conducted a statewide survey on beverages served to preschool-aged children in California child care that identified a need for beverage policy. During 2011, the US Department of Agriculture began requiring that sites participating in the Child and Adult Care Food Program (CACFP) make drinking water available throughout the day and serve only low-fat or nonfat milk to children aged 2 years and older. During 2012, the California Healthy Beverages in Childcare law additionally required that all child-care sites eliminate all beverages with added sweetener and limit 100% juice to once daily.

To assess potential policy effects, we repeated the statewide survey in 2012. During 2008 and 2012, a cross-sectional sample of ∼1,400 licensed child-care sites was randomly selected after stratifying by category (ie, Head Start, state preschool, other CACFP center, non-CACFP center, CACFP home, and non-CACFP home).

Responses were obtained from 429 sites in 2008 and 435 in 2012. After adjustment for child-care category, significant improvements in 2012 compared with 2008 were found; more sites served water with meals/snacks (47% vs 28%; P=0.008) and made water available indoors for children to self-serve (77% vs 69%; P=0.001), and fewer sites served whole milk usually (9% vs 22%; P=0.006) and 100% juice more than once daily (20% vs 27%; P=0.038). During 2012, 60% of sites were aware of beverage policies and 23% were judged fully compliant with the California law.

A positive effect occurred on beverages served after enactment of state and federal policies. Efforts should continue to promote beverage policies and support their implementation.