Jaime A. Coffino

Food insecurity, the limited availability of nutritionally adequate food, is associated with increased risk for obesity and associated health problems. There is a crucial need for sustainable interventions that improve diet-related health in individuals with food insecurity. In behavioral economics, the default option is the option a consumer obtains if they do not make an active choice. The current study aims to improve the nutritional quality of groceries purchased online by individuals with food insecurity with the use of a prefilled online grocery shopping cart (i.e., a default option). Over the course of five weeks, food pantry users (n = 38) purchased approximately $48.50 worth of groceries using a local store’s online website. The first time participants purchased groceries online (T0: baseline) they were instructed to keep in mind nutrition, cost, and taste. For the subsequent four shopping timepoints (T1-T4), participants were randomized to receive nutrition education or a prefilled online grocery shopping cart that met their nutritional needs based on sex and age. From baseline to T1, participants in the Default condition had an immediate, significant increase in Healthy Eating Index (HEI) scores (i.e., a measure of diet quality) and a significant decrease in total calories and energy density of foods purchased. Overall, these differences were maintained throughout the treatment period (T1-T4). In the Default condition, initial improvement in HEI scores was maintained throughout the treatment period. Calories and energy density of foods purchased significantly increased in the Default condition throughout the intervention, but these values were always lower (i.e., indicating healthier grocery purchases) compared with the Nutrition Education condition. In the Nutrition Education condition, initial levels of HEI scores, calories, and energy density, indicating significantly less healthy grocery purchases, were maintained (i.e., no significant increase or decrease) from the beginning to end of treatment. These results provide preliminary evidence that the use of a default option while online grocery shopping can improve food purchasing behavior in individuals with food insecurity and significant budgetary constraints. Implementation of this intervention via online platforms may specifically benefit those living in food deserts with limited access to healthy options.

There is a need for sustainable interventions that improve diet-related health within the food insecure community. We examined if use of a “default” prefilled online grocery shopping cart, compared to nutrition education, would result in the purchase of healthier food items. Fifty participants (M age = 46.4 ± 12.46 years; M body mass index = 28.59 ± 6.48 kg/m2; 74.0% male) were randomized to: (1) read a brochure containing nutrition information (n = 23) or (2) be presented with a “default” prefilled online shopping cart containing groceries that meet nutritional guidelines to which they could freely make changes before completing their grocery purchase (n = 27). Compared to education, the default condition resulted in a significant increase in the purchases of servings of whole grain (p < .001, ηp2 = .38), fruit (p < .001, ηp2 = .37) and vegetables (p < .001, ηp2 = .25), daily fiber (p < .001, ηp2 = .23), and a decrease in average daily calories (p < .001, ηp2 = .25), daily grams of fat (p < .001, ηp2 = .48), saturated fat (p < .001, ηp2 = .47), and daily sodium (p < .001, ηp2 = .26) and cholesterol content (p < .001, ηp2 = .29). This study suggests that a default approach may help improve food choice behaviors in food insecure individuals with significant financial constraints. The default intervention is a non-monetary nudge towards healthy and economical food choices that is sustainable and broadly scalable via online platforms.

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Objective: The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample.Design: Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21).Setting: University in the northeastern region of the USA.Participants: Two hundred sixty-three graduate students.Results: In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η²= 0·09), anxiety (η²= 0·10) and stress (η²= 0·10), compared with those with low food security and high food security (all P’s < 0·001).Conclusions: Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.

Background: To determine how many adolescents follow food/beverage brands on Instagram and Twitter, and examine associations between brands’ youth-targeted marketing practices and percentages of adolescent followers. Methods: We purchased data from Demographics Pro to characterize the demographics of Twitter and Instagram users who followed 27 of the most highly advertised fast food, snack, and drink brands in 2019. We used one-sample t-tests to compare percentages of adolescent followers of the selected brands’ accounts versus all social media accounts, independent samples t-tests to compare followers of sugary versus low-calorie drink brands, and linear regression to examine associations between youth-targeted marketing practices and the percentages of adolescent followers. Results: An estimated 6.2 million adolescents followed the selected brands. A higher percentage of adolescents followed the selected brands’ accounts (9.2%) compared to any account on Twitter (1.2%) (p < 0.001), but not Instagram. A higher percentage of adolescents followed sugary (7.9%) versus low-calorie drink brands (4.3%) on Instagram (p = 0.02), but we observed the opposite pattern for adults on Twitter and Instagram. Television advertising expenditures were positively associated with percentages of adolescent followers of the selected brands on Twitter (p = 0.03), but not Instagram. Conclusions: Food and sugary drink brands maintain millions of adolescent followers on social media.

Objective: This study aimed to examine the prevalence of overvaluation of shape or weight in a nationally representative sample of U.S. adults with binge‐eating disorder (BED) and to compare functioning correlates using a group of adults with bulimia nervosa (BN).Methods: Participants included 207 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnoses of BED (n = 163) or BN (n = 44). Sociodemographic characteristics and functioning were compared in BED with overvaluation (BED+OV), BED without overvaluation (BED), and BN.Results: Approximately 50% of BED respondents reported overvaluation. Mean age was lower in BN than BED. Mean BMI was lower in BED+OV than BED and higher than BN. A greater proportion of BED+OV reported functional impairment than BED. BN was more likely to report “serious problems doing daily tasks” than BED and less likely to report “impairment in normal activities” than BED+OV. BN reported significantly lower mental functioning than BED.Conclusions: Findings based on this nationally representative sample are that overvaluation was associated with greater functional impairment within BED, and BED+OV reported greater impairment than BN in interference with normal activities but less impairment related to mental health. The increased impairment associated with BED+OV provides support for overvaluation as a diagnostic specifier for BED.