Faculty Bibliography

Prior studies assessing the impact of calorie labels in fast-food settings have relied on comparisons across local and state jurisdictions with and without labeling mandates; several well-designed studies indicate a small reduction of calories purchased as a result of the labels. This study exploits a staggered roll-out of calorie labels in California to study the same issue using a novel comparison of in-store purchases with calorie information and drive-through purchases without calorie information at the same locations. With this design, consumers in both the treatment and comparison groups have been subject to the same social signals associated with the policy change and may have been exposed to calorie information during prior purchases, narrowing the intervention under study to the impact of posted menu labels at the point of purchase. Transactions (N = 201,418,976) at 424 unique restaurants at a single fast-food chain were included and a difference-in-differences design was used to examine changes one and two years after the implementation of labels at in-store counters compared to baseline. Using this comparison of consumer purchases within the same jurisdictions, we found no meaningful impact of posted calorie labels at the point of purchase, suggesting that such labels did not induce behavioral change. Additional methods to strengthen the impact of labeling policies are worthy of further study.

BACKGROUND/UNASSIGNED:As part of an initiative to increase COVID-19 testing uptake among underserved populations, we conducted focus groups to explore experiences and attitudes related to testing in two understudied groups-young adults and socially-isolated older adults-recruited from residents living in New York City Housing Authority (NYCHA) public housing developments. MATERIALS AND METHODS/UNASSIGNED: = 32 total). To identify themes, we conducted a rapid qualitative analysis approach. RESULTS/UNASSIGNED:Residents discussed four overarching themes: (1) trusted COVID-19 information sources; (2) reasons for testing; (3) barriers to testing, and (4) strategies to increase testing uptake. Findings were similar across the two age groups; both cited multiple sources of information, including major media outlets, government or public health officials, and doctors. Young adults were more likely to access information from social media despite concerns about misinformation. Participants identified several barriers to testing, such as long lines, insurance coverage, and cost. Young adults reported that at-home COVID testing was more convenient, while older adults expressed concern about accuracy and administering the tests themselves. Recommendations for improving testing emphasized easier access via a central well-known location, in-home visits, free or low-cost tests, and increased outreach. CONCLUSION/UNASSIGNED:Mainstream media, doctors and public agencies remain the most trusted sources of information among younger and older residents alike. Many resident recommendations involved leveraging NYCHA infrastructure, highlighting the continuing role public housing authorities can play in COVID-19 and other health initiatives.

BACKGROUND:Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. OBJECTIVE:We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. METHODS:We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo's posts and Instagram users' comments for their sentiments on the 3 domains. Replies to Instagram users' comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of "likes," were also collected. RESULTS:The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo's content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users' comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo's body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo's health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. CONCLUSIONS:This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies.

Exposure to unhealthy food and beverage marketing is a major contributor to excessive weight gain among young people and it may disproportionately affect Black and Latinx communities. Appropriate and comprehensive regulations on food and beverage companies are essential, particularly as companies expand their reach and leverage the latest technologies to create marketing experiences using immersive virtual reality (VR). Although immersive VR technology is in its infancy, the potential effects of immersive VR food and beverage marketing on consumption, coupled with the history of racially targeted marketing by food and beverage corporations toward Black and Latinx communities, and the heightened burden of diet-related illnesses in Black and Latinx communities underscore a critical need to investigate immersive VR marketing targeting young people of color. This viewpoint will provide a brief description of VR food and beverage marketing as the newest food and beverage marketing frontier, highlight key concerns and knowledge gaps, and underscore future directions in research.

As part of a program evaluation of the New York City Test & Trace program (T2)-one of the largest such programs in the USA-we conducted a study to assess how implementing organizations (NYC Health + Hospitals, government agencies, CBOs) communicated information about the T2 program on Twitter. Study aims were as follows: (1) quantify user engagement of posts ("tweets") about T2 by NYC organizations on Twitter and (2) examine the emotional tone of social media users' T2-related tweets in our sample of 1987 T2-related tweets. Celebrities and CBOs generated more user engagement (0.26% and 0.07%, respectively) compared to government agencies (e.g., Mayor's Office, 0.0019%), reinforcing the value of collaborating with celebrities and CBOs in social media public health campaigns. Sentiment analysis revealed that positive tweets (46.5%) had higher user engagement than negative tweets (number of likes: R² = .095, p < .01), underscoring the importance of positively framing messages for effective public health campaigns.

BACKGROUND:Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease. OBJECTIVE:To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households. METHODS:Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks). RESULTS:On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (β = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks. CONCLUSION/CONCLUSIONS:Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

IMPORTANCE/UNASSIGNED:The mainstream use of chatbots requires a thorough investigation of their readability and quality of information. OBJECTIVE/UNASSIGNED:To identify readability and quality differences in information between a free and paywalled chatbot cancer-related responses, and to explore if more precise prompting can mitigate any observed differences. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study compared readability and information quality of a chatbot's free vs paywalled responses with Google Trends' top 5 search queries associated with breast, lung, prostate, colorectal, and skin cancers from January 1, 2021, to January 1, 2023. Data were extracted from the search tracker, and responses were produced by free and paywalled ChatGPT. Data were analyzed from December 20, 2023, to January 15, 2024. EXPOSURES/UNASSIGNED:Free vs paywalled chatbot outputs with and without prompt: "Explain the following at a sixth grade reading level: [nonprompted input]." MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome measured the readability of a chatbot's responses using Flesch Reading Ease scores (0 [graduate reading level] to 100 [easy fifth grade reading level]). Secondary outcomes included assessing consumer health information quality with the validated DISCERN instrument (overall score from 1 [low quality] to 5 [high quality]) for each response. Scores were compared between the 2 chatbot models with and without prompting. RESULTS/UNASSIGNED:This study evaluated 100 chatbot responses. Nonprompted free chatbot responses had lower readability (median [IQR] Flesh Reading ease scores, 52.60 [44.54-61.46]) than nonprompted paywalled chatbot responses (62.48 [54.83-68.40]) (P < .05). However, prompting the free chatbot to reword responses at a sixth grade reading level was associated with increased reading ease scores than the paywalled chatbot nonprompted responses (median [IQR], 71.55 [68.20-78.99]) (P < .001). Prompting was associated with increases in reading ease in both free (median [IQR], 71.55 [68.20-78.99]; P < .001)and paywalled versions (median [IQR], 75.64 [70.53-81.12]; P < .001). There was no significant difference in overall DISCERN scores between the chatbot models, with and without prompting. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study, paying for the chatbot was found to provide easier-to-read responses, but prompting the free version of the chatbot was associated with increased response readability without changing information quality. Educating the public on how to prompt chatbots may help promote equitable access to health information.

Social media is widely used globally by patients, families of patients, health professionals, scientists, and other stakeholders who seek and share information related to cancer. Despite many benefits of social media for cancer care and research, there is also a substantial risk of exposure to misinformation, or inaccurate information about cancer. Types of misinformation vary from inaccurate information about cancer risk factors or unproven treatment options to conspiracy theories and public relations articles or advertisements appearing as reliable medical content. Many characteristics of social media networks-such as their extensive use and the relative ease it allows to share information quickly-facilitate the spread of misinformation. Research shows that inaccurate and misleading health-related posts on social media often get more views and engagement (e.g., likes, shares) from users compared with accurate information. Exposure to misinformation can have downstream implications for health-related attitudes and behaviors. However, combatting misinformation is a complex process that requires engagement from media platforms, scientific and health experts, governmental organizations, and the general public. Cancer experts, for example, should actively combat misinformation in real time and should disseminate evidence-based content on social media. Health professionals should give information prescriptions to patients and families and support health literacy. Patients and families should vet the quality of cancer information before acting upon it (e.g., by using publicly available checklists) and seek recommended resources from health care providers and trusted organizations. Future multidisciplinary research is needed to identify optimal ways of building resilience and combating misinformation across social media.

IMPORTANCE/UNASSIGNED:Menu labeling has been implemented in restaurants in some US jurisdictions as early as 2008, but the extent to which menu labeling is associated with calories purchased is unclear. OBJECTIVE/UNASSIGNED:To estimate the association of menu labeling with calories and nutrients purchased and assess geographic variation in results. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:A cohort study was conducted with a quasi-experimental design using actual transaction data from Taco Bell restaurants from calendar years 2007 to 2014 US restaurants with menu labeling matched to comparison restaurants using synthetic control methods. Data were analyzed from May to October 2023. EXPOSURE/UNASSIGNED:Menu labeling policies in 6 US jurisdictions. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was calories per transaction. Secondary outcomes included total and saturated fat, carbohydrates, protein, sugar, fiber, and sodium. RESULTS/UNASSIGNED:The final sample included 2329 restaurants, with menu labeling in 474 (31 468 restaurant-month observations). Most restaurants (94.3%) were located in California. Difference-in-differences model results indicated that customers purchased 24.7 (95% CI, 23.6-25.7) fewer calories per transaction from restaurants in the menu labeling group in the 3- to 24-month follow-up period vs the comparison group, including 21.9 (95% CI, 20.9-22.9) fewer calories in the 3- to 12-month follow-up period and 25.0 (95% CI, 24.0-26.1) fewer calories in the 13- to 24-month follow-up period. Changes in the nutrient content of transactions were consistent with calorie estimates. Findings in California were similar to overall estimates in magnitude and direction; yet, among restaurants outside of California, no association was observed in the 3- to 24-month period. The outcome of menu labeling also differed by item category and time of day, with a larger decrease in the number of tacos vs other items purchased and a larger decrease in calories purchased during breakfast vs other times of the day in the 3- to 24-month period. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this quasi-experimental cohort study, fewer calories were purchased in restaurants with calorie labels compared with those with no labels, suggesting that consumers are sensitive to calorie information on menu boards, although associations differed by location.