Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.

Objectives We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria. Methods Phase 1 was a 3-month color-coded labeling intervention (red = unhealthy, yellow = less healthy, green = healthy). Phase 2 added a 3-month choice architecture intervention that increased the visibility and convenience of some green items. We compared relative changes in 3-month sales from baseline to phase 1 and from phase 1 to phase 2. Results At baseline (977 793 items, including 199 513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P < .001), and green items increased in phase 1 (P < .001). The largest changes occurred among beverages. Red beverages decreased 16.5% during phase 1 (P < .001) and further decreased 11.4% in phase 2 (P < .001). Green beverages increased 9.6% in phase 1 (P < .001) and further increased 4.0% in phase 2 (P < .001). Bottled water increased 25.8% during phase 2 (P < .001) but did not increase at 2 on-site comparison cafeterias (P < .001). Conclusions A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention. (Am J Public Health. 2012;102:527–533. doi:10.2105/AJPH.2011.300391)

Background Preventing obesity requires maintenance of healthy eating behaviors over time. Food labels and strategies that increase visibility and convenience of healthy foods (choice architecture) promote healthier choices, but long-term effectiveness is unknown. Purpose Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months. Design Longitudinal pre–post cohort follow-up study between December 2009 and February 2012. Data were analyzed in 2012. Setting/participants Large hospital cafeteria with mean of 6511 transactions daily. Cafeteria sales were analyzed for: (1) all cafeteria customers and (2) longitudinal cohort of 2285 hospital employees who used the cafeteria regularly. Intervention After 3-month baseline period, cafeteria items were labeled green (healthy), yellow (less healthy) or red (unhealthy) and rearranged to make healthy items more accessible. Main outcome measures Proportion of cafeteria sales that were green or red during each 3-month period from baseline to 24 months. Changes in 12- and 24-month sales were compared to baseline for all transactions and transactions by the employee cohort. Results The proportion of sales of red items decreased from 24% at baseline to 20% at 24 months (p<0.001), and green sales increased from 41% to 46% (p<0.001). Red beverages decreased from 26% of beverage sales at baseline to 17% at 24 months (p<0.001); green beverages increased from 52% to 60% (p<0.001). Similar patterns were observed for the cohort of employees, with largest change for red beverages (23% to 14%, p<0.001). Conclusions A traffic-light and choice architecture cafeteria intervention resulted in sustained healthier choices over 2 years, suggesting food environment interventions can promote long-term changes in population eating behaviors.

Purpose Women with early-onset (age ≤40) breast cancer are at high risk of carrying deleterious mutations in the BRCA1/2 genes; genetic assessment is thus recommended. Knowledge of BRCA1/2 mutation status is useful in guiding treatment decisions. To date, there has been no national study of BRCA1/2 testing among newly diagnosed women. Methods We used administrative data (2004–2007) from a national sample of 14.4 million commercially-insured patients to identify newly-diagnosed, early-onset breast cancer cases among women ages 20–40 (n=1,474). Cox models assessed BRCA1/2 testing, adjusting for covariates and differential lengths of follow-up. Results Overall, 30% of women age ≤40 received BRCA1/2 testing. In adjusted analyses, women of Jewish ethnicity were significantly more likely to be tested (HR=2.83, 95% CI 1.52–5.28), while black women (HR=0.34, 95% 0.18–0.64) and Hispanic women (HR=0.52, 95% CI 0.33–0.81) were significantly less likely to be tested than non-Jewish white women. Those enrolled in an HMO (HR=0.73, 95% CI 0.54–0.99) were significantly less likely to receive BRCA1/2 testing than those POS insurance plans. Testing rates rose sharply for women diagnosed in 2007 compared to 2004. Conclusions In this national sample of newly diagnosed breast cancer patients at high risk for BRCA1/2 mutations, genetic assessment was low, with marked racial differences in testing.