Obesity is not only a health but also an economic phenomenon. This chapter (a) examines underlying economic causes, such as technological advancements, behind the obesity epidemic; (b) describes economic consequences of obesity, including increasing obesity-related medical expenditures; and (c) discusses the role of government in combating the obesity epidemic. Because of the high costs of obesity, and the fact that the majority of these costs are financed by taxpayers, there is a clear motivation for government to try to reduce these costs. However, because obesity may result from poor information and addictive behavior and/or as a result of living in an increasingly obesogenic environment, interventions will need to be multifaceted to ensure the best chance of success.

As standards are considered for nutrition front-of-package (FOP) and shelf-labeling systems in the United States, it is important to know what types of systems are most effective in conveying scientifically accurate and useful information to consumers. A systematic literature review identified 38 empirical studies on consumer response to FOP nutrition labeling and shelf labeling. Studies indicate that consumers can more easily interpret and select healthier products with nutrient-specific FOP nutrition labels that incorporate text and symbolic color to indicate nutrient levels rather than nutrient-specific labels that only emphasize numeric information, such as Guideline Daily Amounts expressed as percentages and/or grams. Summary systems may influence consumers to purchase healthier products. However, more research is needed to assess the influence of nutrient-specific labels on consumers' purchases. This review identified few studies that compared consumers' ability to select healthier products using nutrient-specific systems that incorporate text and color codes with multiple-level summary icons. More research is needed to determine the effects of FOP nutrition labeling on consumers' actual shopping behaviors and dietary intakes.

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Objective To explore women's perceptions of the risks and benefits associated with medication use during pregnancy and to better understand how women make decisions related to medication use in pregnancy. Methods We conducted online focus groups with 48 women who used medication during pregnancy or while planning a pregnancy, and 12 in-depth follow-up interviews with a subset of these women. Results We found that women were aware of general risks associated with medication use but were often unable to articulate specific negative outcomes. Women were concerned most about medications' impact on fetal development but were also concerned about how either continuing or discontinuing medication during pregnancy could affect their own health. Women indicated that if the risk of a given medication were unknown, they would not take that medication during pregnancy. Conclusion This formative research found that women face difficult decisions about medication use during pregnancy and need specific information to help them make decisions. Enhanced communication between patients and their providers regarding medication use would help address this need. We suggest that public health practitioners develop messages to (1) encourage, remind, and prompt women to proactively talk with their healthcare providers about the risks of taking, not taking, stopping, or altering the dosage of a medication while trying to become pregnant and/or while pregnant; and (2) encourage all women of childbearing age to ask their healthcare providers about medication use.

Salmonella and Campylobacter cause an estimated combined total of 1.8 million foodborne infections each year in the United States. Most cases of salmonellosis and campylobacteriosis are associated with eating raw or undercooked poultry or with cross-contamination. Between 1998 and 2008, 20% of Salmonella and 16% of Campylobacter foodborne disease outbreaks were associated with food prepared inside the home. A nationally representative Web survey of U.S. adult grocery shoppers (n = 1,504) was conducted to estimate the percentage of consumers who follow recommended food safety practices when handling raw poultry at home. The survey results identified areas of low adherence to current recommended food safety practices: not washing raw poultry before cooking, proper refrigerator storage of raw poultry, use of a food thermometer to determine doneness, and proper thawing of raw poultry in cold water. Nearly 70% of consumers reported washing or rinsing raw poultry before cooking it, a potentially unsafe practice because "splashing" of contaminated water may lead to the transfer of pathogens to other foods and other kitchen surfaces. Only 17.5% of consumers reported correctly storing raw poultry in the refrigerator. Sixty-two percent of consumers own a food thermometer, and of these, 26% or fewer reported using one to check the internal temperature of smaller cuts of poultry and ground poultry. Only 11% of consumers who thaw raw poultry in cold water reported doing so correctly. The study results, coupled with other research findings, will inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella and Campylobacter.

This study evaluated the impact of a four-session interactive nutrition education program-Eat Smart, Live Strong (ESLS)-on the consumption of fruit and vegetables by low-income older adults. A pre-post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants' self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants' average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.

Environmental and consumer groups have called for mandatory labeling of genetically engineered (GE) food products in the United States, stating that consumers have the “right to know.” Herein, we use a nonhypothetical field experiment to examine the willingness to pay for GE-labeled products, using the only second-generation GE product currently on the U.S. market—GE cigarettes. Our results suggest consumers pay less for GE-labeled cigarettes when marketing information is absent. But, when presented with marketing information on the attributes of the cigarette, we find no evidence that consumers pay less for GE-labeled cigarettes.

Adults aged 60 years and older are more likely than younger adults to experience complications, hospitalization, and death because of food-borne infections. Recognizing this risk, we conducted a nationally representative survey (n = 1,140) to characterize older adults' food safety knowledge, attitudes, and practices as well as the demographic characteristics of older adults with risky food handling practices. The survey was conducted using a Web-enabled panel. We found that although older adults consider themselves to be knowledgeable about food safety, many are not following recommended food safety practices. Areas for improvement include the following: reheating deli meats to steaming hot, not eating store-bought deli salads, cooking eggs properly, monitoring refrigerator temperature using a thermometer, using a food thermometer to check doneness of meat/poultry/egg dishes, and storing leftovers properly. The survey results also suggest that food safety education targeting older adults is needed and that such initiatives should emphasize practices to prevent listeriosis, a potentially fatal illness among older adults. Our findings suggest that, in particular, men, individuals with higher incomes, and college-educated individuals would benefit from food safety education.