It’s OK to let your baby cry himself to sleep, study finds

— Many new parents long for a full night of glorious, uninterrupted sleep yet shudder at the thought of letting their baby “cry it out,” the sleep training method in which parents allow babies to cry themselves to sleep. But a new study adds support to the idea that the method is effective and does not cause stress or lasting emotional problems for babies.

Researchers in Australia worked with 43 sets of parents who had babies between 6 and 16 months of age and who had a common complaint: Their child was having problems sleeping. The researchers taught about a third of the parents about graduated extinction, a technical term for crying it out. Parents were asked to leave the room within a minute of putting their child to bed and, if their children cried, to wait longer and longer periods of time before going back to comfort them.

Another third of the parents were asked to try a newer type of sleep training called bedtime fading. In this approach, parents put their infant to bed closer to the time he or she usually fell asleep and could stay in the room until the child dozed off.

The rest of the parents, the control group, did not attempt sleep training and instead received information about infant sleep.

Three months after starting the intervention, the researchers found that babies in the cry-it-out group were falling asleep almost 15 minutes faster than babies in the control group. The babies in the bedtime fading group dozed off about 12 minutes faster compared with the control group.

These improvements would probably be important for parents in more ways than one, said Michael Gradisar, associate professor of psychology at Flinders University in Adelaide, Australia.

“What our data probably do not capture is the peace of mind surrounding bedtime that we see when we work with families,” said Gradisar, lead author of the study, published Tuesday in the journal Pediatrics.

The researchers found that the graduated extinction, or cry it out, group also bested the fading approach in other measures during the three-month intervention, including the number of times babies awoke during the night and their total sleep time.

Marsha Weinraub, professor of psychology at Temple University, agrees that the gains in sleep would help both babies and parents. “When you are waiting for your baby to go to sleep, every minute counts,” said Weinraub, who was not involved in the new study.

Although the new fading technique seems to be effective, it is less effective than graduated extinction, and parents may want to try the latter approach if they are comfortable with it, Weinraub said.

Sleep training did not stress out babies

The most important aspect of the study, Weinraub said, is that both sleep training techniques seem safe for babies in the short and long term. The researchers found that the levels of cortisol, a stress hormone, were lower in the babies in during sleep training interventions. Moreover, one year after the interventions, the babies did not show signs of being more attached to their parents, nor did their parents report more behavioral problems compared with the babies in the control group.

“Parents have been told by some experts that children’s stress levels will increase over time with these techniques and they will have behavioral problems, and this study shows very clearly, which I think is the first to do so, that there are no [poor] effects on children’s stress levels and … children in the intervention groups show less stress than children in the control condition,” Weinraub said.

“This is a concern that has been expressed by many parents, which is interesting to me as a scientist, as there is no compelling evidence to support this claim,” Gradisar said.

What’s more, the study offers an alternative to letting babies cry it out. “Bedtime fading is the more preferred technique parents choose when provided both options. … It’s a gentle technique that works quickly,” Gradisar said, adding that the university’s website has instructions on how to carry out both sleep training methods.

Gradisar and his colleagues found that by a year after the sleep training interventions, all of the babies, including those in the control group, were getting about the same amount of sleep. They suspect this is because babies’ sleep health improves naturally as they get older.

Which sleep training style should parents choose?

Dr. Tanya Remer Altmann, a pediatrician based in Southern California and author of “Mommy Calls,” advises her parents to start sleep training almost from birth. It starts with newborns having a comfortable, safe sleep environment, typically a crib or bassinet. By the time the babies are 2 to 3 months of age, parents should put them to bed when they are drowsy but not yet asleep.

“It can really benefit them in the long run because self-soothing and sleeping techniques really stay with them throughout their entire lives,” said Altmann, who is also the author of “What to Feed Your Baby.” However, it can be helpful to try sleep training for babies who are still having trouble sleeping by 6 months, she added.

As for which method to choose, the two methods in the study appear to help in different ways, which could help guide parents.

“If you have an infant that only has nighttime awakenings, it appears from this study that bedtime fading is not as effective,” whereas both methods could help if your problem is getting your child to fall asleep in the first place, said Daniel Lewin, a pediatric psychologist and sleep specialist at Children’s National Health System in Washington.

“In the real world, you could do a combination” of the two, Lewin said. Parents could put their child to bed later and delay visiting the child if he starts crying, for example.

However, this type of training is not for everyone. Not all parents report that their children have sleep problems, and it is this subset of parents for whom the current findings would most relevant, Lewin said.

For those parents who do think their babies have trouble sleeping, the study brings even more good news: It did not take parents the full three months of the sleep training trial to see effects. Babies in both intervention groups were falling asleep faster one week after their parents started the training, and they continued to improve over the three-month period.

“The thing I often tell parents is that it only takes three days, and [sleep training] is effective,” Weinraub said.

Even babies who sleep well can get thrown off when they have a cold or an earache, she said. But if they have a good sleep schedule, it is easy for them to get back on track in just a few days, she added.

Don’t feel bad, Mom and Dad

Parents can feel a lot of guilt about not comforting their babies while they are crying. “[But] by setting a clear and loving limit for your child, children can function better,” Lewin said.

In his practice, Lewin talks with parents and reassures them that they are not deserting or punishing their child by letting him soothe himself to sleep.

The cry-it-out method can also be difficult for busy parents. Parents may think, “I want to see my infant; I haven’t seen them much today,” Lewin said. It is OK for parents to feel conflict about this, he said, but it is important for them give children the space to fall asleep on their own.

Going to church could help you live longer, study says

— Many Americans say they attend church because it helps them stay grounded and gives them spiritual guidance. A new study suggests that regular attendance may also help increase their lifespan.

Researchers looked at data on nearly 75,000 middle-age female nurses in the United States as part of the Nurses’ Health Study. The participants answered questions about whether they attended religious services regularly every four years between 1992 and 2012, and about other aspects of their lives over the years.

The researchers found that women who went to church more than once a week had a 33% lower risk of dying during the study period compared with those who said they never went. Less-frequent attendance was also associated with a lower risk of death, as women who attended once a week or less than weekly had 26% and 13% lower risk of death, respectively.

Women who regularly attended religious services also had higher rates of social support and optimism, had lower rates of depression and were less likely to smoke. However, the researchers took into account these differences between churchgoers and non-churchgoers when they calculated the decrease in death rates of 13% to 33%.

Going to church could have a number of additional benefits that could, in turn, improve longevity, but the researchers were not able to examine them with the available data. Attendance could promote self-discipline and a sense of meaning and purpose in life, or it could provide an experience of the transcendent, said Tyler J. VanderWeele, professor of epidemiology in the Harvard T.H. Chan School of Public Health. VanderWeele led the new research, which was published Monday in the journal JAMA Internal Medicine.

“Our study suggests that for health, the benefits outweigh the potentially negative effects,” such as guilt, anxiety or intolerance, VanderWeele said.

Most of the women in the study were Protestant or Catholic, so it is not clear whether a similar association would be found between religious service attendance and longevity for people of other Christian religions, Judaism or Islam.

The study also did not explore the association in men. Previous research suggests that male churchgoers also benefit, though their decrease in death rate is not as large as among women, VanderWeele said.

“There have been literally thousands of studies” looking at whether religion is good for your health, said Dr. Dan German Blazer II, professor of psychiatry and behavioral sciences at Duke University Medical Center. The findings have been mixed about whether aspects of religious devotion such as prayer and spirituality — such as reading the Bible or other religious literature — improve longevity.

“The one (aspect) that is significantly more predictive of good health is about religious service attendance,” said Blazer, who wrote an editorial about the new study in the same issue of JAMA Internal Medicine.

Most people report that they are spiritual, and it is possible that actually attending religious services is good for their health because they are taking actions that are in line with their beliefs, Blazer said. “You have a more integrated life in this sense.” However, this explanation is purely speculative, and studies have not explored this theory, he added.

The suggestion that attending religious services regularly could boost longevity has met with some criticism in the field. Other researchers have pointed out that the relationship could be due to other factors, such as the possibility that healthier people are more likely to go to church, perhaps because they are more mobile.

The main strength of the current study is that the researchers were able to look at whether participants reported attending religious services at several points over many years, making it easier to find out which came first, religious activity or disease and health outcomes, Blazer said.

Nevertheless, Blazer warns that it is important not to make too much of the new findings. “This study does not suggest that clinicians prescribe attending religious services as a way to be more healthy,” he said. It was not meant to assess going to church as an actual medical intervention.

On the other hand, the study does suggest that “clinicians who know their patients well and follow them over a period of time, like primary care doctors, inquire when it is appropriate about their religious beliefs and practices,” Blazer said. That way, if patients say that attending religious services is important to them, the doctor can help ensure that they maintain a good relationship with their church, temple or mosque.

This attitude about the place of religion in medical care is becoming more common among health care professionals and has been introduced into the curriculum of more and more medical schools, Blazer said.

People who are alone and lonely are at greater risk of heart disease

— Loneliness and social isolation can impact a person’s health, causing problems ranging from high blood pressure and being overweight to cognitive decline and even an increased risk of dying at a young age.

New research has now put a number on how this can affect someone’s risk of heart disease and stroke specifically.

Researchers at the University of York found that people who are isolated — meaning they have few social connections — or feel lonely have a 29% higher risk of having heart disease and 32% higher risk of having a stroke when compared with their peers who were either well connected or at least felt like they were well-connected.

To arrive at these numbers, researchers combined data from 23 studies that altogether included more than 180,000 adults living in high-income countries in North America, Europe, Asia and Australia.

The studies had assessed the level of isolation and loneliness among the participants and monitored them for between three and 21 years to see whether they developed heart diseases, such as a heart attack, or suffered a stroke.

In most cases, it was participants’ first heart attack or stroke.

“We know from other studies … that people who are lonely or isolated are less likely to recover [from illness],” said Nicole K. Valtorta, research fellow in public health, who led the study published Monday in the journal Heart.

“From our stud,y we are saying it is not just about people who are already sick, but prior to that they might be at risk of developing disease,” she said.

Does loneliness drive heart disease and stroke?

The research puts loneliness and social isolation on par with anxiety as a risk factor for heart disease and stress at work as a driver of stroke risk.

The level of risk does, however, remain lower than that of smoking cigarettes, which increases the risk of heart disease by two to four times. The studies in the analysis made the assumption that smoking was a separate risk factor for heart disease and stroke than isolation and loneliness, but the two could be associated.

“It could be that loneliness and social isolation are linked to an increased risk of smoking, so it’s not as though the smoking risk is necessarily independent of [them],” Valtorta said.

How health can deteriorate

There are many ways that being lonely and isolated can influence health and the onset of a variety of diseases, including heart conditions. For example, people who are on their own could have worse diets or not exercise or sleep as much; they could also be less likely to take medications or see a doctor.

All of these factors, or just the stress and sadness of being alone, could drive up blood pressure and inflammation, which in turn could lead to heart disease. Previous studies have found that people who were less socially connected had higher blood pressure as well as higher levels of a marker of inflammation their blood.

“Being alone, or feeling like you are alone, probably increases the risk of many diseases by about 30%,” said Julianne Holt-Lunstad, associate professor of psychology and neuroscience at Brigham Young University.

Holt-Lunstad wrote an editorial about the research, also published in Heart, in which she states it is particularly important to find out how loneliness and social isolation can affect heart disease because it is the leading cause of death in the United States.

“This study helps build the knowledge base” said Holt-Lunstad.

More research is needed to identify the true role of social relationships in both cardiovascular and general health. In the study, Valtorta adds that it is not possible to state that loneliness and social isolation directly increase heart disease or stroke risk. There could be other ways that people who are less connected differ from those who are well connected, which could contribute to their risk.

Shortened lifespans

Loneliness and isolation also appear to take a toll on a person’s lifespan, according to previous research by Holt-Lunstad and colleagues. The team found that people with the fewest relationships, or who felt like they had the least social support, had a 50% higher risk of dying during the study period than those who were well-connected.

Valtorta was not able to parse out whether loneliness and social isolation were separately associated with heart disease and stroke risk in her study, because most of the studies they analyzed only looked at social isolation.

“[They] are very different things…there are people who are socially isolated but are fairly content … and there are people who are constantly surrounded by people but still feel incredibly lonely,” Holt-Lunstad said.

“I would suspect that if you are both, it is going to be associated with the highest risk, and if you are one or the other, it is going to be associated with the intermediate risk,” she added.

How to stave off social isolation

A number of interventions show promise for helping people make social connections or lifting them out of loneliness. One example is the use of therapy that focuses on improving social skills and programs that offer social opportunities, such as activities for older adults, which have been found to decrease loneliness.

Some areas of the United Kingdom are experimenting with a program called Reconnections that targets older adults in the community that are at risk of becoming socially isolated and connecting them with social workers and members of the community who can help them find, and participate in, activities that interest them. The program is still being evaluated to find out if people feel more connected and if this then boosts their well-being, Valtorta said.

“That is one of the great unknowns, whether interventions can both benefit people’s social relationships, but also benefit their health,” Valtorta said.

One key challenge remaining for health care professionals is identifying people at risk of isolation in the first place. Holt-Lunstad urges clinicians to talk with patients about the importance of social connections for a healthy lifestyle and to recommend counseling or social support services. Medical organizations, such as the American Heart Association, should also add social isolation to the list of major risk factors for heart disease.

According to Holt-Lunstad said, further evidence is needed to ensure this. “Part of the hesitancy,” she said. “There are still a lot of questions about what we do about it.”

The growing danger of mixing prescription drugs and supplements

— A growing number of older adults are combining multiple prescription and over-the-counter medications and supplements in ways that could lead to serious side effects, according to a new study.

From 2006 to 2011, the number of older adults (ages 62 to 85) in the United States taking five or more medications or supplements rose from 53.4% to 67.1%.

A common prescription drug, for example, is warfarin, a blood thinner. But combining it with a supplement such as omega-3 fish oils, which skyrocketed in popularity during the period of the study, increases the risk of bleeding for certain patients.

The number of older adults taking at least one prescription medication or dietary supplement rose between 2005 and 2011, while over-the-counter medications became less prevalent.

The researchers used a database of reported and predicted drug interactions to determine whether the 20 most common prescription drugs and supplements used by the participants in their study were predicted to cause an adverse reaction when taken together.

They found that 16 combinations of prescription medications, over-the-counter drugs and supplements were predicted to increase the risk of adverse reactions, most commonly bleeding. The number of adults taking one of these combinations also increased during the study period, from 8.4% to 15.1%.

“We are trying to improve access to essential prescription medications like statins that could prevent heart disease and improve survival, but we are not prioritizing enough how safe these medications are in the context of all the prescription and nonprescription medications older adults are using,” said Dima M. Qato, assistant professor of pharmacy systems, outcomes and policy at the University of Illinois at Chicago. Qato is the lead author of the study, which was published on Monday in the journal JAMA Internal Medicine.

Some Rx prices drop, fish oil popularity soars

Although doctors are better able to treat chronic conditions with the expanding number of medicines available, each time they prescribe a new medication they should ask about everything else the patient is taking. “We are often treating conditions in a silo,” Qato said.

The most common prescription meds were cholesterol-lowering Zocor (simvastatin) and blood pressure medications such as Prinivil (lisinopril) and Microzide (hydrochlorothiazide), all of which became more common during the study period. In the supplement category, along with fish oil, there was a sharp increase in the use of vitamin D and vitamin E.

The rise in prescription drugs did not come as a surprise, Qato said. In addition to many new medicines entering the market, more and more drugs are becoming available in cheaper generic versions, such as simvastatin. Medicare Part D went into effect in 2006, providing insurance coverage to older adults for prescription drugs, which could also have played a part, Qato said.

What did come as a shock to Qato and her colleagues was that so many people are taking supplements, in particular omega-3 fish oils. The number of adults taking fish oil supplements, which are touted as good for your heart, rose from 4.7% in 2005 to 18.6% in 2011. “There’s very limited evidence of their clinical benefits, and for omega-3s specifically there’s no evidence of their cardiovascular benefits,” Qato said.

Ironically, many people seem to be picking up omega-3s after they fill a prescription for a medication such as warfarin and actually increasing their risk of heart disease by combining the two, Qato said. Warfarin and omega-3 is one of the combinations that the researchers found was associated with increased risk of bleeding. And the incidence of combining them rose from 0.1% to 0.8% from 2005 to 2011.

How to reduce the risk of combining medications

Qato and her colleagues suspect the reason for the decline in over-the-counter medications from 2005 to 2011 is that many of them, such as allergy medications, became more tightly regulated and patients had to ask their pharmacists for them. “That goes to show that when you regulate meds and there are restrictions on over-the-counter medications or dietary supplements, fewer people use them,” Qato said.

However, the people who can benefit from over-the-counter medications are probably still getting them, because their doctors are writing them prescriptions or their pharmacists are giving them access, she added.

Although pharmacies can play a role in reducing the risk from combining medication, they alone cannot solve the problem, Qato said. Databases are already in place to alert pharmacists about potentially dangerous drug interactions, but they miss prescriptions that patients fill at other pharmacies and any over-the-counter drugs and supplements people take.

Changes also have to be made in terms of policy and practice, Qato said. The guidelines that advise doctors on various medications should contain more comprehensive lists of potential drug interactions, including other prescription drugs as well as nonprescription drugs.

One of the best ways to ensure patients are combining medications in a safe way would be to make sure that a patient’s entire health care team, from doctor to nurse to social worker, knows about all the drugs he or she is taking, said Dr. Michael Steinman, professor of medicine at the University of California-San Francisco.

A study that is coming out in the same issue of JAMA Internal Medicine suggests that many patients do not tell their doctors about nonprescription drugs they are taking. Researchers analyzed national survey data of adults of all ages in the United States from 2012 and found that 24.9% of them did not tell their doctor that they were taking a supplement or herb. The most common reasons for nondisclosure were that the physician did not ask, and the patient did not think it was important.

“The message for doctors is that we need to be more proactive about asking patients about things going on in their lives and the different therapies they’re using,” Steinman said. “And there’s really a lesson in there for patients, that it is really useful for doctors to know which therapies you’re taking, even if they’re things the doctor didn’t prescribe.”

Organic meats, milk could have more of good-for-you fats, study finds

— Fatty fish, nuts and vegetable oils get high marks in the nutrition department because they are rich in “good” fat. Red meat and milk may also be a good source of these polyunsaturated fats, and according to research, organic products have more of them than the conventional nonorganic options.

The research is based on an analysis of 67 studies that were done over the last two decades comparing organic and nonorganic meats — beef, chicken, pork, lamb and goat — produced in Europe, the United States and Brazil. In a separate analysis, researchers looked at 196 studies of dairy — mostly cow’s milk but also goat’s milk and buffalo milk, cheese, yogurt and other products — from these same parts of the world.

Organic meats came out on top in the category of omega-3 polyunsaturated fatty acids, with 47% higher levels than their nonorganic counterparts. Omega-3s have been credited with a slew of health benefits — lowering heart disease and inflammation and fending off cognitive decline.

The advantage also went to organic milk, which had 46% higher levels of omega-3s than nonorganic milk.

“The omega-3 fatty acids are things that most nutritionists believe we don’t get enough of in our diet, so taking in more is a good thing,” said Carlo Leifert, professor of ecological agriculture at Newcastle University in England. Leifert led the studies on meat and milk, published this week in the British Journal of Nutrition.

Research suggests that Americans are probably getting adequate amounts, about 1,000 milligrams a day, of a type of omega-3 called alpha-linolenic acid, found in leafy green vegetables, nuts and vegetable oils. However, we may be falling far short of the recommended 300 to 500 milligrams a day of EPA and DHA, types of omega-3s found in fatty fish such as salmon and trout.

In the current analysis, the researchers estimated that organic meat could be serving up about 750 milligrams a day of omega-3s, based on consumption patterns in Europe. However, the researchers were not able to find enough studies to give them an idea whether organic meats were higher in levels of EPA and DHA, specifically. Nor were there enough studies to parse out the omega-3 levels in different types of organic and nonorganic meat.

However because there were more studies on dairy, the researchers were able to determine that organic milk contained 58% more EPA and DHA than conventional milk.

The source of fatty acids

The reason for the higher levels of omega-3s in organic meat is probably what the livestock are eating. One of the requirements for meats that are labeled “organic,” whether in the United States or Europe, is that animals spend at least a minimum amount of time grazing, whereas conventionally raised animals tend to spend more time indoors and have a diet that is richer in grains. “In simple terms, if the animals eat more fresh grass, the omega-3s go up,” Leifert said.

Consumers could get the same omega-3 boost from beef that is marketed as grass-fed, which, along with beef that is labeled organic, is regulated by the U.S. Department of Agriculture.

Meat is an important source of omega-3s in the United States because people tend to eat so much of it, said Dr. Michelle Hauser, a postdoctoral research fellow in cardiovascular disease prevention at the Stanford University School of Medicine. Organic meat may provide higher levels of omega-3s, but that does not mean we have carte blanche to eat as much of it as we want.

“We also have to think about other things that go along with meat,” including the fact that it has high levels of fat overall, she added. Although the recent USDA dietary guidelines do not recommend limiting the level of total fats, they do recommend keeping saturated fats, which are plentiful in foods like beef and milk, to 10% or less of total calories.

The current study did not find a difference in the levels of saturated fat between organic and nonorganic meat. And organic meats were actually found to have about 16% more omega-6 polyunsaturated fats, which at high levels have been linked to heart disease, inflammation and cancers. However, the increase in desirable omega-3s in organic meat is greater than the increase in omega-6s, Leifert pointed out.

The analysis aimed to compare the levels of vitamins, minerals and antioxidants between organic and nonorganic meats, but not enough studies have been done to indicate whether there were any differences.

Organic meat and the environment

The researchers were able to look at a list of other nutrients in milk. They found that organic milk also topped up the levels of vitamin E and iron, with 13% and 20% higher concentrations respectively. Organic milk contained 74% less iodine and 21% less selenium, minerals that are only needed in small amounts and found mostly in iodized salt and vegetables.

The USDA dietary guidelines make suggestions for how much meat and eggs we should eat, but they don’t give specifics for amounts of different meats. Hauser generally advises her patients to eat one serving or less of red meat a week because of studies suggesting better outcomes in terms of obesity and heart disease.

As for the question of whether or not to buy organic meat, “I don’t think we can say based on this or other studies that, nutrient-wise, it’s really all that different,” Hauser said. “(But) it is really important, at least for people who can afford to, to consider that organic might be better for the environment.”

Organic meat production may be more environmentally friendly because it does not use as much grain, although the matter is debated. In addition, research suggests that organic meat is less likely to harbor antibiotic-resistant bacteria.

The current studies were funded in part by the Sheepdrove Trust, a UK-based organization that supports research on organic and sustainable farming systems.

Rules to make school lunches healthier are working, study finds

— Ever since new meal standards went into effect in schools across the United States in 2012, experts have worried that the changes would result in fewer students eating school lunches. A new study of a Washington state school district suggests this has not been the case.

The meal standards, which are part of the United States Department of Agriculture Healthy, Hunger-Free Kids Act of 2010, made sweeping changes to the breakfasts and lunches served at U.S. schools. They put a cap on the number of calories per meal and required that meals contain at least one serving of fruits and vegetables.

Researchers examined the impact of these changes at three middle schools and three high schools in an urban, racially diverse Washington state school district that enrolls about 7,200 students. The researchers looked at the nutritional value of lunches the schools prepared, as well as what the students selected, in the 16 months before the changes and 15 months after.

The researchers found increases in the levels of six nutrients — calcium, vitamin A, vitamin C, iron, fiber and protein — in the meals after the changes were introduced. (Unhealthy components such as fat and sodium were not included in the analysis.) They also found that nearly as many students in the school district participated in the meal program before the Healthy, Hunger-Free Kids Act took effect as after, 47% compared with 46%.

“This is, in my mind, really verification that implementing these changes are first of all doable,” said Donna B. Johnson, professor in the School of Public Health at University of Washington and lead author of the study, which was published Monday in the journal, JAMA Pediatrics.

The other important finding is that school meal participation did not change, especially among high school students who can leave campus during lunch and buy other food, said Johnson, who is also a registered dietitian and member of the Academy of Nutrition and Dietetics. “Our thinking was, if it’s going to work for these older students who have more options, that’s really a powerful statement.”

Pushback on lunch changes

Johnson and her colleagues did not look at whether students actually ate the healthier lunches they chose, or if those servings of fruits and veggies ended up in the trash bin. However, they cited previous research that found that the amount of plate waste has not changed since meal changes were introduced. And if plate waste hasn’t increased while portions of healthy foods have gone up, it probably means that kids are eating more of these foods, Johnson said.

The researchers found that the improvements in nutritional quality of school lunches were due mostly to the increases in portion size and variety of fruits and vegetables. These changes will hopefully inspire better eating habits among students.

“We tend to eat more if larger portions are put in front of us and if there’s more variety,” Johnson said. “We can use that to our advantage to nudge people along to make good choices.”

There has been pushback from groups such as the School Nutrition Association, which argues that the meal changes mandated by the Healthy, Hunger-Free Kids Act has driven up costs and resulted in more food waste.

In October, the School Nutrition Association and the School Superintendents Association wrote a letter to Congress stating that school districts do not receive full reimbursement from the USDA for the increased costs associated with the new school meal standards. (The letter states that the requirements added 10 cents to the cost of a lunch and 27 cents to the cost of a breakfast, but schools were only given an additional 6 cents per lunch and no additional money for breakfasts.)

The School Nutrition Association also advocates changes that it says could improve meal participation rates, such as repealing the requirement that all grains be whole grain rich and returning to the previous requirement that only half of grains be whole grain rich.

“We commend schools that have maintained student participation in meal programs, but the JAMA study ignores the unintended consequences causing nationwide decreased participation in the National School Lunch Program,” said Jean Ronnei, president of the School Nutrition Association and chief operations officer at Saint Paul Public Schools in Minnesota.

A report by the Center for Science in the Public Interest suggested, however, that the decrease in meal participation is due to factors other than the new meal requirements. The decline began in the 2007-2008 school year, before the Healthy, Hunger-Free Kids Act went into effect, and was mostly among kids who paid for lunch and not those who qualified for free lunches. Thus, the report concluded, the trend was probably driven by the Great Recession.

In response to criticism of the meal changes, Johnson said, “All I can do is come back and say our study showed it’s working and it’s achieving its intended purpose and millions of students every day are eating healthier meals because of it.”

More research to come

Erin R. Hager, assistant professor of pediatrics at University of Maryland, agrees that the new study suggests that the Healthy, Hunger-Free Kids Act is meeting its goal of making school meals healthier, and doesn’t seem to be affecting how many kids are having school lunches.

“It’s nice to see in such a well designed study that participation rates did not decline,” said Hager, who was not involved in the research, but wrote an editorial about the study that was published in the same issue of JAMA Pediatrics.

However, it remains unclear at this point whether the findings of the current study capture what is happening in other school districts in the country with different demographics and that are more rural, Hager said.

“This is a new policy so we’re just starting to see these nicely designed studies come out that show an impact or no impact [on what students are eating], and I bet we will see a lot more data in this year come out about consumption and choice,” she said.


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What is safe sex for someone with HIV?

— Actor Charlie Sheen announced this week that he has HIV, but in the four years since his diagnosis, he said, he’s always shared his status with sexual partners.

Sheen said in a “Today” show interview that he’d had unprotected sex with two people since his diagnosis and it was “impossible” that he’d transmitted the virus to others. Sheen’s doctor, Robert Huizenga, who joined him for the interview, said the 50-year-old actor started taking antiviral therapy after he was diagnosed with HIV, which has reduced his viral load.

It is not impossible for Sheen to infect others, but it is “incredibly low,” said Huizenga, an assistant professor of clinical medicine at UCLA.

Indeed, there’s still stigma around HIV, but with the right precautions, people with HIV can still have sex safely, experts said.

“Patients who have HIV can certainly have sex. What’s important is that they do several things to decrease the risk of transmission,” said David Rosenthal, medical director of the Center for Young Adult, Adolescent and Pediatric HIV at North Shore-LIJ Health System in Great Neck, New York.

The first thing is to decrease a patient’s viral load, or the amount of HIV in the blood, semen and other bodily fluids, by taking antiretroviral therapy.

“The less amount of virus floating around in one’s system, the less chance of giving it to someone else,” Rosenthal said.

HIV is spread through sex — primarily anal and vaginal sex, but oral sex also carries risk. The other common way to spread the virus is through sharing needles, syringes and other injection-drug paraphernalia.

Antiretroviral therapy is a combination, or cocktail, of three or more medications that block the virus from replicating. The therapy has become much more simple for patients over the years — whereas they used to take 15 pills twice a day, they might now only have to take one pill once a day, Rosenthal said.

“If you’re able to get the viral load low, below the level of detection in lab tests, it’s very unlikely to transmit the virus. Not impossible, but very unlikely. The risk is far less than 1%,” said Dr. Stephen Boswell, president and CEO of Boston’s Fenway Health, a health care organization that works with lesbian, gay, bisexual and transgender people.

It can be hard for some patients to get their viral load below the level of detection using therapy, Boswell said. They have to be diagnosed early in their infection and take the medication every day, which can be a challenge. “It’s very hard for people to take a pill day in and day out and not miss a dosage,” he said.

Even if people with HIV are on therapy, and especially if they are not, Rosenthal recommends using condoms or other types of barrier protection during sex. This can include female condoms or dental dams. Latex condoms can prevent HIV transmission, but lambskin condoms are not effective for protecting against the virus.

Barrier protection is particularly important for people who miss doses of their therapy or in cases where the virus develops resistance, or finds ways to replicate even in the presence of antiretroviral drugs, Rosenthal said.

“Each thing that you do adds an additional level of decreased transmission risk,” Rosenthal said.

Although it is hard to know exactly how much condoms reduce the risk of HIV transmission, research suggests they bring down the risk about 80%. One study of heterosexual couples found that people with HIV were about 78% less likely to infect their partner if the couples reported regularly using condoms compared with those who did not.

Patients who have HIV can also reduce the risk of transmitting the virus by telling their sexual partners about their status so they can also make choices about how to protect themselves, Rosenthal said.

People who do not have HIV have the option of taking Truvada, a type of pre-exposure prophylaxis or PrEP that can reduce their risk of becoming infected by up to 96%. Truvada, which was approved by the U.S. Food and Drug Administration in 2012, is a pill taken once a day. It’s recommended by the CDC for HIV-negative individuals who are at high risk, such as those in a relationship with someone who is HIV positive.

“Often I see patients that are in multiple relationships with multiple different people and they choose to start PrEP to keep themselves safe from HIV,” Rosenthal said. Likewise, PrEP can help those who are in a committed relationship with someone who has HIV.

Although Sheen said in the “Today” interview that he told all his sexual partners about his HIV diagnosis, Sheen’s ex-girlfriend, Bree Olson, told the “Howard Stern Show” on Tuesday that she learned about it only in the past few days. The couple lived together in 2011, the year Sheen was diagnosed. According to Olson, they had sex almost daily for a year using lambskin condoms, which are not recommended for disease protection.

Sheen’s representative, Larry Solters, said he had no comment.


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Kids seeing more unhealthy snack ads, report says

— Food companies have been increasing their advertising to children for chips and other junk foods, even as marketing of healthy snacks such as yogurt has not kept pace, according to a report released on Monday.

About 40% of all the food and beverage ads children and teens see on TV are for snacks, and there’s a growing amount of snack advertising on social media and mobile phone apps, said researchers at the University of Connecticut’s Rudd Center for Food Policy and Obesity.

For the report, which is being presented this week at the annual meeting of the American Public Health Association, researchers compared how many snack ads young people typically saw in 2010 and 2014, and how many promoted products such as chips, cookies and fruit snacks, or healthier options, such as yogurt, fruit and nuts.

Preschoolers ages 2 to 5 saw an average of 582 snack ads on TV in 2014, an increase of 18% since 2010, researchers found. Children ages 6 to 11 saw 629 snack ads, an increase of 10%, and and teens ages 12 to 17 saw 635 snack ads, an increase of 29%. Adults also saw their share of snack ads: 793 in 2014, a 32% increase since 2010.

Although snacks ads online were much less prevalent than on TV, big food companies placed millions of ads on Facebook and YouTube in 2014.

Researchers focused on the 43 companies — including General Mills, PepsiCo and Kellogg Company — that spent at least $1 million advertising snack food brands. The researchers analyzed Nielsen syndicated data to calculate exposure to TV advertising in 2010 and 2014 and comScore syndicated data to calculate advertising viewed on websites in 2014.

What companies are selling

Advertising for healthy snacks did not get a big piece of the pie. The majority of snack ads that preschoolers, children and teens saw were for sweet snacks and savory snacks, and only about a quarter of these snacks were considered healthy by the USDA Smart Snacks standards. These standards are based on levels of calories, sodium, fats and sugar in the snack and determine which snacks can be sold in schools.

For some of the age groups, advertising of unhealthy snacks increased from 2010 to 2014: Marketing of savory snacks to children increased by 23% and advertising of sweet snacks to teens increased by 17%.

Meanwhile, from 2010 to 2014, exposure to advertising of yogurt products, nearly all of which are considered healthy based on the USDA Smart Snacks standards, did not change.

The number of ads for fruits increased between 3.5 and 6 times to the different age groups and the number of ads for nuts nearly doubled. But even after the increase, marketing for fruits and nuts represented only about 5% of all snack ads.

“It’s hard to translate the number of advertisements to actual consumption, but if you just look at the imbalance (between healthy and unhealthy snacks) it would suggest that advertising is probably not increasing children’s fruit and nut consumption,” said Jennifer L. Harris, director of marketing initiatives at the University of Connecticut’s Rudd Center.

The advertisers and their audience

Among the most concerning findings from the report was the increase in unhealthy snack ads seen by preschool-age children, Harris said.

“Their minds are extremely malleable, so the advertisements aren’t just trying to get kids to get their parents to buy the products, they are trying to create an emotional association in kids’ brains (and) the emotional connection (at this young age) is basically impossible to get rid of,” she said.

Harris was also concerned about the discrepancy between advertising to white children compared with black and Hispanic youth. Marketing of savory snacks to black and Hispanic youth shot up 551%, whereas yogurt ads dropped 93% between 2010 and 2014. Black children saw 64% more snack food ads on TV than white children, and 129% more ads for savory snacks.

“It’s really an irresponsible practice, especially among kids,” given that these minority groups have higher rates of obesity, diabetes and weight-related conditions, Harris said.

Food companies that spent the most money advertising snack foods were General Mills ($315 million in 2014), PepsiCo ($189 million in 2014) and Kellogg Company ($153 million in 2014). PepsiCo did not respond to CNN’s request for comment.

In an email, a spokesperson for General Mills said they haven’t seen the report and can’t comment on it. The company “does not advertise any product on programming or media primarily directed to preschool children.”

“We generally don’t agree with Rudd definitions or analysis,” said Bridget Christenson, General Mills corporate communications manager. The company’s marketing and advertising guidelines are posted on its website.

In an emailed statement, Kellogg Company spokesperson Kris Charles said the company follows guidelines set forth by the Children’s Food and Beverage Advertising Initiative, does not advertise foods to children younger than 6, and only advertises foods that meet certain nutritional criteria to children ages 6 to 11.

“As a founding member of the (Children’s Food and Beverage Advertising Initiative) and a member of 15 similar initiatives worldwide, we believe self-regulation works and we are actively involved in industry efforts to strengthen the self-regulatory process,” Charles said.

Room for regulation?

Many food companies participate in the Children’s Food and Beverage Advertising Initiative, which was created by and is regulated by the industry. Participants pledge not to advertise unhealthy food options on TV that is directed toward children.

However, this pledge only applies to programming that is considered “child-directed media,” such as shows on Nickelodeon and Cartoon Network, but not programs children might view on other networks, Harris said.

Harris and co-authors of the report recommend the definition of media for children should be expanded to include all shows where children are the intended audience. In addition, the authors urge the advertising initiative agreement to follow the USDA Smart Snacks standards for healthy foods, which are more stringent than the standards that the snack industry group set.

“There is a lot of snacking that is going on among children and a lot of that snacking is less healthy food,” said Aviva Must, professor and chair of public health and community medicine at Tufts University. “I don’t think there’s any doubt that the marketing of these snacks influences eating behavior.”

Must was not involved in the Rudd Center report, but called it helpful and comprehensive.

“I would have hoped that the landscape would’ve improved more than it has (in recent years), but I think in the absence of strong regulation like they have in the United Kingdom, the environment that we have created in terms of food marketing to children is not going to change,” Must said. The UK bans the advertising of unhealthy foods and beverages to children younger than 16.

Although it is probably not realistic to pass regulations in the United States like those in the UK, Harris said, “we found that when parents and the media start getting concerned about what companies are doing, companies will respond.”

Although research by Harris and her colleagues suggests that parents are generally aware that there are a lot of ads for junk food on TV, they usually don’t realize how imbalanced ads are between healthy and unhealthy foods, and the number of ads on social media.

“That’s one of the reasons we do this research — to raise awareness of what’s happening and hopefully get parents to start protesting,” Harris said.


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Math-letes rule! Fit, healthy kids do better in school, especially math

— The familiar saying that exercise is good for the body and mind may be especially true for children. Kids who are physically fit actually have differences in their brain structures that might allow them to do better in math, according to a new study.

Researchers put a small group of children ages 9 and 10 to the test both mentally, with standardized math and reading exams, and physically, testing their endurance on a treadmill. They also scanned their brains using MRI and found that the children who could run for longer periods of time on the treadmill had thinner sections of gray matter in the front of their brains, which actually signifies more brain maturation, than those with lower stamina. These children also ran laps around their less fit peers in the math test.

“It’s part of a natural process that the brain goes through a period of thinning during adolescence (as) brain connections that are deemed not necessary are thinned out. (Fit) kids may be further along in this maturation process,” said Charles H. Hillman, professor of kinesiology and community health at the University of Illinois Urbana-Champaign. Hillman is one of the authors of the study, which was published in August in the online journal PLOS ONE.

This part of the brain, also called the frontal cortex, could be especially key for academic performance because it is involved in working memory, which helps us figure out math problems, for example, and cognitive flexibility, or the ability to tune out distractions, Hillman said.

Earlier studies have linked physical fitness with changes in other regions of the brain, such as a larger hippocampus. A combination of areas in the brain, and connections between them, are probably important for scholarly tasks, Hillman said. And development of these areas may be either spurred or stagnated depending on exercise.

Although the current study only detected a link between fitness and math ability, other studies that Hillman and his colleagues have done suggest that reading comprehension and other areas of academic performance may also be affected by these changes in brain structure. “I don’t think it’s selective to math,” Hillman said.

Despite the large body of research suggesting that physical activity pays off in the classroom, many schools have cut back their physical education classes and recess time, according to a 2013 report by the Institute of Medicine, a private nonprofit scientific organization.

“The vast majority of schools were not serving kids in terms of their physical activity needs,” said Hillman, who was a member of the committee that wrote the Institute of Medicine report.

The report recommended that all children should be able to get an hour of moderate or vigorous activity every day in school, through physical education classes and recess. Achieving this goal will require participation from teachers and administration, as well as the use of school buildings and outdoor space, the report stated.

There are currently no federal requirements for the amount of physical activity that students receive every day, although there are government incentives for schools that promote exercise. Some states are also trying to tackle the problem, Hillman said. Texas, for example, requires that children in prekindergarten through elementary school get at least a half-hour of physical activity a day.


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Couples who share the burdens of childcare are happier together

— Couples that raise children together — and share the burden of childcare fairly equally — are happier together, according to a new study.

Researchers asked almost 500 couples across the United States who were married or living together about how they divided certain childcare responsibilities such as playing and enforcing rules, and also how satisfied they were with their relationships and their sex lives.

The researchers found that most people in the survey — 73% of the women and 80% of men — reported that they shared childcare equally with their partner. Among the rest of the women, 24% said that they did the bulk of the work. As for the remainder of the men, about 10% said they assumed most of these responsibilities themselves and another 10% said their partners did.

“It was definitely interesting” that many couples viewed their division of childcare labor as equal, said Daniel L. Carlson, assistant professor of sociology at Georgia State University and lead author of the study. The study was presented on Sunday at the American Sociological Association meeting, but has not been published in a peer-reviewed scientific journal.

The researchers found that couples that reported splitting the child-rearing responsibilities also reported the highest level of satisfaction with their relationship and sexual intimacy, and the lowest amount of fighting. “Being satisfied is a strong predictor of relationship stability, so these things bode well for (couples) staying together,” although the study did not look at divorce rates, Carlson said.

On the other hand, couples in which the woman took on most or all of the childcare work reported the least amount of satisfaction and highest amount of relationship conflict. The minority of couples in which the man did the lion’s share of the work reported an intermediate level of satisfaction.

Part of the reason that the study found such a high rate of dads pitching in could be because the survey asked about tasks — playing, praising, creating and enforcing rules — that men are more inclined to do, Carlson said. It is not clear if the men were also doing their share of cooking and cleaning for the children, he said.

Some research does suggest, however, that women and men might be divvying up all childcare tasks more fairly. One study found that, although women spend slightly more time each week on childcare in recent years (13.7 hours) than in the 1960s (10.5 hours), men are putting in a lot more time now (7.2 hours) than before (2.5 hours).

It is hard to know if the trend will continue to the point that women and men are investing about the same amount of time in childcare, said Margaret L. Usdansky, a research associate professor of child and family studies at Syracuse University. There is some evidence that progress has stalled, possibly because of factors such as income inequality.

In general, couples who are more egalitarian in their childcare responsibilities tend to have better relationships, Usdansky said. “Not everybody wants sharing, but most couples need two incomes, it’s not just a choice, and when two people are working, then I think in most cases couples are going to be happier when there is more sharing of all the different kinds of work,” including childcare and housework, she said.

The current study found that couples that shared childcare pretty evenly did not necessarily spend more time together. “It’s plausible that you could have a positive impact on (relationship) satisfaction without changing the amount of time that couples spend together,” said Usdansky, who was not involved in the current study. “They might be spending more of their time together enjoying (each other) and less of it scheduling and figuring out what they are doing tomorrow,” she said.